Inter-ethnic and intra-cultural differences on somatic and psychological/affective expressions of emotional distress: A case study of Puerto Rican, non-Hispanic Black and non-Hispanic White women in the South Bronx

Prior research suggests that cultural differences in expressions of emotional distress complicate cross-cultural evaluation of emotional disorder. Using survey data on women in the South Bronx, this study compares inter-ethnic groups (Puerto Rican, non-Hispanic Black and non-Hispanic White) and, among Puerto Ricans, acculturation groups in somatic and psychological/affective expressions. The mental health items are from the often cited Dohrenwend Short Form Scale, widely used in community studies. Within ethnic groups, Puerto Ricans reported more severe somatic than psychological complaints, while non-Hispanic Whites reported more severe psychological than somatic complaints. Non-Hispanic Blacks reported similar levels of somatic and psychological complaints. Between groups, Puerto Ricans expressed both more severe somatic and psychological complaints than Blacks, who in turn expressed more somatic and psychological complaints than Whites. These inter-ethnic differences are related to socioeconomic and demographic differences between groups. In particular, lower education, lower household income and heading a household significantly increase both somatic and psychological complaints. Once these correlates are controlled, only the difference between Puerto Ricans and non-Hispanic Whites on reported somatic complaints persists. Within our Puerto Rican sample, acculturation decreased severity of both somatic and psychological complaints, but was only significant for somatization. Among the most culturally traditional Puerto Ricans, greater severity was reported for somatic than psychological complaints. With acculturation, reporting of somatic complaints decreases so that levels of somatic and psychological complaints are more similar. The acculturation difference associated with somatization loses significance once socioeconomic and demographic factors are controlled. Both analyses highlight the importance of controlling for socioeconomic and demographic factors in evaluating the effect of culture on mental health expressions. The finding, however, that cultural differences between Puerto Ricans and non-Hispanic Whites on somatization persist even after controlling socioeconomic/demographic factors supports earlier recommendations that a larger number of emically derived somatic items are necessary to reflect Hispanic expressions of emotional distress. Puerto Rican women, especially culturally traditional women, risk misdiagnosis and culturally incongruent treatment when evaluated by non-Hispanic White normed scales