Our analyses indicate that ataques de nervios are more prominent among Puerto Ricans and that our previous emphasis on this population was important. At the same time, these analyses indicate that the experience of ataque de nervios, as assessed with the CIDI screener, is recognized and reported across Latino groups. Looking beyond results on the screener to the more detailed questions on ataque experiences (data not shown), the groups are remarkably similar. There were no significant differences in the distribution of the specific symptoms (15 were assessed) that were reported across the Latino groups, in the mean number of symptoms, in the proportion meeting syndrome criteria, nor in the mean number of ataque episodes. Thus, while Puerto Ricans are more likely to endorse the CIDI screener for ataques, once a Latino endorses the screener they appear to be reporting a very similar phenomenon in terms of symptom pattern.
Ataques de nervios
are strongly associated with a range of social and psychiatric vulnerabilities among Latinos living on the U.S mainland. As Amaro and colleagues (2005)
note, social vulnerabilities are related to gender relations as well as economic and political circumstances, such as poverty, family disruption and migration processes. Women and those whose families have been disrupted by divorce or other family stresses are more likely to report ataques de nervios
At first, we were somewhat puzzled that those who were U.S. born, were citizens, had spent most of their life in the U.S. and spoke more English were also more likely to report an ataque de nervios
. Given the strong cultural meanings attached to ataques
, our initial hypothesis was that they would be more prominent in those more closely tied to Latino cultures. However, in line with the research on the Latino paradox, the fact that those who had been in the U.S. longer experienced more distress fits with previous findings (Vega, et al., 1998
; Alegria, et al., 2007
). Ataques de nervios
endure as an important idiom of distress for Latinos in the U.S., even as they speak more English and become more acculturated to U.S. society.
The strong association with psychiatric disorder and psychiatric symptoms mirrors previous research on ataques in Puerto Rico and with clinical populations of Puerto Ricans and Dominicans in New York. The much higher rates of psychiatric disorder in those who endorsed the ataque screener and also met the additional syndrome criteria indicate that this question is taping significant mental health need among Latinos. From a public health perspective, this question is a powerful and simple-to-administer indicator for mental health need. These results highlight the strong connection between ataques de nervios and both depression and anxiety disorders.
Clinically, the higher rates of suicidal symptoms associated with ataque
suggest that clinicians should directly inquire about these symptoms when their Latino patients report an ataque de nervios
). The association with psychotic symptoms is probably more an indicator of dissociative tendencies than of a psychotic disorder, and again is a broader indicator of mental distress (Lewis-Fernandez, et al., in press
). That ataques de nervios
are an indicator of mental health need is further borne out by the higher rates of general medical services and specialty mental health services among those who reported an ataque
, as well as the much higher rates of hospitalization for a mental health problem.
While these findings are robust, there are some limitations that readers need to keep in mind. Our screener for ataque de nervios
follows from our extensive research that identified that an episode of severe loss of control was a core feature of ataques
of mental health relevance. At the same time, we do not know what respondents specific label was for this episode. We have limited data on the nature of the experience captured by this question, in large part due to the large number of issues that were investigated in the NLAAS and the limited opportunity to explore any one in depth. These results argue for more in-depth investigation of the experiences Latinos are reporting, particularly for groups other than Puerto Ricans, where there is an extensive literature (Guarnaccia & Rogler, 1999
The findings on the role of ataque de nervios as an indicator of social and psychiatric vulnerabilities among Latinos are important both for the public health and clinical fields. For public health, the ataque question is a simple, yet powerful, indicator of a range of mental health needs. For the clinician, asking about ataques de nervios provides an opening to explore a range of social and psychiatric issues with clinical significance.