Household Composition and Longitudinal Health Outcomes for Older Mexican Return Migrants.

Mexican return migrant population is increasing, yet our knowledge about their lives after resettlement in Mexico remains fragmentary. Using 2001-2012 longitudinal data from the Mexican Health and Aging Study, we investigate difference in household composition for older migrants who returned from the United States compared to nonmigrants. Furthermore, we fit a Cox proportional hazards model to assess the relationship between household composition and health and functional trajectories of return migrants and nonmigrants. The results indicate that return migrants with long duration of U.S. stay have different household composition than nonmigrants or short-term migrants: On average, they have smaller household size, including fewer females who may be available to offer assistance to older adults. Presence of middle-age females in the household has positive effects on health and functional trajectories. We highlight implications of this research for policy makers in Mexico and the United States.

Mental health status and use of mental health services by California adults.

In 2005, nearly one in five adults in California, about 4.9 million people, said they needed help for a mental or emotional health problem. Approximately one in 25, or over one million Californians, reported symptoms associated with serious psychological distress (SPD). Of those adults with either perceived need or SPD, only one in three reported visiting a mental health professional for treatment. This policy brief, based on data from the 2005 California Health Interview Survey (CHIS 2005), presents the first comprehensive overview of mental health status and service use in California, and highlights differences by age, gender, race/ethnicity, income and insurance status. It also demonstrates the critical need for continued efforts to expand mental health services and threats to such services caused by the ongoing state budget crisis.

Diabetes awareness and knowledge among Latinos: does a usual source of healthcare matter?

OBJECTIVE: To provide national prevalence estimates of usual source of healthcare (USHC), and examine the relationship between USHC and diabetes awareness and knowledge among Latinos using a modified Andersen model of healthcare access. PARTICIPANTS: Three thousand eight hundred and ninety-nine Latino (18-years or older) participants of the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic/Latino Health survey from the 48 contiguous United States. DESIGN: Cross-sectional, stratified, random sample telephone interviews. METHODS: Self-reported healthcare service use was examined in regression models that included a past-year USHC as the main predictor of diabetes awareness and knowledge. Anderson model predisposing and enabling factors were included in additional statistical models. RESULTS: Significant differences in USHC between Latino groups were found with Mexican Americans having the lowest rates (59.7%). USHC was associated with significantly higher diabetes awareness and knowledge (OR=1.24; 95%CI=1.05-1.46) after accounting for important healthcare access factors. Men were significantly (OR=0.64; 95%CI=0.52-0.75) less informed about diabetes than women. CONCLUSION: We found important and previously unreported differences between Latinos with a current USHC provider, where the predominant group, Mexican Americans, are the least likely to have access to a USHC. USHC was associated with Latinos being better informed about diabetes; however, socioeconomic barriers limit the availability of this potentially valuable tool for reducing the risks and burden of diabetes, which is a major public health problem facing Latinos.

The role of patient activation on patient-provider communication and quality of care for US and foreign born Latino patients.

BACKGROUND: Previous research has shown positive effects of patient activation on healthcare outcomes, but there is practically no information on the generalization of these findings for Latino patients. Little data are available on whether patient activation is associated with healthcare outcomes for Latino patients and whether activation varies by language proficiency and nativity status. OBJECTIVE: We examined the levels of activation by characteristics of Latino patients (e.g. nativity, language, health status). We investigated whether patient activation relates to the quality of care received and enhanced doctor-patient communication for Latino patients. DESIGN: We conducted analyses of 1,067 US born and foreign born Latinos who participated in the second wave of the PEW/RWJF Hispanic Healthcare Survey during 2008. PARTICIPANTS: Participants were self-identified Latinos (18+) with a doctor visit, living in the contiguous United States who could be contacted by telephone. RESULTS: US born Latinos had significantly (P < 0.001) greater patient activation scores than foreign born Latinos (75 versus 70). Latinos classified as bilingual and those reporting excellent health evidenced higher mean activation scores as compared to Spanish-speaking Latinos and those reporting fair or poor health. After adjusting for demographics, health status, other language and service use factors, patient activation was strongly associated with self-reported quality of care and better doctor-patient communication among both US and foreign born Latino respondents. CONCLUSIONS: Interventions that augment patient activation could increase quality of care and improved patient-provider communication, potentially reducing health care disparities for Latinos.

Perceived discrimination and self-reported quality of care among Latinos in the United States.

BACKGROUND: Given the persistence of health and health-care disparities among Latinos in the United States and evidence that discrimination affects health and health care, an investigation of the relationship between perceived discrimination and quality of health care among Latinos is warranted. OBJECTIVE: To examine the relationship of perceived discrimination (in general and in regard to doctors and medical personnel) with self-reported quality of health care and doctor-patient communication in a nationally representative Latino population sample. PARTICIPANTS: Participants were 1,067 Latino adults aged >or=18 years living in the US selected via random-digit dialing. Telephone interviews were conducted in 2008 during Wave 2 of the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey. RESULTS: US-born Latinos were twice as likely to report general discrimination as foreign born: 0.32 SD versus -0.23 SD (P < 0.001) on the Detroit Area Survey (DAS) discrimination scale. Higher DAS discrimination was associated with lower self-reported quality of care in US-born Latinos [OR = 0.5; 95% CI (0.3, 0.9); P = 0.009]. For foreign-born Latinos, report of any doctor or medical staff discrimination was associated with lower quality of care [OR = 0.5; 95% CI (0.3, 0.9); P = 0.03], but the DAS was not. For US-born Latinos, doctor discrimination and higher DAS were jointly associated with worse doctor-patient communication. For foreign-born Latinos, the effect of discrimination on doctor-patient communication was significantly smaller than that observed in US-born Latinos. CONCLUSIONS: Given the association between perceived discrimination and quality of care, strategies to address discrimination in health-care settings may lead to improved patient satisfaction with care and possibly to improved treatment outcomes.

Social Relationships, Social Assimilation, and Substance-Use Disorders among Adult Latinos in the U.S.

Based on social control perspectives and results from prior studies we test hypotheses about the extent to which characteristics of family and social networks are associated with substance use disorders (SUD), and whether these associations vary by sex. In this study SUD is alcohol or illicit drug abuse or dependence as defined by criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association. With nationally representative data of adult Latinos from the National Latino and Asian American Survey (NLAAS), we found that respondents' language use with family, rather than language proficiency, appears to be a more efficient proxy for social assimilation to represent differential levels of risk of SUD. SUD was positively associated with problematic family relations for men but not women, and SUD was positively associated with more frequent interactions with friends for women but not men. The results suggest that the salient features of social assimilation associated with SUD include the context of language use and transformations in family and social network relationships that differ in important ways between Latino men and women.

Report on an open-label prospective study of divalproex sodium for the behavioral and psychological symptoms of dementia as monotherapy and in combination with second-generation antipsychotic medication.

BACKGROUND: Studies of pharmacotherapy for agitation in dementia have primarily been limited to single-drug trials and have not determined if some forms of agitated behaviors are more responsive to treatment than others. OBJECTIVE: The goal of this study was to determine if manifestations of agitation (ie, physical aggression, physically nonaggressive behavior, and verbally agitated behaviors) show different degrees of response to divalproex sodium (extended release or sprinkles) alone or in combination with second-generation antipsychotic agents. METHODS: This was a 6-week, open-label, naturalistic pilot study of patients aged >60 years recruited from a geriatric psychiatry inpatient unit, 2 nursing homes, and 4 assisted living residences. Patients were referred for study if they displayed Behavioral and Psychological Symptoms of Dementia. The primary outcome measure was the Cohen-Mansfield Agitation Inventory (CMAI), an instrument whose subscales allow measurement of physically aggressive behaviors, physically nonaggressive behaviors (eg, wandering), and verbally agitated behaviors. The Neuropsychiatric Inventory-Nursing Home version (NPI-NH) was also used to assess patients' behavior. RESULTS: Fifteen patients were included in the study (10 men, 5 women; mean [SD] age, 81.9 [7.7] years). Total CMAI improved by 17.1% at week 1, showed an additional improvement of 3.4% at week 3, and no further improvement by week 6 (total score dropped by 1.1%). Aggressive behavior improved at weeks 3 and 6 while physically nonaggressive and verbally agitated behaviors improved at weeks 1 and 3, and lost much of the gains by week 6. The NPI-NH agitation/aggression score decreased a mean (SE) of 1.3 (0.5) points (P = 0.03), the irritability/lability subscale decreased a mean (SE) of 2.3 (0.6) points (P = 0.005), and the disinhibition subscale decreased a mean (SE) of 1.4 (0.4) points (P < 0.01). Seven patients were on divalproex monotherapy and 8 patients were on combination therapy. Daily doses of divalproex (mean dose, 656 mg/d) in combination with a second-generation antipsychotic were 28% lower than divalproex monotherapy (mean dose, 914 mg/d). The most common adverse events were somnolence (7 of 15) and gait disturbance (5 of 15). One death was observed in the study; the death was due to a prior medical condition and was judged unlikely to be study related. CONCLUSIONS: Patients with higher levels of agitation receiving divalproex had reduced agitation on the physical aggression subscale of the CMAI. Divalproex was less effective on physically nonaggressive behavior and verbal agitation. Irritability, as measured on the NPI-NH, was also reduced. Patients who received both divalproex and an antipsychotic agent were responsive at lower doses of divalproex. In either case, the effective dosage of divalproex was lower than that commonly used for epilepsy or mania in elderly patients. The most common adverse events included somnolence and gait disturbance.

Prevalence and correlates of lifetime suicidal ideation and suicide attempts among Latino subgroups in the United States.

OBJECTIVE: Limited data are available to understand the prevalence and correlates of suicidal behavior among U.S. Latino subgroups. This article compares the prevalence of lifetime suicidal ideation and suicide attempts among major U.S. Latino ethnic subgroups and identifies psycho-sociocultural factors associated with suicidal behaviors. METHOD: The National Latino and Asian American Study includes Spanish- and English-speaking Mexicans, Puerto Ricans, Cubans, and other Latinos. A total of 2554 interviews were conducted in both English and Spanish by trained interviewers between May 2002 and November 2003. Lifetime psychiatric disorders were measured using the World Health Organization-Composite International Diagnostic Interview. Descriptive statistics and logistic models were used to determine demographic, clinical, cultural, and social correlates of lifetime suicidal ideation and suicide attempts. RESULTS: The lifetime prevalence of suicidal ideation and suicide attempts among Latinos was 10.1% and 4.4%, respectively. Puerto Ricans were more likely to report ideation as compared with other Latino subgroups, but this difference was eliminated after adjustments for demographic, psychiatric, and sociocultural factors. Most lifetime suicide attempts described by Latinos were reported as occurring when they were under the age of 18 years. Any lifetime DSM-IV diagnoses, including dual diagnoses, were associated with an increased risk of lifetime suicidal ideation and suicide attempts among Latinos. In addition, female gender, acculturation (born in the United States and English speaking), and high levels of family conflict were independently and positively correlated with suicide attempts among Latinos, even among those without any psychiatric disorder. CONCLUSIONS: These findings reinforce the importance of understanding the process of acculturation, the role of family, and the sociocultural context for suicide risk among Latinos. These should be considered in addition to psychiatric diagnoses and symptoms in Latino suicide research, treatment, and prevention, especially among young individuals.

Understanding differences in past year psychiatric disorders for Latinos living in the US.

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 US account for differences in 12-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 US-born or arrived before age 6: In-US-as-Child [IUSC]; or whether they arrived after age 6: later-arrival immigrants [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 compared to IUSC Latinos, after age and gender adjustments. For substance use disorders, family factors do not offset the elevated risk of early exposure to neighborhood disadvantage, but coming to the US after age 25 does offset it. Family conflict and burden were consistently related to the risk of mood disorders. Our findings suggest that successful adaptation into the US is a multidimensional process that includes maintenance of family harmony, integration in advantageous US neighborhoods, and positive perceptions of social standing. Our results uncover that nativity may be a less important independent risk factor for current psychiatric morbidity than originally thought.

Looking Beyond Nativity: The Relation of Age of Immigration, Length of Residence, and Birth Cohorts to the Risk of Onset of Psychiatric Disorders for Latinos.

Past studies yield inconsistent results regarding risk of psychopathology for U.S. Latinos by nativity possibly due to differences across immigrants in their age of arrival to the U.S., their length of residence in the U.S., or birth-cohort differences. This paper seeks to document the relation of age of arrival, time in the U.S., and cohort effects on the risk of onset of psychiatric disorders using a nationally representative sample of 2554 Latinos in the coterminous United States. Risk of onset of psychiatric disorders was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI, Kessler & Ustun, 2004). Findings indicate that Latino immigrants have lower risks of onset for some psychiatric disorders in their country of origin, but once in the U.S., Latino immigrants appear to experience similar risks of onset as U.S.-born Latinos of the same age. The longer Latino immigrants remain in their country of origin, the less cumulative risk of onset they experience, resulting in lower lifetime rates of disorders. These findings could potentially be due to variation in cultural and social norms and expectations across geographical contexts, differences in family structure and gender roles, as well as artifactual-level explanations.

Social cohesion, social support, and health among Latinos in the United States.

The role of individual versus community level social connections in promoting health is an important factor to consider when addressing Latino health. This analysis examines the relationships between social support, social cohesion, and health in a sample of Latinos in the United States. Using data from the National Latino and Asian American Study, the analysis uses ordered logistic regression to explore the relationships of family support, friend support, family cultural conflict, and neighborhood social cohesion with self-rated physical and mental health, taking into account language proficiency and use, nativity, and sociodemographic variables. Family support, friend support, and neighborhood social cohesion were positively related to self-rated physical and mental health, and family cultural conflict was negatively related when controlled only for sex and age. After controlling for education, income, and other demographic measures, only family support was found to have a weak association with self-rated physical health; however, the relationship seemed to be mediated by language. In contrast, family support and family cultural conflict were strongly associated with self-rated mental health, after controlling for language, education, income, and other demographic measures. The study did not find neighborhood social cohesion to be significantly related to either self-rated physical or mental health, after accounting for the effects of the other social connection variables. Language of interview did not explain the highly significant effects of language proficiency and use. Social connections are important for health and mental health, but language and other sociodemographic factors seem to be related to how Latinos establish these social linkages. Further investigation into the role of language in the development and maintenance of social connections may help unravel the mechanisms by which they promote or decrease health.

Putative psychotic symptoms in the Mexican American population: prevalence and co-occurrence with psychiatric disorders.

It is reported that Latin Americans describe culturally normative experiences or express putative psychotic symptoms in medical and mental health treatment settings that complicate the diagnostic process. Previous research reported that Latinos were more likely than European Americans and African Americans to have their diagnoses changed from schizophrenia to other disorders. This study describes the prevalence and likelihood of putative psychotic symptoms being expressed independent of any psychiatric disorder or co-occurring with common disorders such as depression or anxiety within a Mexican American population sample. Epidemiologic data of the Mexican American Prevalence and Services Survey (N = 3012) were used to contrast rates and patterns of putatively psychotic features among adults by demographic variables and diagnostic status using DSM-III-R criteria and receipt of treatment. Putative psychotic symptoms were reported by 17% of US-born and 7% of immigrants without disorders, and by 38% of US-born and 28% of immigrants with lifetime disorders, totaling 18% lifetime prevalence for the entire study population of Mexican Americans. First-rank Schneiderian symptoms were higher in those with a disorder compared with those without a disorder for both sexes. The results of this study indicate that putative psychotic symptoms are common among Mexican Americans, and their presence is a strong precautionary signal for evaluating clinicians to correctly distinguish whether putative psychotic symptoms are indicators of nonorganic psychoses or other psychiatric disorders, or are simply cultural expressions. Research is needed to identify the determinants of misdiagnosis in clinical practice, and guidelines are needed to assist clinicians.

Tryptophan hydroxylase polymorphism is associated with age of onset of alcoholism related behaviors.

The purpose of this study was to explore the association of a tryptophan hydroxylase gene polymorphism (TPH1 A218C) with the age of alcoholism onset in a Korean population. The genotype and allele frequencies of TPH1 were investigated in 182 male hospitalized patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for alcohol dependence. Alcoholics with the TPH1 AA or AC genotypes had an earlier age of disease onset (median age of onset, 26.5 years) than those with the CC genotype (median age of onset, 30 years; p=.002). Age of onset has been used in classifying alcoholics. The TPH1 polymorphism may explain, in part, the biological basis for these typologies.

12-month prevalence of DSM-III-R psychiatric disorders among Mexican Americans: nativity, social assimilation, and age determinants.

The burden of disease attributable to mental illnesses has major costs and human services implications in the United States. Mexican Americans compose two thirds of the nation's largest and fastest-growing minority group, Latinos. We report 12-month DSM-III-R psychiatric disorder rates among Mexican Americans derived from a population survey of immigrants and US-born adults of Mexican origin conducted in rural and urban areas of central California. Rates of 12-month total mood, anxiety, and substance disorders were 14.2% for immigrant women, 12.6% for immigrant men, 27.8% for US-born women, and 27.2% for US-born men. For immigrants, younger age of entry and longer residence in the United States were associated with increased rates of psychiatric disorders. Three dominant explanations are reviewed to explain these differences: selection, social assimilation and stress, and measurement artifact. Our results and other research studies collectively support a social assimilation explanation based on aversive impact on health behaviors and protective resources such as families. Greater social assimilation increases psychiatric morbidity, with rates for subjects who are US-born of Mexican origin approximately the same as rates for the US general population.

Co-occurring alcohol, drug, and other psychiatric disorders among Mexican-origin people in the United States.

We examined co-occurrence of (comorbid) alcohol, drug, and non-substance use psychiatric disorders in a population sample of Mexican-origin adults from rural and urban areas of central California. Co-occurring lifetime rates of alcohol or other drug disorders with non-substance use psychiatric disorders, or both, were 8.3% for men and 5.5% for women and were 12.3% for the US born and 3.5% for immigrants. Alcohol abuse or dependence with co-occurring psychiatric disorders is a primary disorder among Mexican-origin adult males (7.5% lifetime prevalence). US-born men and women are almost equally likely to have co-occurring disorders involving substances. Cobormidity is expected to increase in the Mexican-origin population owing to acculturation effects of both sexes.

Parental risk factors and social assimilation in alcohol dependence of Mexican Americans.

OBJECTIVE: This study examines the reciprocal relationship of social assimilation and four parental behavioral risk factors in the intergenerational development of alcohol abuse or dependence (AAD) among adults of Mexican origin in the United States. Whereas many studies have shown U.S. nativity and English language use are markers for enhanced risk of AAD among Mexican Americans, such studies have not examined the extent to which predisposing biobehavioral factors are conditioned by social assimilation in the United States. METHOD: Language use patterns as a proxy of cultural assimilation and length of time in the U.S. as a proxy for social assimilation were used to compare the distribution of parental behavioral factors (alcohol, drug abuse, depression and anxiety) and the influence of these factors on AAD onset in adult children of Mexican immigrants. Data were obtained from an epidemiologic field survey in Central California of 3,012 Mexican origin adults. RESULTS: Complex effects structured by gender were found: parental behavioral risk factors predicted AAD onset; Mexican American adults born in the U.S. were much more likely than were immigrants to report parents with behavioral risk factors; women were more susceptible to the effects of parent risk factors in the context of social and cultural assimilation. Women required more total risk factor exposure, including parent risk factors, for AAD onset. CONCLUSIONS: Reciprocal influences of parent risk factors on assimilation were found, suggesting that parental behavioral factor effects on AAD in adult children of Mexican Americans are subordinate to social and cultural assimilation.

Evidence for an N-glycosylation polymorphism of arylsulfatase a predisposing to alcoholism in Koreans.

This study investigated the possible effect of the pseudodeficient N-glycosylation polymorphism of the arylsulfatase A (ASA) gene on alcohol dependence among Koreans. Alcoholic patients (N=123) were more likely than control subjects to be heterozygous or homozygous for the ASA pseudodeficient N-glycosylation site (36% of alcoholics versus 20% of controls; P<0.01). Among these 123 alcoholic patients, 42 alcoholics were heterozygous and two were homozygous for the ASA pseudodeficient N-glycosylation polymorphism. This result provides evidence that the ASA pseudodeficient N-glycosylation site allele increases the risk of alcohol dependence within a Korean population.