Acculturation, Ethnicity and Symptoms of Schizophrenia

1
Acculturation, Ethnicity and Symptoms of
Schizophrenia

• Vamsi K. Koneru and Amy G. Weisman
• University of Miami

Discussion
Hypotheses
Results
Objective

• Due to the rapid rise in international migration,
  understanding how cultural factors influence
  mental illness is paramount for clinical practice
  and intervention development.
• The purpose of this study is to better understand
  the relationship between acculturation and
  severity of schizophrenia symptoms. This study
  also examines whether ethnicity moderates the
  relationship between acculturation and symptoms
  of schizophrenia.

• A hierarchical regression analysis indicated that
  acculturation was a significant predictor of more
  severe symptoms of schizophrenia (R2 .084, B
  0.29, plt.05) when examining the group
  collectively. This would appear to support
  hypothesis 1.
• Acculturation did not significantly interact with
  ethnicity (pgt.05).
• Despite analyses indicating no significant
  interaction between acculturation and ethnicity,
  a series of Pearson correlations revealed that
  the findings are complex and vary by ethnicity
  (see Figure 1).
• For Whites, there was a positive trend between
  acculturation and symptom severity (r .24).
• For Latinos, there was a negative trend between
  acculturation and symptom severity (r -.13).
• For Blacks, there was essentially no relationship
  between acculturation and symptom severity (r
  .07).

• Based on the mixed findings of the existing
  literature, in this study we tested the following
  two competing hypotheses
• - Hypothesis 1 Following results of Karno, et
  al., (1989) and Shen and Takeuchi (2001) it is
  hypothesized that greater acculturation will be
  associated with more severe symptoms of
  schizophrenia.
• - Hypothesis 2 Following results of
  Escobar, et al.,
• (1983) and Lam, et al., (1997) it is
  hypothesized that
• greater acculturation will be
  associated with less severe symptoms
  of schizophrenia.
• - On an exploratory basis we also examine whether
  the relationship between acculturation and
  symptom severity is moderated by ethnicity.

• Study results are consistent with some previous
  work on depression, anxiety, and eating disorders
  and indicate a detrimental relationship between
  greater acculturation and more severe symptoms of
  schizophrenia when examining the sample
  collectively.
• However, study results also indicate that the
  relationship between acculturation and severity
  of schizophrenia symptoms is complex and varies
  by ethnic group.
• For Whites, increasing acculturation was
  predictive of more severe symptoms of
  schizophrenia.
• For Latinos, there was a trend towards an inverse
  relationship between acculturation and overall
  severity of schizophrenia symptoms. This may be
  due to the Latino subgroups integrative tendency
  as reflected by the negative correlation between
  the ethnic interaction subscale and symptoms.
• - Integration tends to be the most adaptive
  acculturation strategy because it allows for the
  maintenance of cultural identity while also
  allowing for participation in the larger society
  (Berry, 2001).
• For Blacks, acculturation showed no relationship
  with severity of symptoms. However, there was a
  strong negative correlation between increasing
  cultural behavior and less severe schizophrenia
  symptoms. This may be indicative of an
  integrative acculturation strategy and/or an
  ability to reduce barriers which can prevent
  access to healthcare.

What is Acculturation?

• Acculturation has been defined as the social and
  psychological exchanges that take place when
  there is continuous contact and interaction
  between individuals from different cultures
  (Berry, 1997 Ryder, Alden, Paulhus, 2000).

Methods
Background

• Previous research on acculturation and health has
  demonstrated mixed findings. For example some
  studies demonstrate that greater acculturation is
  associated with a poorer course in depression,
  anxiety, and eating disorders when evaluating
  ethnic groups including Hispanics,
  African-Americans, and Asians.
• Gil, Wagner and Vega (2000) suggest that as
  individuals and families acculturate there may be
  a disintegration of supportive, familial
  structures common in traditional societies. The
  expressed emotion (EE) literature may support
  this view. This literature consistently
  demonstrates that patients living in unsupportive
  and critical home environments (high EE) tend to
  have a poorer course of illness (Butzlaff
  Hooley, 1998). And, high EE is much less
  commonly observed in more traditional cultures
  (e.g., among Hispanics) than in mainstream Anglo
  culture.
• However, it is important to point out that some
  studies have found a beneficial association
  between increasing acculturation and mental and
  physical health. For example, findings have
  demonstrated that greater acculturation is
  associated with healthier symptom profiles for
  PTSD and preventative health behaviors (e.g., pap
  smears, tuberculosis screenings) among Hispanics
  and Asians.
• Rodriguez-Reimann, et al. (2004) suggest that
  this may be due to increasing acculturation being
  associated with a greater awareness of and access
  to healthcare and information.
• To date, the association between acculturation
  and severity of schizophrenia symptoms has yet to
  be examined.

• Participants, included 47 patients, who met
  DSM-IV criteria for schizophrenia or
  schizoaffective disorder, who were recruited as
  part of a larger study focusing on the
  psychosocial correlates of schizophrenia.
• 16 of the patients were White, 17 were Latino and
  14 were Black. Ethnicity was based on patient
  self-report (Weisman, Rosales, Kymalainen,
  Armesto, 2005). No significant ethnic
  differences were found on age, education, and
  occupation.
• Data was collected in interview format from
  trained bilingual interviewers.

Conclusion, Limitations, and Future Directions

• To the best of our knowledge, this is the first
  study to assess the association between
  acculturation and severity of schizophrenia
  symptoms. Collectively, findings suggest that
  greater acculturation is associated with more
  severe symptoms. However, findings are complex
  and appear to vary by ethnicity.
• This study was marked by several limitations
  including a small sample size and a heterogeneous
  Latino subgroup.
• Future research with larger samples, and ethnic
  subsamples, are needed to clarify the association
  between acculturation and symptoms of
  schizophrenia.

Measures
Results (cont.)

• The Suinn-Lew Self-Identity Scale (adapted
  version) has four subscales language, cultural
  behavior, ethnic interaction, and ethnic
  identity.
• On an exploratory basis, a series of correlations
  were conducted to determine if there were
  relationships among particular subscales of
  acculturation and severity of schizophrenia
  symptoms. Power analyses indicate several
  moderately strong correlations. However, it
  should be noted that the majority are not
  significant due to small sample size.
• For Whites, there were positive correlations
  between language and symptom severity (r .23, d
  .13) as well as cultural behavior and symptom
  severity (r .48, d .54).
• For Latinos, a higher degree of ethnic
  interaction was associated with less severe
  schizophrenia symptoms (r -.39, d .37).
• For Blacks, greater cultural behavior was
  associated with less severe schizophrenia
  symptoms (r -.32, d .19).

• Severity of Schizophrenia Symptoms were assessed
  using the sum total of items on the Brief
  Psychiatric Rating Scale (Ventura, Lukoff,
  Nuechterlein, Liberman, Green, Shaner, 1993).
• Acculturation was assessed using the sum total of
  items on the Suinn-Lew Self-Identity Scale
  (adapted version) (Suinn, Ahuna, Khoo, 1992).

This poster was constructed by the Media Division
of the Florida Diagnostic and Learning Resources
Systems Center at the University of
Miami supported in part by FDOE Grant
874-90510-2P001