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Health Problems in Mexican Immigrants

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Mental Health of Farmworkers: The Role of Context and Culture Maria de Jesus Diaz-Perez, PhD ( c ) Salud Family Health Centers Fort Lupton, CO * 13 * 7 * 26 * 28 ... – PowerPoint PPT presentation

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Title: Health Problems in Mexican Immigrants


1
Mental Health of Farmworkers The Role of
Context and Culture

Maria de Jesus Diaz-Perez, PhD ( c ) Salud Family
Health Centers Fort Lupton, CO
2
Outline
  • Context of Mexican immigration
  • History, changing demographics
  • Why culture?
  • How body works
  • How people get sick Culture bound syndromes
  • How they cope with illness Therapeutic networks
  • Implications for services

3
History of Mexican Immigration
  • 1942 1964
  • Bracero Program
  • 1964 1986
  • Start of undocumented immigration
  • 1986 Now
  • Era of misguided legislation

4
Bracero Program 1942 - 64
  • Federal program to subsidize growers
  • Immigrants worked in agriculture and farms
  • Great number of immigrants were documented
  • Temporary nature

5
Era of undocumented immigration 1964-86
  • Characteristics of immigration
  • Increasingly undocumented
  • Circular movement of male workers
  • Identifiable, predictable patterns

6
Era of Misguided Legislation 1986 - Present
  • 1986
  • Immigration Reform and Control Act (IRCA)
  • 1996
  • Illegal Immigration Reform and Immigrant
    Responsibility Act (IIRIRA)

7
1986 Immigration Reform and Control Act (IRCA)
  • Employer Sanctions
  • Border control enforcement
  • Amnesty Program

Goal Reduce undocumented immigration
8
1996 Illegal Immigration Reform and Immigrant
Responsibility Act (IIRIRA)
  • Welfare reform to exclude immigrants
  • Federal actions to deny means tested programs to
    immigrants
  • State actions to restrict services to immigrants

Goal Reduce undocumented immigration
9
IRCA and IIRIRA
  • Increased risks of injury and death
  • Geographic diversification
  • Shift toward permanency
  • Declining wages

Ever increasing migration, worsening
living conditions
10
How successful has this legislation been in
stemming the flow of undocumented immigrants?
11
New Arrivals From Mexico Per Year by
Documentation Status
12
New destinations
2000 2007 Main, New Hampshire, Western
Virginia had over a 100 times MX population
increases
Mexican population increased from 14 to 18 times
in the 90s Alabama, Tennessee, Kentucky, North
and South Carolina
Leite, P., Angoa, M., Rodriguez, M. (2009). La
emigración Mexicana a Estados Unidos balance de
las últimas décadas. Situación demográfica.
México CONAPO.
13
Mexican Migration Today
  • More permanent
  • Feminization and urbanization of migrant
    populations

14
Mexican Migration Today
  • Will continue growing
  • New sending communities
  • More undocumented migration from Southeast and
    Central regions
  • More migration from rural places from Southeast
    region, going to South in the US

15
New origins
16
Factors Against Immigration
  • No jobs
  • High anti-immigrant sentiment
  • Federal raids
  • State laws
  • Very dangerous to cross

17
Relative employment growth
Leite, P., Angoa, M., Rodriguez, M. (2009). La
emigración Mexicana a Estados Unidos balance de
las últimas décadas. Situación demográfica.
México CONAPO.
18
Characteristics of Rural Mexico
  • High rates of underemployment
  • Mostly Catholic
  • Traditional gender roles
  • Low levels of education
  • Limited availability of basic services
  • Social marker POVERTY

In 2008 Mexico received about 26 billion dollar
in remittances. Migrant remittances represent
the second source of revenue after oil
19
Community of origin Families and Women Left
Behind
  • Silent actors in the migratory process
  • Provide instrumental help
  • Hold favorable attitudes toward the United
    States, but value morals and traditions of
    Mexican culture
  • Migration has a similar impact on the mental
    health of those left behind and those who migrate

20
Migrants families stress inventory (INEFAM.
Inventario de estrés para familias de migrantes)
  • Cultural distance
  • Concern about the well-being of the spouse
  • Increasing of responsibilities
  • Family disintegration

Source Salgado de Snyder, V.N. (1993). Family
life across the border Mexican wives left
behind. Hispanic Journal of Behavioral Sciences,
15, 391-401.
21
Hispanic Stress Inventory
  • Financial/occupational stress
  • Parental stress
  • Marital stress
  • Migration stress
  • Cultural conflict

Source Cervantes, R., Padilla, A., Salgado de
Snyder, V.N. (1991). The Hispanic Stress
Inventory A culturally relevant approach to
psychosocial assessment. Psychological
Assessment Journal of Consulting and Clinical
Psychology, 3, 438-447.
22
Risk Factors for Health and Mental Health
Problems in Migrant Populations
Family Separation Trauma during
crossing Undocumented residency Discrimination Poo
r labor conditions Poverty Isolation Overcrowded,
inadequate housing Lack of knowledge of English
23
The double standard of Mexican migrants
  • Perceived as someone to be proud of for taking
    the risk of going north and work in a hostile
    environment.
  • In the US they are considered illegal aliens.

24
Mexican Immigrants in the U.S.
  • Come for economic reasons to work!
  • Many of them want to be in the U.S. temporarily
  • Mexico and their villages remain part of the
    psychic present, not a lost past

25
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26
Culture
  • Integrated pattern of human behavior of a racial,
    ethnic, religious or social group
  • Transmitted to succeeding generations

27
Culture
  • Culturally grounded knowledge is often
    transparent to those who use it. Once learned,
    it becomes what one sees with, but seldom what
    one sees

28
Why Does Culture Matter?
  • The functioning of the body
  • How people get sick
  • Whether people seek help and the type of help
    they seek
  • How much stigma they attach to different
    illnesses
  • Culture also influences the meanings that people
    assign to their illness

29
The Functioning of the Body
  • Balance and imbalance
  • Balance dependent on external forces

30
How people get sick Culture-Bound Syndromes
  • A symptom complex occurring in a specific
    geographic distribution, associated with certain
    unique environmental circumstances and cultural
    beliefs
  • Associated with ways in which different cultures
    express, experience, and cope with feelings of
    distress

31
Mexican Culture Bound Syndromes
  • Culturally specific
  • More common in rural Mexico
  • Contain somatic and psychological components
  • Mind-body split does not exist

32
Mexican Cultural Syndromes
  • Nervios
  • Susto
  • Mal de Ojo
  • Empacho
  • Mollera Caida
  • Aire

33
Nervios
Culturally-specific illness condition that
prevails in Latin American countries More
prevalent among women Somatic and psychological
components manifested through a variety of
symptoms The manifestation of this condition
does not differentiate the body-mind duality that
prevails in biomedicine
Salgado de Snyder, V. N., et.al. (2001). The
prevalence of nervios and associated
symptomatology among inhabitants of Mexican rural
communities. Culture, Medicine and Psychiatry.
34
Nervios
  • An attempt to re-establish balance under
    excessive demand
  • May be a coping strategy temporarily free from
    demands until balance is recovered
  • Does not always indicate presence of
    psychopathology

35
Nervios
  • Treatment
  • Many people seek medical treatment
  • Usually resolves with time
  • Patient usually doesnt expect meds
  • Note
  • Similar to anxiety or mood disorders
  • The word Nervios has two meanings

36
Comorbidity of Nervios with Mood and Anxiety
Disorders among Mexican Rural Population
Salgado de Snyder, V. N., et.al. (2000). The
prevalence of nervios and associated
symptomatology among inhabitants of Mexican rural
communities. Culture, Medicine and Psychiatry, .
37
Prevalence of Somatic Symptoms among Rural Women
who Declared Having Nervios
Vomiting throughout the entire pregnancy
14.4 Gastrointestinal problems
19.2 Headaches
11.5
Backaches
4.8 Lump in the throat
10.6
Chest pains
3.8 Difficulty
breathing
3.8 All other symptoms
29.8
This category was comprised of 30 somatic
symptoms other than those listed
Salgado de Snyder, V. N., et.al. (2000). The
prevalence of nervios and associated
symptomatology among inhabitants of Mexican rural
communities. Culture, Medicine and Psychiatry,
38
Susto
  • Sudden fright
  • Soul is dislodged from the body and can be lost
  • Crosses all age, sex, and socioeconomic groups

39
Susto
  • Symptoms
  • Multiple somatic complaints,
  • Appetite disturbances,
  • Sleep disturbances,
  • Feelings of low self worth, sadness
  • Weight loss
  • Can cause diabetes

40
Susto
  • Treatment
  • Determined by severity of illness
  • Herbal teas for mild cases
  • Ritual sweeping in more severe cases (limpia,
    barrida)
  • Best performed by a curandero but can be
    performed by family member or other traditional
    healer
  • focused on cleansing the body so the soul can
    return

41
Coping Styles
  • Culture relates to how people cope with everyday
    problems and more extreme types of adversity
  • Spirituality and Religion
  • Religiosity, positive reframing, denial

42
Influence of Culture
  • Familismo
  • Importance of family over individual
  • Respect for elders
  • Family needs to be included in treatment
    decisions
  • Fatalismo
  • Our fate is out of our control
  • Coping mechanism
  • Can lead to non-compliance if not addressed

43
Therapeutic Networks
  • Simultaneous use of multiple forms of therapy
  • Popular sector
  • Folk sector
  • Professional sector
  • Based on availability, payment, and on how the
    sick person explains the origin of ill health
  • What makes sense
  • Use different sources of care at the same time or
    in sequence

44
Pathways to Mental Health Services
1. Selfcare
2. Social Network
3. Informal Services
RESOURCES
Cognitive Evaluation of the Symptom
4. General Physician
5. Specialist
Symptom is Alleviated
Source Salgado de Snyder, V. N., y cols. (1998).
Pathways to mental health services among
inhabitants of a Mexican village with high
migratory tradition to the U.S. Health and Social
Work, 23(4), 249-261.
45
Services Utilization for Mental Health Problems
24.3
14
Physician
6.5
1.4
Homeopath
5.4
0
Any Mood disorder
10
8.6
MH specialist
Any anxiety disorder
4.8
21.4
Any substance abuse disorder
17.2
Priest
12.9
7.1
Folk healer
4.3
0
4.3
8.6
Hospitalization
6.5
24.3
34.4
Remedies, prays
8.1
0
5
10
15
20
25
30
35
40
46
Why this matters to youhere?
  • Continue to hold the same beliefs and repeat the
    same behavioral patterns learned and internalized
    while growing up in their communities of origin.
  • Beliefs and behaviors remain unchanged until the
    immigrants get familiar with the new culture and
    feel comfortable dealing with the new health
    system.
  • Not familiar with obtaining formal health
    services even as adults in their own country.

47
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48
Services Utilization for Mental Health Problems
among Mexican Origin Population
  • Seventy-three percent of the respondents who had
    one or more mental disorders didnt receive
    services for their condition
  • Only 15.4 of immigrants received care compared
    to 37.5 of US born Mexicans

Source Sergio A. Aguilar-Gaxiola. Linking
Research to Practice Implications for Cultural
Competence and Mental Health Services. Conference
presented at Beyond Sensitivity Awareness
Serving the Mental Health Needs of a Diverse
Community. Oregon Department of Human Services.
Portland, OR., October 31, 2001
49
Barriers to Health Care Utilization
  • Economic barriers
  • Poverty
  • Lack of medical insurance
  • Language
  • Low literacy
  • Cultural Background
  • Immigration Status
  • fear, lack of knowledge of programs available,
    and concern over repercussions to their
    immigration status
  • Discrimination

50
Health Care Quality Survey, Commonwealth Fund
  • Minorities more likely to report being treated
    with disrespect or being looked down upon in the
    patient-provider relationship
  • Asians 20.2
  • Latinos 19.4
  • African Americans 14.1
  • Whites 9.4
  • Blanchard Lurie (2004)

51
Survey of Latinos in Colorado
  • My doctor discriminates against me
  • My doctor doesnt always respect me
  • My doctor cant speak my language

52
Prevalence of Psychiatric Disorders among Mexican
Origin Population
  • Mexican immigrants 24.9
  • US born Mexicans 48.7
  • US general population 48.6
  • The risk of having a mental disorder increased
    significantly among MX immigrants with more than
    13 years living in the US

Source Vega, W.A., Kolody, B., Aguilar-Gaxiola,
S. et al. (1998). Lifetime prevalence of
DSM-III-R psychiatric disorders among urban and
rural Mexican Americans in California. Archives
of General Psychiatry, 55, 771-778.
53
Prevalence of Psychiatric Disorders among Mexican
Migrant Farmworkers
Source Alderete, E. et al (2000). Lifetime
prevalence and risk factors for psychiatric
disorders among Mexican migrant farmworkers in
California. American Journal of Public Health,
90(4), 610-614.
54
Integration of Mental Health Care and Primary Care
  • Minorities are more likely to seek help in
    primary care as opposed to specialty care.
  • Minority patients are among those at greatest
    risk of non detection of mental disorders in
    primary care.

55
Services Utilization for Mental Health Problems
  • The general medical sector was the preferred
    source of help among those who suffered at least
    of one mental disorder (18.4)
  • Only 8.8 received care in the mental health
    sector

Source Sergio A. Aguilar-Gaxiola. Linking
Research to Practice Implications for Cultural
Competence and Mental Health Services. Conference
presented at Beyond Sensitivity Awareness
Serving the Mental Health Needs of a Diverse
Community. Oregon Department of Human Services.
Portland, OR., October 31, 2001
56
Salud Family Health Centers
  • Migrant/community health center
  • 60 Latino
  • Fully integrated behavioral health care
  • Universal screening for behavioral/mental health
    problems

57
Screening Results
  • PTSD 13
  • Anxiety 35
  • Depression 38
  • Total positive 50

58
Culture Counts
  • Patients culture
  • Clinicians culture
  • Western medicine
  • Emphasizes body/mind separation
  • Evidence-based

59
Recommendations to Service Providers
  • Maximize already existing personal and social
    resources
  • Religion
  • Culture
  • Family
  • Social networks
  • Personal

Source Salgado de Snyder, V. N., y cols. (1998).
Pathways to mental health services among
inhabitants of a Mexican village with high
migratory tradition to the U.S. Health and Social
Work, 23(4), 249-261.
60
Final comments
  • Dont forget context
  • Come for economic reasons to work!
  • Increased violence and trauma
  • Increased anti immigrant sentiment
    discrimination
  • Dont forget culture Culture goes both ways
  • Build partnerships and bridges

61
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