1. Chapter 4
Impact of Race, Ethnicity, and Culture on the Expression and Assessment of Psychopathology

2. Multicultural Competency
The relevance of ethnicity in adult psychopathology has been substantiated by identifying disparities in:
Prevalence rates
Symptom presentation
Mental health service utilization across diverse ethnic groups

3. Ethnic Identity and Acculturation
Ethnic identity is influenced by a person’s:
Identification as a member of an ethnic group
Sentiments and evaluations of the ethnic group
Self-perception of their group membership
Knowledge and commitment to the group
Ethnic-related behaviors and practices
Acculturation has traditionally been defined as the extent to which ethnic minorities adopt the values and participate in the traditional activities of the mainstream culture
Recent reconceptualizations of the acculturation process utilize a multidimensional approach

4. Sociocultural Factors
Important sociocultural contributors to the mental health of ethnic minorities:
- Socioeconomic status
- Stressful life events
- Ethnic background
- Age cohort

5. Cross-Cultural Measurement Equivalence
Some guidelines for determining equivalence:
Linguistic or translation equivalence
The accuracy of the translation and whether diverse individuals have a similar understanding of words or phrases used in the instrument
Conceptual equivalence
Whether the underlying construct holds the same meaning across groups
Psychometric equivalence
Whether the instrument measures the same attribute among people from different groups

6. Multicultural Versus Ethnocentric Perspective to Assessment
Multiculturalism: Recognition of equality of various cultural groups and the right of individuals to follow their own specified path
Ethnocentrism: Cognitive bias that supports judgment about other ethnic, national, and cultural groups from the observer’s perspective

7. Factor Patterns in Ethnic Minorities
In studies that examine factor patterns across racial and ethnic minority groups, structural equation modeling (SEM) is used to examine relationships among variables while controlling for measurement error
Investigators often use this approach when evaluating equivalence of commonly used assessment tools for use with minorities

8. Symptom Expression and Diagnosis
The current diagnostic system assumes some commonalities across symptom clusters
Research defining those symptom clusters was largely based on European American individuals
Diagnostic descriptions may not capture experiences of psychological distress by individuals from nondominant cultures
Symptoms linked to pathology in dominant individuals may not be indicative of pathology for individuals from nondominant cultures

9. Cultural Concepts of Distress
Susto is a Latin American folk illness attributed to a frightening experience, thought to involve “soul loss” as part of this culture-bound syndrome (similar to PTSD)
Koro is uncommon in Western cultures but involves anxiety over the possibility of one’s genitalia receding into the body (OCD)
Shenjing shuairuo (neurasthenia) involves a depletion of vital energy (MDD)

10. Somatization Across Cultures
Somatization is common across all cultures; however, the type and frequency of bodily symptoms expressed may vary
Higher level of stigma associated with mental illness in ethnic minorities
More holistic conceptualization of the person, and less distinction between mind and body among ethnic minorities

11. Racism and Discrimination
In the United States, racial discrimination is highest in African Americans, followed by Asian Americans and Hispanic Americans
Perceived discrimination has been found to be negatively correlated with mental health; this effect appears to be strongest for Asian Americans (followed by Hispanic Americans and African Americans)

12. Influence of Language
Another influence on symptom expression is the language used by clinician and client
There is a tendency for clinicians to rate Latino clients speaking Spanish or Spanish and English as having more severe psychopathology and as functioning less well than Latino clients speaking English only

13. Stereotypes and Biases
The ideology that different ethnoracial groups should all be treated the same, without regard to cultural differences, is known as the colorblind approach
Multiculturalism embraces differences, strengths, and uniqueness of each cultural group
Generalizations about people used as a means of explaining and justifying differences between groups and using these differences to oppress a group is called pathological stereotyping

14. Symptom Expression and Diagnosis
Psychotic disorders are often overdiagnosed among African Americans and others, when a diagnosis of depression (or no diagnosis) may be more accurate
Some aspects of hallucinations are culturally determined:
The definition of the experience as pathological or not
The sensory modality through which they are most commonly experienced

15. Mistrust of Medical Institutions
Tuskegee Study: “Special free treatment” for untreated syphilis in African American males
Actually performed spinal taps without anesthesia
No informed consent
Active treatment withheld
Led to the National Research Act in 1974, which mandated IRB approval

16. Lack of Awareness—Misdiagnosis
“Gold standard” assessment measures
Diagnostic criteria based on European Americans
Lack of multicultural training
Stereotypes affect clinician judgment
Poor therapeutic alliance due to lack of cultural awareness

17. Over-/Underdiagnosis of Minorities
African Americans and Hispanic Americans are often overdiagnosed with psychotic disorders and underdiagnosed with mood disorders
Healthy cultural paranoia is a term used to describe a defensive posture taken by African Americans when approaching a new situation that could involve racism or discrimination
Negative stereotypes dictate that drug users are largely Black and Hispanic, which is not true!

18. Summary
Professionals must be cognizant of cultural factors and the impact on mental health
Ethnoracial minorities make up 36.6% of the U.S. population and account for 50.4% of all births
Non-Hispanic Whites are projected to be minority by 2050