Cross-cultural study of idioms of distress among Spanish nationals and Hispanic American migrants: susto, nervios and ataque de nervios
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Susto (fright), nervios (nerves) and ataque de nervios (attack of nerves) are idioms of distress widely experienced amongst Hispanic Americans, often associated with psychiatric disorders. This study explores understanding of these idioms of distress and attitudes to help seeking amongst indigenous Spanish and Hispanic American residents in Spain.
A population survey was undertaken in four adult education centres in Spain. Hypothetical case vignettes of individuals suffering from the idioms of distress were used to investigate understanding and help seeking by a Spanish sample compared with Hispanic American migrants to Spain. 350 questionnaires were obtained (94.6% response rate).
The idioms ataque de nervios and nervios were recognised by the majority of the Spanish group but by significantly more of the Hispanic American migrants. However, susto was infrequently recognised by the Spanish group but it was recognised by half of the Hispanic Americans. Hispanic Americans were also more likely to recommend consultation with a psychiatrist/psychologist than Spanish respondents for ataque de nervios and nervios. The Spanish group were more likely to recommend non-medical sources of support such as relatives and priest than Hispanic Americans. Hispanic Americans, more recently arrived, did not show greater recognition of the three idioms than those who have been in Spain longer. Regression analysis showed that being Hispanic American and having lower educational attainment was associated with greater use of susto.
The study suggests that people hold multiple models of distress and disorder. This may influence clinical presentations and help seeking behaviour in Spanish as well as Hispanic American populations.
KeywordsIdioms of distress Culture-bound syndromes Ataque de nervios Susto Nervios
We are extremely grateful to the heads of the centres and the participants who made this study possible. Thanks also to Mª Carmen Carrasco León for her support with this project, and to Dalia Levi, Huda Thakur and Yasmin Braganza for helping with data loading.
- 1.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (DSM-IV). American Psychiatric Association, Washington, D.C.Google Scholar
- 4.Berry J, Poortinga Y, Segall M, Dasen P (1992) Cross-cultural psychology. Research and applications. Cambridge University Press, New YorkGoogle Scholar
- 5.Centre for Sociological Investigations (Centro de Investigaciones Sociologicas) (2009a) Estudio CIS 2.811 (Barometro de Julio 2009). http://www.cis.es/cis/opencms/-Archivos/Marginales/2800_2819/2811/es2811.pdf. Accessed 10 September 2010
- 6.Centre for Sociological Investigations (Centro de Investigaciones Sociologicas) (2009b) Estudio CIS 2.806 (Barometro de Junio 2009). http://www.cis.es/cis/opencms/-Archivos/Marginales/2800_2819/2806/ES2806.pdf. Accessed 10 September 2010
- 8.Davis DL, Low SM (1989) Gender, health and illness: the case of nerves. Hemisphere Publishing, New YorkGoogle Scholar
- 9.De La Cancela V, Guarnaccia P, Carrillo E (1986) Psychosocial distress among Latinos: a critical analysis of ataques de nervios. Hum Soc 10:431–447Google Scholar
- 10.Demographia (2010) World Urban Areas. http://www.demographia.com/db-worldua.pdf. Accessed 10 September 2010
- 12.Field A (2009) Discovering statistics using SPSS. Sage, LondonGoogle Scholar
- 14.Guarnaccia PJ, De La Cancela V, Carrillo E (1989) The multiple meanings of ataques de nervios in the Puerto Rico Disaster Study: the role of culture in psychiatric epidemiology. J Nerv Ment Dis 181:159–167Google Scholar
- 20.Helman CG (2007) Culture, health and illness. Hodder Arnold, LondonGoogle Scholar
- 21.Jilek WG (2004) Culturally related syndromes. In: Gelder MG, Lopez-Ibor JJ, Andreasen NC (eds) New Oxford textbook of psychiatry. Oxford University Press, New York, pp 1061–1066Google Scholar
- 22.Kleinman A (1978) Problems and prospects in comparative cross-cultural medical and psychiatric studies. In: Kleinman A, Kunstadter P, Alexander E, Gate J (eds) Culture and healing in Asian societies. Anthropological, psychiatric and public health studies. Schenkman, CambridgeGoogle Scholar
- 23.Kleinman A (1980) Patients and healers in the context of culture. University of California Press, BerkleyGoogle Scholar
- 24.Kleinman A (1988) Rethinking psychiatry: from cultural category to personal experience. Free Press, New YorkGoogle Scholar
- 26.Lee R, Balick MJ (2003) Stealing the soul, soumwahu en naniak, and susto: understanding culturally-specific illnesses, their origins and treatment. Altern Ther 9:106–109Google Scholar
- 28.Lewis-Fernández R, Guarnaccia PJ, Ruiz P (2009) Culture-bound syndrome. In: Sadock BJ, Sadock VA (eds) Kaplan and Sadock’s comprehensive textbook of psychiatry. Lippincott Williams and Wilkins, Philadelphia, pp 2520–2538Google Scholar
- 33.Ministry of Work and Migration (Ministerio de Trabajo e Inmigracion (2011) Foreign people residents in Spain on the 31st March 2011 (Extranjeros residentes en España a 31 de marzo de 2011). Spanish Government (Gobierno de España), MadridGoogle Scholar
- 35.National Institute of Statistics (Instituto Nacional the Estadistica) (2011) Padron of Spanish residents in a foreign country on the 1st January 2011 (Padron de españoles residentes en el extranjero a 1 de enero de 2011). http://www.ine.es/prensa/np649.pdf. Accessed 19 July 2011
- 36.Organization for Economic Cooperation and Development (2006) Competitive cities in the global economy. OECD territorial reviews. OECD Publishing, ParisGoogle Scholar
- 39.Spitzer RL, Gibbon M, Skodol AE, Williams JBW, First MB (2003) DSM-IV-TR Libro de casos (Spanish edition): Compañero del DSM-IV-TR, Manual diagnóstico y estadístico de los trastornos mentales, texto revisado (casebook: a learning companion to the diagnostic and statistical manual of mental disorders). Masson, BarcelonaGoogle Scholar
- 40.Tseng W-S (2001) Handbook of cultural psychiatry. Academic Press, San DiegoGoogle Scholar
- 42.Weller SC, Baer RD, Garcia De Alba Garcia J, Glazer M, Trotter R, Pachter L, Klein RE (2002) Regional variation in Latino descriptions of susto. Cult Med Psychiatr 26:449–472Google Scholar
- 43.Weller SC, Baer RD, Garcia De Alba Garcia J, Rocha ALS (2008) Susto and nervios: expressions for stress and depression. Cult Med Psychiatry 32:406–420Google Scholar
- 44.World Health Organisation (WHO) (1993) International classification of diseases. Diagnostic criteria for research. WHO, GenevaGoogle Scholar