Time for Healing: Somatization among Chronically Mentally Ill Immigrants
Shiroma, Paulo R., Alarcon, Renato D., Journal of Cultural Diversity
Abstract: In a cross-sectional study, we examined demographic factors and acculturation level with somatization among chronically mentally ill groups of immigrants (Russians and Latinos). Ninety Russian and 90 Latino patients attending a university affiliated Day Treatment Program were assessed on somatoform symptoms and acculturation by the 12-item somatization subscale of the SCL-90-R and by a 12- items short acculturation scale, respectively. Higher somatization was significantly associated to women, Russian ethnicity, high school or above level of education, shorter length of residence in the U.S., and lower acculturation. Interaction by ethnic group showed that somatization was influenced by the length of residence in the U.S. among Russians but not among Hispanics. In a multivariate model, higher somatization corresponds to female, Russian, and shorter residence in the U.S. (only among Russians). Length of stay in the host country rather than the level of acculturation influence the frequency of somatic complaints, modified by ethnicity.
Key Words: Somatoform Disorders, Acculturation, Cross-Cultural Comparison, Emigration and Immigration.
Somatization has been broadly defined as the presentation of one or more medically unexplained somatic symptoms (Lipowski,1988) related to substantial emotional stress (Escobar, Burnam, Karno, Forsythe, & Golding,1987), and a powerful coping mechanism for psychosocial stress in many societies (Escobar, Randolph, & Hill, 1986).
In most cultures, the presentation of personal /social distress in the form of somatic complaints is a frequent occurrence (Kleinman,1982), as the perception and expression of emotions as such is not valued and is often stigmatized. Immigrants from around the world experience significantly more stressful life events and psychological distress than members of native populations (Ritsner,Ponizovsky, Kurs, & Modai, 2000). Among them, the phenomenon of somatization as a coping or adapting mechanism seems extremelyand understandably- intense and abundant (Castillo, Waitzkin, Ramirez, & Escobar, 1995).
Studies among different ethnic groups have identified demographic factors related to somatization although without full consistency. Non-married (Canino, Rubio-Stipec, Canino, & Escobar, 1992; Kohn, Flaherty, & Levav, 1989), women (Wool & Barsky, 1994; Piccinelli & Simon,1997), with lower socioeconomic status (Escobar, Rubio-Stipec, Canino, & Karno,1989), and lower level of education (Escobar et al.-, 1989) portray "higher somatizers" immigrants. In addition, certain ethnicities namely Latinos (Escobar, Gomez, & Tuason,1983; Mezzich & Raab,1980), Russians (Kohn et al.,1989), and Chinese (Hsu & Folstein, 1997) are more prone to somatize when compared to Caucasians in the United States.
If somatization were a characteristic of a traditional culture, recent immigrants would manifest more somatic complaints than the more accultura,ted immigrants. Studies in Mexican Americans (Escobar et al., 1989) and Puerto Ricans (Angel & Guarnaccia, 1989) seem to confirm this hypothesis. However, it is unclear whether somatization and acculturation interact in similar fashion among immigrants of different ethnicities and which demographic variables play a role in this phenomenon.
In an analytic cross-sectional study, we examined the possible connection between demographic factors and acculturation level with somatization among two chronically mentally ill groups of immigrants (Russians and Hispanics) traditionally associated with high indices of somatization.
The population attended a university affiliated Day Treatment Program which provides psychiatric care to a large and culturally diverse community mainly composed by Chinese, Southeast Asians, Russians, and Hispanics. Ninety three percent of patients reside in the designated catchment area for the community medical center and essentially referred through the outpatient psychiatric clinic, satellite primary care clinics or after an acute hospitalization. …