Mental Health

Minority Mental Health Issues

Although words such as “depression” and “anxiety” do not exist in certain Native American languages, the suicide rate for American Indian and Alaska Native males between the ages of 15 and 24 is two to three times the national rate. The overall prevalence of mental health problems among Asian Americans and Pacific Islanders does not differ significantly from prevalence rates for other Americans, but this group has the lowest utilization rate for mental health services among ethnic populations. Mexican Americans born outside the United States have lower prevalence rates for many lifetime disorders than Mexican Americans born in the United States, and 25% of Mexican-born immigrants show signs of mental illness or substance abuse, compared with 48% of U.S.-born Mexican Americans. Somatic symptoms are almost twice as likely to be found among African Americans as among Caucasians.

The four most recognized racial and ethnic minority groups are themselves quite diverse. American Indians and Alaska Natives comprise more than 500 tribes with different cultural traditions, languages, and ancestry. Asian Americans and Pacific Islanders include at least 43 separate subgroups who speak more than 100 languages. Hispanic Americans are of Mexican, Puerto Rican, Cuban, and Central and South American heritage. Diversity has increased in the African American community as Black immigrants have arrived from the Caribbean, South America, and Africa. Some members of these subgroups have largely acculturated or assimilated into mainstream U.S. culture, whereas others speak English with difficulty and interact almost exclusively with members of their own ethnic group.

Diagnosis and Culture

Western medicine has become the cornerstone of health worldwide because it is based on scientific research. The hallmark of Western medicine is its [Page 296]reliance on accurate diagnosis, that is, the identification and classification of disease. The accurate diagnosis dictates the type of treatment and supportive care, and it sheds light on the prognosis and course of illness. The diagnosis of mental disorders is arguably more difficult than diagnoses in any other areas of medicine and health because there are no definitive lesions or, in most cases, laboratory tests. Rather, a diagnosis depends on a pattern or clustering of symptoms (i.e., subjective complaints), observable signs, and behavior associated with distress or disability.

The formal diagnosis of a mental disorder is made by a clinician, and it is based on three components: (1) the patient's description of the nature, intensity, and duration of symptoms; (2) signs from a mental status examination; and (3) the clinician's observation and interpretation of the patient's behavior, including functional impairment. The final diagnosis rests on the clinician's judgment about whether the patient's signs, symptom patterns, and impairment meet the criteria for a particular diagnosis. The American Psychiatric Association sets forth diagnostic criteria in a standard manual known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). This is the most widely used classification system, both nationally and internationally, for teaching, research, and clinical practice.

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