Elsevier

General Hospital Psychiatry

Volume 34, Issue 4, July–August 2012, Pages 323-331
General Hospital Psychiatry

Psychiatry and Primary Care1
Prevalence of physical symptoms and their association with race/ethnicity and acculturation in the United States

https://doi.org/10.1016/j.genhosppsych.2012.02.007Get rights and content

Abstract

Objective

Physical symptoms are common and a leading reason for primary care visits; however, data are lacking on their prevalence among racial/ethnic minorities in the United States. This study aimed to compare the prevalence of physical symptoms among White, Latino and Asian Americans, and examine the association of symptoms and acculturation.

Methods

We analyzed data from the National Latino and Asian American Study, a nationally representative survey of 4864 White, Latino and Asian American adults. We compared the age- and gender-adjusted prevalence of 14 physical symptoms among the racial/ethnic groups and estimated the association between indicators of acculturation (English proficiency, nativity, generational status and proportion of lifetime in the United States) and symptoms among Latino and Asian Americans.

Results

After adjusting for age and gender, the mean number of symptoms was similar for Whites (1.00) and Latinos (0.95) but significantly lower among Asian Americans (0.60, P<.01 versus Whites). Similar percentages of Whites (15.4%) and Latinos (13.0%) reported three or more symptoms, whereas significantly fewer Asian Americans (7.7%, P<.05 versus Whites) did. In models adjusted for sociodemographic variables and clinical status (psychological distress, medical conditions and disability), acculturation was significantly associated with physical symptoms among both Latino and Asian Americans, such that the most acculturated individuals had the most physical symptoms.

Conclusions

The prevalence of physical symptoms differs across racial/ethnic groups, with Asian Americans reporting fewer symptoms than Whites. Consistent with a “healthy immigrant” effect, increased acculturation was strongly associated with greater symptom burden among both Latino and Asian Americans.

Introduction

General physical symptoms are prevalent in the community and are associated with functional impairment, psychopathology and health service use [1], [2], [3], [4], [5]. Although many believe that physical symptoms vary across cultures, the data suggesting associations between race/ethnicity, acculturation and physical symptoms are inconsistent. Some have suggested that physical symptoms themselves or their presentation as an expression of distress is especially common among racial/ethnic minorities [6], [7], [8], [9], [10], [11], [12] and that the process of acculturation may shape the expression of physical symptoms among racial/ethnic minorities in the United States [13]. In contrast, there are evidence that physical symptoms are common across countries and cultures [3], [14], evidence of considerable cross-cultural overlap in idiopathic or unexplained physical symptoms [15] and studies indicating that physical symptoms are more common among non-Latino White Americans than certain racial/ethnic minorities [2], [5].

Because physical symptoms are the most common reason for primary care visits, are a common clinical presentation of mental disorders and are associated with disproportionate use of general medical rather than mental health services for mental health care [1], [2], [14], [16], it is important to understand how race/ethnicity and acculturation are associated with physical symptoms in the general population. Prior epidemiological data on lifetime physical symptoms in the community derive from the Epidemiological Catchment Area (ECA) studies of the early 1980s [17], which revealed mixed results on how lifetime physical symptoms are associated with race/ethnicity. Findings from the Los Angeles ECA study revealed a higher prevalence of physical symptoms among Latina women compared to White women, but this pattern was not evident among men [6]. Compared to Whites and Mexican Americans in the ECA sample, island Puerto Ricans in a parallel survey had higher rates of somatization disorder and abridged somatization [8]. In contrast, in Los Angeles, Latinos, African Americans and Asian Americans were significantly less likely than Whites to meet criteria for somatization disorder [18]. Across respondents from four communities in the study, there were few differences in lifetime physical symptom prevalence by race, although most symptoms were slightly more common among White compared to non-White respondents [2]. Among the full ECA sample, after adjustment for sociodemographic variables, compared to Whites, significantly more African Americans but fewer Asian Americans met the full criteria for somatization disorder, whereas rates did not differ among Latinos and Whites [18]. Although the authors of the latter report conclude that the assumption that somatization is more common among Latino and Asian Americans may be erroneous [18], nevertheless, the notion that somatization is particularly common among racial/ethnic minority groups was embedded into the highly influential Surgeon General's report and the subsequent supplement on culture, race and ethnicity [19], [20]. Physical symptoms were not included in recent epidemiological surveys such as the National Comorbidity Survey, the National Comorbidity Survey replication or the National Survey of American Life. Consequently, the National Latino and Asian American Survey (NLAAS) is the only nationally representative survey with data on the prevalence of physical symptoms in the United States.

The present study reports the prevalence of physical symptoms and their association with race/ethnicity and acculturation among the NLAAS sample, a nationally representative community-based sample of non-Latino White, Latino and Asian Americans. This research tests the following two hypotheses: (1) Latino and Asian Americans experience more physical symptoms than non-Latino White Americans, and (2) less acculturated Latino and Asian Americans experience more physical symptoms than their more acculturated counterparts.

Section snippets

Participants

This study analyzed data from the NLAAS, part of the National Institute of Mental Health Collaborative Psychiatric Epidemiology Studies [21]. Participants were a nationally representative sample of noninstitutionalized adults (age 18 years or older) living in one of the 50 states or the District of Columbia. The final NLAAS sample consisted of 2554 Latino Americans (Mexican, Puerto Rican, Cuban and “other”), 2095 Asian Americans (Chinese, Vietnamese, Filipino and “other”) and 215 non-Latino

Sociodemographic data

Table 1 reports the demographic characteristics for Latino, Asian and non-Latino White participants adjusted for age and gender. Relative to non-Latino Whites, more Latinos had low income, whereas both Latinos and Asians were more likely to be married or cohabitating, have lower education, be foreign-born, be with foreign-born parents and have lived a smaller proportion of their lives in the United States.

Clinical data

After adjustment for age and gender, psychological distress was higher among Latinos than

Discussion

The prevalence of physical symptoms in the United States is associated with race/ethnicity and acculturation. Overall, non-Latino Whites and Latinos report a similar number of physical symptoms, and the percentages experiencing any physical symptom or a high symptom burden are similar. Some prior research has found higher rates of physical symptoms among Latinos [6], [8], [18], whereas our findings indicate that rates do not differ once the influence of other individual characteristics are

Acknowledgments

The NLAAS data used in this analysis were provided by the Center for Multicultural Mental Health Research at the Cambridge Health Alliance. The authors gratefully acknowledge financial support from the Dupont–Warren and Livingston Fellowships of the Department of Psychiatry at Harvard Medical School, training grant T32 MH20021 from the National Institute of Mental Health, National Institutes of Health Research Grant U01 MH62209 funded by the National Institute of Mental Health as well as the

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