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Idioms of Distress Among Spanish-Speaking
Cultures
In Session
With Glòria Durà-Vilà, MD,
MRCPsych, MSc:
Idioms of Distress Among
Spanish-Speaking Cultures
Glòria Durà-
Vilà, MD, MRCPsych, MSc
Consultant Child and Adolescent
Psychiatrist, Surrey and Borders Partnership NHS
Foundation Trust, UK; Visiting Lecturer, Department
of Mental Health Sciences, University College
London
First published in
Psychiatry Weekly, Volume 7, Issue
7, on April 9, 2012
Q: How can descriptions of
mental distress vary among some Spanish-speaking
cultures?
A:
Susto, nervios, and
ataque de
nervios—“fright,”
“nerves,” and “attack of
nerves”—are idioms of distress widely
experienced among Hispanic Americans; they are
often associated with psychiatric disorders,
especially mood and anxiety disorders. We
undertook a population survey in four adult
education centers in Spain using hypothetical case
vignettes of individuals suffering from these idioms
of distress. This is, to our knowledge, the first study
to explore these idioms in a population resident in
Spain. The aims of the study were to investigate
understanding of these idioms of distress, and
attitudes toward help-seeking, among indigenous
Spanish and Hispanic American residents in Spain.
We found that the idioms
ataque de nervios and
nervios were recognized by the
majority of the Hispanic American and Spanish
participants. However, though susto
was recognized by half of the Hispanic Americans, it
was only infrequently recognized by the Spanish
group. In fact, Hispanic Americans had statistically
significantly higher levels of use of the three idioms
than Spanish people. Findings from the regression
analysis showed that being Hispanic American and
having lower educational attainment were
associated with greater use of susto.
Q: Did the Spanish and
Hispanic American groups vary in their
recommendations of help-seeking for the idioms of
distress?
A: Hispanic
Americans were found to have statistically
significantly higher levels of medical help-seeking
behavior—seeing a psychiatrist or
psychologist—than Spanish people (for
ataques and nervios). In
contrast, those born in Spain relied significantly
more on non-medical sources of support, such as
family and friends, than Hispanic Americans. This
difference might arise simply because the
immigrant participants had fewer family and friends
near them and were less inclined to think about
them as an immediate source of support for the
characters of the vignettes. Despite the differences
found amongst ethnic groups regarding non-medical
sources of help, these sources were indeed widely
used across groups: the help of relatives and
friends was recommended by over half of the
participants. The most frequently recommended
medical help-seeking behavior was seeing a
psychiatrist or a psychologist, highlighting the
psychological—rather than
physical—nature of the complaints.
Interestingly, the study has found a
complex fit between the use of the idioms of
distress and help-seeking. It suggests that people
hold multiple models of distress and disorder in
their minds. It is essential that efforts be made by
mental health professionals to carefully explore the
patient’s own understanding of their
symptoms and their wider social and cultural
context, thereby gaining insight into the subjective
experience of illness.
Disclosure: Dr.
Durà-Vilà reports no affiliations
with, or financial interests in, any organization that
may pose a conflict of interest.
References:
1. Durà-Vilà G,
Hodes M. Cross-cultural study
of idioms of distress among Spanish nationals and
Hispanic American migrants: susto, nervios and
ataque de nervios. Soc Psychiatry
Psychiatr Epidemiol. 2012 Jan 24 [Epub
ahead of print]