Transcript Mental Health Issues in Hispanics

Hispanics in a
Biopsychosocial Context
Hispanic Neuropsychological Society
@
National Academy of Neuropsychology
Seattle, Washington
November 19, 2004
Contact Information:
Antonio E. Puente, Ph.D.
Department of Psychology
University of North Carolina at Wilmington
910.962.3812
[email protected]
www.uncw.edu/people/puente
Background
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Purpose
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Provide Contextual Background
Prior Attempts
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Ponton
Several chapters
US Demographic Context
(from various sources especially US Census Bureau, 2004)
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Population
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US = 290, 807,770
NC =
8,407,248
US Demographic Context
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Income (household)
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Median
Mean
= $45,631
= $61,587
US Demographic Context
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Education
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Doctoral Degree
Professional Degree
Master’s Degree
Bachelor’s Degree
Associate’s Degree
High School Degree
Less than High School
No Schooling
=
=
=
=
=
=
=
=
1.0
2.0
5.9
15.5
6.3
80.4
18.2
1.4
Hispanics in the United States:
Overview
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United States Trends
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Is the largest ethnic minority group in US
Is the fastest growing ethnic group in US
Approximating 15% of the population
Will represent the majority group in 2040
Probably undercounted (hence projections are
probably off with a wide margin of error)
Demographics:
Hispanics in the United States
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United States Statistics
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Overall
= 12.5% (Vs. 12.1% for AA)
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Before 18
= 35%
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18-65
65 +
= 60%
=
5%
Less Educated than counterparts
More Fertile than counterparts
US Demographics: Population
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Shifting Demographics
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Non-Hispanic White
African American
Hispanic
69.4%
12.7%
12.6%
57.5%
13.9%
20.1%
US Demographics: Work Force
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Percentage of Work Force
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1980
1990
2000
2010
2020
2030
5.7%
8.5%
11.7%
14.1%
16.9%
10.9%
US Demographics:
Undergraduate Education
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Bachelor’s Degrees Awarded to Hispanics
(%)
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1980
1990
2000
2010
2020
2030
2.3%
3.4%
6.2%
7.0%
8.0%
8.8%
Demographics:
Hispanics in North Carolina
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North Carolina Statistics
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Overall = 4.7%
Migration for Foreign Born = 50%
Primarily from California (also from the NE)
 Comparison (ND = 282% decrease)
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From 1990 to 2000 = 394% increase
Demographics:
Hispanics in New Hanover County
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New Hanover (Wilmington, NC) Statistics
Estimates
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Total Population = 147,642 (22.7% increase)
1980 = 788;
1990 = 747;
2000 =1,828
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Estimate = severe undercounting
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Additional Hispanic Statistics
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Percentage of Population
- In US = 12.5%
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In NC =
4.7%
- 36% are from Latin America
- 30% are from Mexico
Anticipated Growth
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In US = Births will outpace immigration
In NC = Over 500% growth
North Carolina: More Closely
(partially from Common Sense Foundation, October, 2004)
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University of North Carolina @ Wilmington
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Chancellors or Vice-Chancellors (0 of 6)
Deans (0 of 5)
Faculty (15 out of 705)
Students (254 out of 11,327)
Issues of Documentation
Glass Ceiling of Non-Resident Tuition
Glance (continued)
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High School Students in North Carolina
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One third of all high school graduates by the
year 2013 will be Hispanic
Graduation rate for Hispanics nationally =
54%
Graduation rate for Hispanics in North
Carolina = 38%
Glance (continued)
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Language Ability
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(in US about 30 million speak Spanish)
US = 22% speak English “poorly”
NC =34% speak English “poorly”
Governmental Representation
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Two Elected Officials
No High Ranking Judges
One Executive Level Office
Glance (continued)
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Health Insurance
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37% lack insurance nationally
54% lack insurance in North Carolina
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Increases to 64% if non-documented
Income
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27% live in poverty
NC Median family income = $30,529
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National MFI
NC MFI for whites
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National MFI
= $ 44,468
= $51,951
= $61,587
Psychological Literature
(from PsyInfo, 11.01.04)
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Psychology
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Hispanics
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799
Hispanics and Intelligence
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7,718
Hispanics and Mental Health
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485,230
172
Hispanics and Neuropsychology
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52
What Does Being “Hispanic” Mean?
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Speaking Spanish
Being Catholic (or Christian, probably
conservative/fundamentalist)
Religion as source of support and socialization
Family above all (and extended family)
Children are highly desired and valued
Friends and social groups are critical
Cooperation versus competition
Keep one’s problems to themselves or family
Respect and formality
The important use and knowledge of a name (and title)
Hospitality through gifts, food, and drink
Smooth interpersonal relations are critical (amabilidad)
Time to be enjoyed not conquered
Modesty (pudor)
Less material & consumer focused
More emotional
Personalismo
Fatalismo (chance and God explain just about everything)
Sources of Biopsychosocial Problems
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Culture and Acculturation Issues
Language Limitations
Family Dysfunction
Ineffective Social Support
Low Self Esteem
Limited Education
Financial Limitations
Religious Affiliation
Documentation
Health Status
Gender Issues
Interpretation of Efficiency
Cultural Issues
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Misunderstanding of the Majority Culture’s
Unwritten Social Rules and Agendas
Isolation to Mainstreaming
Language Limitations
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English
Variations of Spanish
Spanish as a Second Language
Anxiety Associated with Learning English and
Losing Your Culture
Non-Verbal Communication is Important
Children as Translators
Children Choosing English over Spanish
Family
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Defining Family (Familismo)
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Nuclear
Extended
Double
Functional
Divided Families
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Economics
Geography
Politics
Ineffective Social Support
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Medical
Religious
Educational
Financial
Social
Marital
Low Self Esteem
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Productivity and Materialism
Connectivity
Self-Effacing Presentation
Loss of Respect From Others
Self-Fulfilling Prophecy
Education
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Typical Educational Background
What it Means to be “Educated”
the difference between schooling and
education
Financial & Related Limitations
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The Limits and Hazards of Being
Undocumented
Type of Vocational Opportunities &
Corresponding Pay
Banking Issues
Saving for Retirement
Driver’s Licenses
Religion
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Predominantly Catholic, but not
Exclusively (about 25%)
Importance of Religion and Related Social
Support
Prayers are Directed to a Saint
A “Milagro” is a Special Need
Church and Related Services in Spanish
Documentation
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Education
Medical
Legal
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Tax ID Numbers
Social Security Numbers
Driver’s Licenses
Aliases
Health Status
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Increased and Disproportionate Health Problems
Higher Low Birth Weights & Infant Mortality
Increased Morbidity
Under-Utilization of Health Services
Health Viewed as Absence of Pain
Women as Primary Care Providers in Family
Disability is a Family Affair
Hospitals as Last Place for Health Care or
Possibly a Place One Goes to Die
Gender Issues
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Males Vs. Female
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False = loss of dignity and respect
True = Protector, supporter
Heterosexual issues
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27%
Machismo
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Males
Females 17%
Clashing of cultures
Availability of partners
Prostitution
STDs
Sexual Identity Issues
Childhood Sexuality & Abuse
Interpretation of Efficiency
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Time (enjoyment vs. completion)
Cooperation (vs. competition)
Process (vs. outcome)
Outcome of Problems
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Anxiety
13%
Substance abuse
8%
Depression
5%
Violence
?%
Ethnic identity issues
?%
Poverty and marginalization
?%
Hispanics & Neuropsychology
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Presentations (Dates are approximate/estimates)
 Approximately 1994 Puente NAN Workshop
 INS soon thereafter, Ponton Workshop (Galveston?)
 2000 HNS/NAN Informal Symposium
 2002 Ardila NAN Workshop
 2004 HNS NAN Workshop
Books
 4
 3 Edited; 1 Authored
Non-Empirical Publications
 30
 Mostly Chapters
Empirical Publications
 20
 Two Dissertations
 Acculturation/testing
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Psychology
Neuropsychology
= 35
= 6 (most non-empirical)
Merging Problems (Outside
Traditional Biopsychosocial Realm)
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Lack of Science
Lack of Personnel
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HNS as an Example
Lack of Tests
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Copyright
Standardization
Translation Issues
Heterogeneity of Hispanics
The Difficulty in Developing Tests
A Model for Integration
1. Isolation
2. Acculturation
3. Assimilation
4. Mainstream
In Three Generations
(from Hispanic Business, 2003)
Income
Size
Time in US
Locale
Values
Language
Isolation
Acculturation
$20,500
3.9
1st gen.
Inner City
Hispanic
Spanish
$36,100
3.6
US born
Suburbs ?
Partial Hispanic
Bilingual
Assimilation
$37,000
3.1
4th Gen.
Suburbs
Anglo
English
The Future
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Clashing Curves and Cultures
21st Century “Slavery”
Pay Now or Pay Later
What is the United States Going to Do?
Future?
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Demographic Shifts Are Obvious
Socio-political Shifts Are Not
The Lack of Integration of These Two
Shifts Will Result in Social
Misunderstanding & Unrest