Abstract
Mexican immigrants in the US often incorporate folk beliefs into diabetes etiologies but little is known about the relationship between such beliefs and depression. This study examines the relationship of diabetes beliefs and depression among 404 first- and second-generation Mexican immigrants seeking diabetes care in safety-net clinics in Chicago and San Francisco. We used multivariate linear regression to compare the association of depression with beliefs that susto (fright), coraje (anger), and/or interpersonal abuse cause diabetes, adjusting for gender, age, income, education, diabetes duration, co-morbidities, language preference, and acculturation. We incorporated the belief that abuse causes diabetes based on previous ethnographic research. Individuals reporting belief that abuse contributes to diabetes were significantly more likely to report symptoms of depression before (β = 1.37; p < 0.05) and after adjustment (β = 2.03; p < 0.001). Believing that susto and/or coraje cause diabetes was not significantly associated with depression before or after adjustment. The significant association between depression and belief that abuse contributes to diabetes onset suggests that belief in a specific form of social distress may be more closely associated with depression among people with diabetes than a folk belief such as susto or coraje.
Similar content being viewed by others
Notes
These quotes were collected in a study conducted by the first and last author for which the methods have been explained elsewhere (Mendenhall and Jacobs 2012).
References
Ali, S., M. Stone, et al. (2006). “The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis.” Diabetic Medicine 23: 1165-1173.
Anderson, R. J., R. E. Clouse, et al. (2001). “The Prevalence of Comorbid Depression in Adults with Diabetes.” Diabetes Care 24(6): 1069-1078.
Baer, R. D., S. C. Weller, et al. (2003). “A Cross-Cultural Approach to the Study of the Folk Illness Nervios.” Culture, Medicine and Psychiatry 27(315-337).
Black, S. (1999). “Increased health burden associated with comorbid depression in older diabetic Mexican Americans. Results from the Hispanic Established Population for the Epidemiologic Study of the Elderly Survey.” Diabetes Care 22(1): 56–64.
Chavez, L. R., F. A. Hubbell, et al. (1995). “Structure and Meaning in Models of Breast and Cervical Cancer Risk Factors: A Comparison of Perceptions Among Latinas, Anglo Women, and Physicians.” Medical Anthropology Quarterly 9(1): 40-74.
Coronado, G., B. Thompson, et al. (2004). “Attitudes and beliefs among Mexican Americans about type 2 diabetes.” Journal of Health Care for the Poor and Underserved 15(4): 576-588.
Cowie, C. C., K. F. Rust, et al. (2010). “Prevalence of Diabetes and High Risk for Diabetes using A1C Criteria in the U.S. Population in 1988-2006.” Diabetes Care 33(3): 562-568.
Cueller, I., B. Arnold, et al. (1995). “Acculturation rating scale for Mexican Americans II.” Hispanic Journal of Behavioral Sciences 17(3): 275-304.
deGroot, M., B. Pinkerman, et al. (2006). “Depression treatment and satisfaction in a multicultural sample of type 1 and type 2 diabetic patients.” Diabetes Care 29: 549-553.
Dohrenwend, B., M. Dodson, et al. (1984). “Symptoms, Hassles, Social Supports, and Life Events: Problem of Confounded Measures.” Journal of Abnormal Psychology 93(2): 222-230.
Egede, L. and C. Ellis (2010). “Diabetes and Depression: Global Perspectives.” Diabetes Research and Clinical Practice 87: 302-312.
Finkler, K. (1991). Physicians at Work, Patients in Pain: Biomedical Practice and Patient Response in Mexico. Boulder, CO, Westview Press.
Finkler, K. (1994). Women in Pain: Gender and Morbidity in Mexico. Philadelphia, University of Philadelphia Press.
Finkler, K. (1997). “Gender, Domestic Violence and Sickness in Mexico.” Social Science and Medicine 45(8): 1147-1160.
Garro, L. C. (2008). “Remembering what one knows and the construction of the past; A comparison of cultural knowledge of cultural consensus theory and cultural schema theory.” Ethos 28(3): 275-319.
Gilbody, S., D. Richards, et al. (2007). “Screening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ): A Diagnostic Meta-Analysis.” Journal of General Internal Medicine 22(11): 1596-1602.
Golden, S., M. Lazo, et al. (2008). “Examining a bidirectional association between depressive symptoms and diabetes.” Journal of the American Medical Association 299(23): 2751-2759.
Golden, S. H., B. L. H. Chang, et al. (2007). “Depression and Type 2 Diabetes Mellitus: The Multiethnic Study of Atherosclerosis.” Psychosomatic Medicine 69: 529-536.
Gonzalez, H. M., W. Tarraf, et al. (2010). The Epidemiology of Major Depression and Ethnicity in the United States. Journal of Psychiatric Research 44(15): 1043-1051.
Good, B. (1977). “The heart of what’s the matter: The semantics of illness in Iran.” Culture, Medicine, and Psychiatry 1: 25-58.
Good, M.-J. D., B. Good, et al. (1992). Pain as Human Experience: An Anthropological Perspective. Berkeley, University of California Press.
Guarnaccia, P. J. (1992). “Ataque de nervios in Puerto Rico: Culture-bound Syndrome or Popular Illness?.” Medical Anthropology 15: 1-14.
Kleinman, A. (1980). Patients and Healers in the Context of Culture: An Exploration of the borderland between Anthropology, Medicine and Psychiatry. Berkeley, University of California Press.
Kleinman, A. (1988). The Illness Narratives: Suffering, Healing and the Human Condition. New York, Basic Books.
Knol, M., J. Twisk, et al. (2006). “Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis.” Diabetologia 49(5): 837–845.
Low, S. M. (1989). Gender, Emotion, and Nervios in Urban Guatemala. In Gender, Health, and Illnesses: The case of Nerves. D.L. Davis, and S.M. Low, eds., pp. 115-140. New York: Hemisphere Publishing Co.
Mattingly, C. and L. C. Garro (2000). Narrative and the Cultural Construction of Illness and Healing. Berkeley, University of California Press.
Mendenhall, E., and E.A. Jacobs. (2012) Interpersonal Abuse and Depression among Mexican Immigrant Women with Type 2 Diabetes. Culture, Medicine and Psychiatry 36(1): 136-153.
Mendenhall, E., R. Seligman, et al. (2010) Speaking through Diabetes: Rethinking the Significance of Lay Discourses on Diabetes. Medical Anthropology Quarterly 24(2): 220–239.
Mercado-Martinez, F. J. and I. M. Ramos-Herrera (2002). “Diabetes: The Layperson’s Theories of Causality.” Qualitative Health Research 12(6): 792-806.
Mezuk, B., W. Eaton, et al. (2008). “Depression and type 2 diabetes over the lifespan: a meta-analysis.” Diabetes Care 31(12): 2383–2390.
Musselman, D., E. Betan, et al. (2003). “Relationship of Depression to Diabetes Types 1 and 2: Epidemiology, Biology, and Treatment.” Biological Psychiatry 54: 317-329.
Nichter, M. (1981). “Idioms of Distress: Alternatives in the expression of psychosocial distress: A case study from South India.” Culture, Medicine and Psychiatry 5: 379-408.
Poss, J. and M. A. Jezewski (2002). “The role and meaning of susto in Mexican Americans’ explanatory model of type 2 diabetes.” Medical Anthropology Quarterly 16(3): 360-377.
Rubel, A. J., C. W. O’Nell, et al. (1984). Susto, A Folk Illness. Berkeley, University of California Press.
Schoenberg, N., E. Drew, et al. (2005). “Situating Stress: Lessons from Lay Discourses on Diabetes.” Medical Anthropology Quarterly 19(2): 171-193.
Seligman, H., E. A. Jacobs, et al. (2011) Food Insecurity and Hypoglycemia among Safety Net Patients with Diabetes. Archives of Internal Medicine 17(13): 1204–1206.
Seligman, H., E. A. Jacobs, et al. (2012) Food Insecurity and Glycemic Control among Low-Income Patients with Type 2 Diabetes. Diabetes Care 35(2): 233-238.
Talbot, F. and A. Nouwen (2000). “A Review of the Relationship between Depression and Diabetes in Adults: Is There a Link?” Diabetes Care 23(10): 1556-1562.
Vijayaraghavan, M., E. Jacobs, et al. (2011). “The Association Between Housing Instability, Food Insecurity and Diabetes Self-Efficacy in Low-Income Adults.” Journal of Health Care for the Poor and Underserved 22(4): 1279-1291.
Weller, S., R. Baer, et al. (1999). “Latino Beliefs about Diabetes.” Diabetes Care 22(5): 722-728.
Weller, S., R. Baer, et al. (2002). “Regional variation in Latino descriptions of Susto.” Culture, Medicine and Psychiatry 26: 449-472.
Weller, S., R. Baer, et al. (2008). “Susto and Nervios: Expressions for Stress and Depression.” Culture, Medicine and Psychiatry 32: 406-420.
Wittkampf, K. A., L. Naeije, et al. (2007). “Diagnostic accuracy of the mood module of teh Patient Health Questionnaire: A systematic review.” General Hospital Psychiatry 29(5): 388-395.
Acknowledgments
We wish to thank the Russell Sage Foundation and the Commonwealth Fund for funding this article. In addition, Dr. Fernandez was partly supported by an award from the Arnold P. Gold Foundation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mendenhall, E., Fernandez, A., Adler, N. et al. Susto, Coraje, and Abuse: Depression and Beliefs About Diabetes. Cult Med Psychiatry 36, 480–492 (2012). https://doi.org/10.1007/s11013-012-9267-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11013-012-9267-x