Significance of Endorsement of Psychotic Symptoms by US Latinos

Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, New York, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 06/2009; 197(5):337-47. DOI: 10.1097/NMD.0b013e3181a2087e
Source: PubMed


In US regional studies, Latinos frequently endorse psychotic symptoms associated with impairment and mental health service use, yet do not meet criteria for psychotic disorder. Using a nationally representative Latino sample (N = 2554), we examined the prevalence of psychotic symptoms, their relationship to psychotic disorder, their correlates, and their relationship to mental health outcomes. In this sample, 9.5% (SE = 0.7) endorsed 1 or more lifetime psychotic symptoms, yet 93% of endorsers did not meet Structured Clinical Interview for DSM-IV criteria for psychotic disorders. Endorsement was associated with physical and emotional distress, particularly lifetime anxiety and current substance use disorder. Acculturation to US society and reliance on spiritual/religious help were also associated with psychotic symptom endorsement. These symptoms have substantial clinical significance, being independently associated with suicidal ideation, mental health-related disability, and outpatient mental health service utilization. Endorsed psychotic symptoms in Latinos may constitute a clinically significant marker of general psychiatric vulnerability rather than a sign of psychotic disorder.

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Available from: Margarita Alegria, Oct 10, 2014
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    • "Migrants reported more psychotic symptoms, which might be related to depression per se (more severe, more frequently psychotic depression), past traumatization (PTSD has been associated with the presence of psychotic symptoms (Braakman et al., 2009); however, the psychotic symptoms elicited during the interview might be more properly considered as dissociative symptoms), or cultural factors (for instance, studies found a high prevalence of psychotic symptoms in Latino subjects, either in the absence of any psychiatric disorder or associated with anxiety disorders (Lewis-Fernandez et al., 2009; Minsky et al., 2003)). "
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    ABSTRACT: Migration is considered a depression risk factor when associated with psychosocial adversity, but its impact on depression's clinical characteristics has not been specifically studied. We compared 85 migrants to 34 controls, examining depression's severity, symptomatology, comorbidity profile and clinical course. A MINI interview modified to assess course characteristics was used to assign DSM-IV axis I diagnoses; medical files were used for Somatoform Disorders. Severity was assessed with the Montgomery-Asberg scale. Wherever possible, we adjusted comparisons for age and gender using logistic and linear regressions. Depression in migrants was characterized by higher comorbidity (mostly somatoform and anxiety disorders), higher severity, and a non-recurrent, chronic course. Our sample comes from a single center, and should be replicated in other health care facilities and other countries. Somatoform disorder diagnoses were solely based on file-content. Depression in migrants presented as a complex, chronic clinical picture. Most of our migrant patients experienced significant psychosocial adversity before and after migration: beyond cultural issues, our results suggest that psychosocial adversity impacts on the clinical expression of depression. Our study also suggests that migration associated with psychosocial adversity might play a specific etiological role, resulting in a distinct clinical picture, questioning the DSM-IV unitarian model of depression. The chronic course might indicate a resistance to standard therapeutic regimen and hints at the necessity of developing specific treatment strategies, adapted to the individual patients and their specific context.
    Full-text · Article · Aug 2013 · Journal of Affective Disorders
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    • "There is some debate about the appropriate measurement and interpretation of psychotic symptoms and their relationship to clinically relevant psychotic disorders. Misinterpretation of self-report by lay interviewers can lead to erroneous reports of psychotic symptoms, and even " true " psychotic symptoms appear reasonably common (around 4%−10%) in the general population where they rarely lead to psychotic disorder or other serious mental illness (Kendler et al., 1996;Lewis-Fernàndez et al., 2009;Van Os, Hanssen, Bijl, & Ravelli, 2000). Furthermore, some psychotic symptoms (e.g., " hearing voices " ) appear more culturally normative in some Asian and Latino cultures than in mainstream U.S. culture. "
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    ABSTRACT: Immigrants report more psychotic symptoms than native-born populations. This study used data from the U.S.-based, nationally representative and culturally validated National Latino and Asian American Study to investigate whether refugees are at higher risk of psychotic symptoms than voluntary migrants. In this study, refugee status predicted more psychotic symptoms. Effects remained significant in most models after controlling for demographic covariates and traumatic experiences, however the direction of the effect differed for pre- versus post-migration periods. The study concludes that refugees are at higher risk for developing psychotic symptoms, which arise among refugees more often in the pre-migration period and less often post-migration.
    Preview · Article · Jul 2013 · Journal of Immigrant & Refugee Studies
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    • "We hypothesized that isolated psychotic (presumably psychosis-like) symptoms would be more prevalent in Latinos (Olfson et al., 2002; Minsky et al., 2003) and that their impact on treatment outcome of depression would be less prominent in Latinos. Finally, we predicted that isolated psychotic symptoms would be associated with trauma and PTSD (Lewis-Fernandez et al., 2010), and possibly with other anxiety disorders, at higher rates in Latinos than in other ethnic–racial groups (Olfson et al., 2002; Vega et al., 2006; Lewis-Fernandez et al., 2009). "
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    ABSTRACT: OBJECTIVE: To determine whether isolated psychotic symptoms are more likely to be endorsed by depressed Latinos as opposed to other ethnic-racial groups; whether these symptoms affect Latinos similarly to other ethnic-racial groups in terms of treatment response; and whether they are more likely to be associated with anxiety disorders in depressed Latinos. METHODS: We analyzed data from STAR⁎D subjects who self identified as White, Black, or Latino. Rates of isolated psychotic symptoms were assessed by the self-rated Psychiatric Diagnostic Screening Questionnaire (PDSQ) and compared between ethnic-racial groups. Depressive remission outcomes were compared within each ethnic-racial group between subjects who endorsed psychotic symptoms versus no psychotic symptoms. Associations between isolated psychotic symptoms and anxiety disorders were also examined. RESULTS: Among 2597 eligible subjects with at least one post-baseline assessment and available PDSQ data excluding first-rank symptoms, the prevalence of auditory-visual hallucination was 2.5% in Whites (n=49/1928), 11.3% in Blacks (n=45/398) 6.3% in Latinos (n=17/270) (χ(2)=64.9; df=2; p<0.001). Prevalence of paranoid ideation was 15.5% in Whites (n=299/1927), 31.5% in Blacks (n=126/400), and 21.1% in Latinos (n=57/270) (χ(2)=57.3; df=2; p<0.001). Among Whites and Blacks but not Latinos, depressive remission rates were worse in subjects with auditory-visual hallucinations compared to those without them. Paranoid ideation had a significant negative impact on remission in Whites only. In all ethnic-racial groups, a significant association was found between auditory-visual hallucinations and PTSD and panic disorder. LIMITATIONS: The STAR*D study did not include any structured clinician-based assessment of psychotic symptoms. CONCLUSION: Latinos do not appear to have worse outcomes when treated for MDD with auditory-visual hallucinations, differently from Whites and Blacks.
    Full-text · Article · Mar 2013 · Journal of Affective Disorders
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