Papers by Peter Guarnaccia
Practicing Anthropology, 1981
Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship, 2006
Culture, medicine and …, 1998
The current study assesses the relationship between presenting symptomatology of the self-labeled... more The current study assesses the relationship between presenting symptomatology of the self-labeled Hispanic popular diagnosis of ataques de nervios and the specific co-morbid psychiatric diagnoses. Hispanic subjects seeking treatment at an anxiety disorders clinic (n = 156) were assessed with a specially designed self-report instrument for both traditional ataque de nervios and panic symptoms, and with structured or semistructured psychiatric interviews for Axis-I disorders. This report focuses on 102 subjects with ataque de nervios who also met criteria for panic disorder, other anxiety disorders, or an affective disorder. Distinct ataque symptom patterns correlated with co-existing panic disorder, affective disorders, or other anxiety disorders. Individuals with both ataque and panic disorder reported the most asphyxia, fear of dying, and increased fear during their ataques. People with ataques who also met criteria for affective disorder reported the most anger, screaming, becoming aggressive, and breaking things during ataques. Ataque positive subjects with other anxiety disorders were less salient for both panic-like and emotional-anger symptoms. The findings suggest that (a) ataque de nervios is a popular label referring to several distinct patterns of loss of emotional control, (b) the type of loss of emotional control is influenced by the associated psychiatric disorder, and (c) ataque symptom patterns may be a useful clinical marker for detecting psychiatric disorders. Further study is needed to examine the relationship between ataque de nervios and psychiatric disorders, as well as the relationship to cultural, demographic, environmental, and personality factors.
Culture, medicine and psychiatry, 2003
This paper is about naming illnesses--about who determines what categories are used and the impli... more This paper is about naming illnesses--about who determines what categories are used and the implications of these determinations. The central concerns of medical/psychiatric anthropology have been to understand popular categories of and systems for classification of illness, to examine the relationship of illness categories to cultural understandings of the body, and to interpret the role of categories of illness in mediating between the personal and social spheres. At the same time, the paper also discusses the interplay of popular categories and psychiatric diagnoses. This paper examines the multiple experiences of nervios among Puerto Ricans in Puerto Rico and New York City. Our contention is that nervios is more than a diffuse idiom of distress, and that there are different categories and experiences of nervios which provide insights into how distress is experienced and expressed by Puerto Ricans and point to different social sources of suffering. The data in this paper come fro...
Culture, medicine and psychiatry, 2002
This article examines a clinical sample of 66 Dominican and Puerto Rican subjects who reported at... more This article examines a clinical sample of 66 Dominican and Puerto Rican subjects who reported ataques de nervios and also psychiatric disorder, and disentangles the phenomenological experiences of ataque de nervios, panic attacks, and panic disorder. In-depth cultural interviews assessed the symptomatic phenomenology of ataque episodes from the local perspective as well as in terms of key panic features, such as recurrence, rapid peaking of symptoms, and lack of provocation. Independent diagnostic assessments of panic attacks and disorder were also used to establish the phenomenological overlap between ataque and panic. Our findings indicate that 36 percent of ataques de nervios fulfill criteria for panic attacks and between 17 percent and 33 percent for panic disorder, depending on the overlap method used. The main features distinguishing ataques that fulfill panic criteria from ataques that do not include whether the episodes were provoked by an upsetting event in the person'...
New directions for mental health services, 1998
There is growing attention to the roles of families as caregivers of relatives with serious menta... more There is growing attention to the roles of families as caregivers of relatives with serious mental illness. This chapter examines the experiences of family caregivers in diverse cultures and discusses the implications of these experiences for the goal of supporting families in these roles.
Hispanic journal of behavioral sciences, 2007
This paper provides a profile of a range of important variables for assessing diversity among dif... more This paper provides a profile of a range of important variables for assessing diversity among different Latino groups from the National Latino and Asian American Study (NLAAS). The NLAAS is a nationally representative study of the mental health needs and mental health services use of the Latino population of the United States. The NLAAS employs a stratified area probability sampling design. There are 2,554 respondents in the Latino portion of the NLAAS. The paper demonstrates through a detailed presentation of a wide range of variables the diverse experiences of Latino groups in their encounters with U.S. culture. Language use and migration experiences show considerable variability both within and across Latino groups and are promising areas for analysis of their mental health consequences.
Qualitative Health Research, 2014
People living with serious mental illness (SMI) have shorter life expectancies than the general p... more People living with serious mental illness (SMI) have shorter life expectancies than the general population. We examined how contextual factors influence the physical health of this population. We conducted interviews, focus groups, and participant observations with stakeholders from six behavioral health organizations. We found that consumers' avoidance of overt disagreement during medical visits, their mistrust of medical institutions, and cultural variations in body image influenced the clinical encounter. Mental health providers' ambivalence about intervening in consumers' physical health, primary care providers' misattribution of physical symptoms to mental disorders, and providers' stigmatization of consumers shaped clinical encounters. Consumers' diets were shaped by food environments and social norms associated with traditional diets. Internal and external factors impacted consumers' physical activity. In this article, we illustrate the importance of considering contextual factors in the development and implementation of interventions aimed at improving the physical health of people with SMI.
Transcultural Psychiatry, 2015
Relative to non-Latino Whites, Latinos in the United States with major depressive disorder (MDD) ... more Relative to non-Latino Whites, Latinos in the United States with major depressive disorder (MDD) show low engagement in antidepressant therapy, whether engagement is defined as pharmacotherapy access, medication initiation, pill-taking, or treatment retention. One potential reason for this disparity in depression care is the low cultural congruence of pharmacotherapy for this population. To examine Latinos' views of depression and antidepressant therapy, we conducted qualitative interviews with 30 Latino outpatients initiating antidepressants prior to their first treatment visit using the semistructured Treatment Adherence and Retention Questionnaire. These baseline interviews were randomly selected from data collected for a randomized controlled trial testing a novel intervention to enhance engagement by depressed Latino outpatients. Participant narratives were analyzed using open coding and the iterative analytical approach derived from grounded theory. Patient views about depression addressed stigmatizing views held by others in their social circle. Most participants directly refuted these views by providing alternate explanations to depression experiences. Antidepressant therapy narratives also revealed marked stigmatization, but participants tended not to refute these views. Instead, patients expressed concerns about antidepressants and showed marked ambivalence about seeking psychiatric care. Participants, however, did suggest ways in which clinicians and patients might collaborate to address their concerns about antidepressants. Some cultural views, such as concerns about addiction to or dependence on medication, may be negotiable barriers to treatment. Prescribing clinicians should address cultural views and concerns in order to improve Latino engagement in antidepressant therapy.
Social Science & Medicine, 2007
This study seeks to identify risk factors for psychiatric disorders that may explain differences ... more This study seeks to identify risk factors for psychiatric disorders that may explain differences in nativity effects among adult Latinos in the USA. We evaluate whether factors related to the processes of acculturation and enculturation, immigration factors, family stressors and supports, contextual factors, and social status in the U.S. account for differences in twelve-month prevalence of psychiatric disorders for eight subgroups of Latinos. We report results that differentiate Latino respondents by country of origin and age at immigration (whether they were U.S.-born or arrived before age 6 [IUSC] or whether they arrived after age 6 [LAI]). After age and gender adjustments, LAI Mexicans and IUSC Cubans reported a significantly lower prevalence of depressive disorders than IUSC Mexicans. Once we adjust for differences in family stressors, contextual factors and social status factors, these differences are no longer significant. The risk for anxiety disorders appears no different for LAI
International Journal of Methods in Psychiatric Research, 2004
This paper describes the development, translation and adaptation of measures in the National Lati... more This paper describes the development, translation and adaptation of measures in the National Latino and Asian American Study (NLAAS). We summarize the techniques used to attain cultural relevance; semantic, content and technical equivalency; and internal consistency of the measures across languages and Latino sub-ethnic groups. We also discuss some of the difficulties and challenges encountered in doing this work. The following three main goals are addressed in this paper: (1) Attaining cultural relevance by formulating the research problem with attention to the fundamental cultural and contextual differences of Latinos and Asians as compared to the mainstream population;
Social Science & Medicine, 1988
This paper analyzes nervios among Central American refugees living in the United States. Nervios ... more This paper analyzes nervios among Central American refugees living in the United States. Nervios is analyzed as personal descriptions of distress, statements about family relations, and commentaries on the broader social forces affecting people's lives. A description of the clinical presentations of 28 Salvadorans who suffer from nervios and an indepth analysis of an extended interview with a nervios sufferer are presented to examine the multiple meanings of nervios. Nervios is identified as a powerful idiom of distress used by Latinos to express concerns about physical symptoms, emotional states, and changes both in the family and in the broader society.
Social Science & Medicine, 1989
In this analysis we employ the recently released Hispanic Health and Nutrition Examination Survey... more In this analysis we employ the recently released Hispanic Health and Nutrition Examination Survey (Hispanic HANES) to investigate the issue of somatization among Mexican Americans and Puerto Ricans. In order to do so, we use the physician's assessment as a control, and examine the association between depressive affect and self-perceptions of health for individuals with similar evaluated health levels. The data reveal rather dramatic discrepancies between individuals' assessments of their own health and physicians' evaluations. In addition, the data reveal that, net of the physician's evaluation, individuals' assessments of their overall health status are significantly influenced by their affective states. The data also reveal a strong effect of language of interview on self-assessments of health and depressive affect.
Social Science & Medicine, 1989
In this paper, we examine the factor structure of the Center for Epidemiologic Studies-Depression... more In this paper, we examine the factor structure of the Center for Epidemiologic Studies-Depression Scale (CES-D) in the Hispanic Health and Nutrition Examination Survey (Hispanic HANES). The Hispanic HANES provides a unique opportunity to examine the patterning of depressive symptoms among the three major Hispanic groups in the U.S. and to compare the factor structures that emerge from the analysis to other studies using this approach. Different factor structures emerged for the Hispanic groups as compared to previous analyses of the CES-D with non-Hispanic populations. We also found significant intra-group differences among Mexican-Americans, Puerto Ricans, and Cuban-Americans which were strongly influenced by the gender of the respondent and the language in which the person was interviewed.
Risk Analysis, 2008
Conflict frequently occurs between community members and environmental/public health officials wh... more Conflict frequently occurs between community members and environmental/public health officials when an unusual number of cancer cases is reported. This conflict may result from different ways in which laypeople and experts interpret facts to judge whether there is an environmental cause of the cancer cases, but little is known about this issue. Volunteer laypeople (N = 551) and epidemiologists (N = 105) read a hypothetical scenario about cases of cancer on one neighborhood block. Participants judged whether each of the 23 facts about the situation made it "much more likely" to "much less likely" that something in town was causing the cancer cases (7-point scale). The facts were designed to be "alarming," "reassuring," or "neutral" (i.e., according to epidemiological principles, should increase, decrease, or have no impact on the likelihood of an environmental cause). The laypeople were alarmed by most of the facts (mean response significantly greater than the scale midpoint), including all of the neutral facts and over half of the reassuring facts. The experts were more balanced: they were alarmed by none of the neutral or reassuring facts. Their responses showed significantly less alarm than the laypeople's responses (p < 0.0001 for all comparisons). This study reveals that laypeople are not reassured by information that substantially lowers the chance of an environmental cause for cancer cases. Lay responses differ significantly and systematically from experts who are far less alarmed by relevant facts. These findings may help explain the conflicts between the two groups in situations where concern about cases of cancer arises in a community.
Medical Anthropology, 1985
Medical Anthropology, 1993
Ataque de nervious is a popular illness category among Puerto Ricans and other Latinos written ab... more Ataque de nervious is a popular illness category among Puerto Ricans and other Latinos written about in anthropological and psychiatric literature for over thirty years. This paper discusses the issue of categorizing ataque de nervios as a &quot;culture-bound syndrome&quot; using data from the first community-based study of this phenomena using epidemiological methods. The paper summarizes the social and psychological correlates of ataques de nervios and provides a preliminary overview of the situations which provoke ataques and the symptoms people experience. The paper critically examines the use of the &quot;culture-bound syndrome&quot; framework analyzing ataques de nervios and suggests that the term &quot;popular illness&quot; is a more effective label for categorizing this syndrome.
Medical Anthropology, 1989
Ataques de nervios (&amp;amp;quot;attacks of nerves&amp;amp;quot;) have been discussed in... more Ataques de nervios (&amp;amp;quot;attacks of nerves&amp;amp;quot;) have been discussed in the psychiatric and anthropological literature for over thirty years. The early psychiatric articles focused on the pathology expressed by the ataque. More recent articles by anthropologists and Latino mental health professionals have reconceptualized the ataque through understanding its cultural meaning and the social factors which provoke an ataque de nervios. This article is a contribution to this reinterpretation of the ataque de nervios among Latinos. Through a series of case studies, we argue that the ataque is an expression of anger and grief resulting from the disruption of family systems, the process of migration, and concerns about family members in peoples&amp;amp;#39; countries of origin.
Journal of the American Academy of Child & Adolescent Psychiatry, 2005
To provide the first empirical analysis of a cultural syndrome in children by examining the preva... more To provide the first empirical analysis of a cultural syndrome in children by examining the prevalence and psychiatric correlates of ataques de nervios in an epidemiological study of the mental health of children in Puerto Rico. Probability samples of caretakers of children 4-17 years old in the community (N = 1,892; response rate: 90%) and in clinical services (N = 761; response rate 72%) were administered structured interviews to assess the presence and correlates of ataques de nervios. Nine percent of children in the community sample and 26% of children in the clinical sample had a reported history of an ataque de nervios. In contrast to the overall community and clinical samples, which had more boys in them, the ataque de nervios groups in both samples had more girls in them. Family history of ataques de nervios was associated with ataques de nervios in children in both samples. Across a wide range of depression, anxiety, and disruptive disorders, children who reported an ataque de nervios were more likely to meet research criteria for psychiatric disorder in both samples. Ataques de nervios are a frequently reported cultural syndrome among children in Puerto Rico. Adolescent girls are more likely to report this experience. Ataques de nervios have a significant relationship with psychiatric disorder and impairment in Puerto Rican children.
The Journal of Nervous and Mental Disease, 2005
Within somatization, unexplained neurological symptoms (UNSs) have been shown to mark a distinct ... more Within somatization, unexplained neurological symptoms (UNSs) have been shown to mark a distinct subgroup with greater clinical severity. However, some UNSs resemble ataque de nervios somatic symptoms. This raises questions about cultural factors related to Hispanics with somatization characterized by UNSs. To examine cultural factors, preliminary analyses examined the relationship between Hispanic ethnicity, UNSs, and ataque de nervios. Data were obtained from 127 primary care patients (95 Hispanic, 32 European American) with somatization. The Composite International Diagnostic Interview provided somatization data, whereas the Primary Care Evaluation of Mental Disorders was used for data on Axis I disorders. Ataque de nervios was assessed via a proxy measure. Within each ethnic group, cross-tabs examined the relationship between ataque de nervios and multiple UNSs, and ataque de nervios and selected Axis I disorders. Only among Hispanics, a significant overlap was found between ataque de nervios and having four or more UNSs (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), and ataque de nervios and a diagnosis of panic disorder (p = .05). Although equal percentages of European Americans and Hispanics experience multiple UNSs, these results show that the presentation of UNSs among some Hispanics may be qualitatively different, because it may involve features related to ataque de nervios. A diagnosis of panic disorder also appears to interact with cultural factors.
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Papers by Peter Guarnaccia