Culture-Specific Factors of Posttraumatic Outcomes in Latinas

Antonella Bariani

Individuals of Latino origin (Latinx), the fastest growing minority group within the United States (U.S.; Grieco et al., 2012), have been found to be at high risk for trauma exposure related to migration, low socioeconomic status, and residence in communities with high crime rates (Cleary et al., 2018; Llabre et al., 2017). Further, Latinx in the U.S. are at an increased likelihood of facing prejudice and discrimination – an experience that, when chronic in nature, may be traumatic and have effects that mirror posttraumatic outcomes (Nadal, 2018; Rivera et al., 2010). That said, research examining how Latinx women (Latinas) uniquely experience trauma sequalae has been limited despite evidence that Latinas differ in types of trauma exposure in comparison to Latinx men (Latinos; Llabre et al., 2017) and women of other ethnic groups (Andrews et al., 2015).

In Latinas, trauma exposure has been associated with depression, posttraumatic stress disorder (PTSD), anxiety, and substance use (Cuevas et al., 2012; Ulibarri et al., 2015). However, findings examining posttraumatic differences between Latinas and non-Latinas have been mixed. Some studies have found that Latinas tend to endorse more severe posttraumatic symptoms, such as intrusive thoughts, dissociation, and avoidance, in comparison to White women and Latino men (Edelson et al., 2007; Hall-Clark et al., 2016). Other researchers have reported no difference across ethnicity and gender even when controlling for trauma type (see Hinton et al., 2011; Perez et al., 2010). The aim of this article is to discuss the discrepancy in these findings through consideration of culture-specific factors, such as acculturative stress and nativity, and their relation to trauma sequalae. Particularly, this article aims to highlight the importance of within-cultural variances for Latinas, the dearth of research examining these variances, and the limitations to be addressed in future research.

Culture-Specific Factors

Latinxs are a heterogenous group comprised of individuals with diverse backgrounds, differing in country of origin, customs and cultures, and languages (Hall-Clark et. al., 2016; Nadal et al., 2014). Latinas are often treated as a homogenous group in research studies when compared to other ethnic groups, though they may differ on acculturative stress, nativity, and level of discrimination and prejudice associated with both (Sabina et al., 2012; Nadal et al., 2014). A disregard for within-group differences among Latinas, particularly in studies conducted in the U.S., may explain the discrepancy in research findings (Sabina et al., 2012; Nadal et al., 2014). Nadal and colleagues (2014) noted that within a group of Latinxs, experiences of discrimination and mental health variables may vary depending on acculturation, country of origin, skin color/physical appearance, generational status, and others – factors that are rarely accounted for in the literature. This has been further supported by studies finding that frequent experiences of identity-related discrimination, which is associated with acculturative stress, anger, anxiety, depression, and dissociation, varies depending on nativity and country of origin (Cuevas et al., 2012; Lopez, 2008),

Acculturative stress, which may vary depending on nativity status and country of origin (see Nadal et al, 2014), refers to the struggles an individual may face when adapting to a dominant culture (Berry, 2006; Schwartz et al., 2010). Indeed, acculturative stress among Latinxs is most likely the result of the intersection between identity-related discrimination and prejudice, as well as a growing sense of distance from or abandonment of one’s ethnic culture (Berry, 2006; Rodriguez et al., 2002; Schwartz et al., 2010). Amongst Latinas with a history of trauma, acculturative stress is associated with depression, anxiety, chronic stress, and somatization (Cuevas et al., 2012; Zvolensky et al., 2018). In a study conducted by Cuevas and colleagues (2012), acculturation influenced the relation between trauma exposure and psychological distress in Latinas. Specifically, among Latinas with a history of trauma, the relation between trauma exposure and posttraumatic outcomes (e.g., anger, dissociation, and anxiety) was stronger for individuals who indicated a lower level of adjustment to U.S. dominant culture. Such results are in accordance with a review on racial differences in posttraumatic symptomology by Hall-Clark and colleagues (2016), which indicated that Latinxs tend to report and express their posttraumatic symptoms as somatization, anxiety, sadness, and anger. This review also found differences based on nativity, reporting that Latinx immigrants tend to express their symptoms as stress and/or fear, and are more likely to report medical problems and somatization in response to trauma in comparison to their U.S. born counterparts. Studies such as Cuevas et al. (2012) and Hall-Clark et al. (2016) suggest that acculturative stress and nativity plays an important role in the varied expression of posttraumatic symptomology. Still, more research is needed to understand how cultural-specific factors specifically impact trauma-related symptoms in Latinas.

The current understanding of the cultural complexities of posttraumatic outcomes in Latinas is restricted by studies that look at Latinxs as a whole. Of those studies that conduct within-group analyses, findings indicate that Latinas tend to endorse more severe mental health outcomes in comparison to their male counterparts (Edelson et al., 2007; Hall-Clark et al., 2016; Zvolensky et al., 2018). Further, studies have also found that both immigrant and U.S. Latinas demonstrate varied levels of acculturative stress and posttraumatic outcomes (see Cuevas et. al., 2012) which may be partly due to differing understandings, appraisals, and descriptions of symptoms between immigrants and U.S.-born individuals (Hall-Clark et al., 2016). While findings suggest the unique experiences of posttraumatic symptomology within Latinas, studies geared towards examining the nuances of these differences is limited and lack consideration for intersectionality or layered complexity and overlap of having multiple marginalized identities (Nadal et al., 2014). Attentiveness to cultural factors (e.g., nativity, country of origin, skin color, language proficiency), gender roles and expectations, and the varying levels of discrimination and acculturative stress that are interwoven with both culture and gender identity (Cuevas et al., 2012; Nadal et al., 2014) may allow for a more holistic understanding of trauma sequalae in Latinas.

Discussion

There is growing evidence in the research which indicates that acculturative stress and nativity are vital facets of the Latina experience within the U.S. that may have unique effects on the relationship between trauma exposure and posttraumatic symptoms. That said, research examining how acculturative stress in Latinas impacts trauma-related symptoms is still lacking. Particularly, due to the high variance amongst Latinas across a number of variables, it is difficult to draw conclusions from studies that do not account for culture-specific factors. This, in part, has contributed to the mixed findings with respect to how Latinas experience trauma sequalae. More research is needed to understand how Latinas, in particular, experience trauma within the context of their intersecting cultural identities. Currently, our understanding is limited to findings from studies that focus solely on one of these culture-specific factors at a time. Future research should carefully address these issues through appropriate sampling efforts of Latinas, both immigrants and U.S.-born individuals, and with the utilization of valid measures in English and Spanish that adequately capture the myriad of experiences of Latinas. Research pertaining to culture-specific factors is needed to extend the current state of the literature examining Latina survivors of trauma and to allow for better clinical understanding and consideration of different experiences related to race and cultural identity that may further compound traumatic experiences.

References

Andrews, A. R., Jobe-Shields, L., López, C. M., Metzger, I. W., de Arellano, M. A. R., Saunders, B., & G. Kilpatrick, D. (2015). Polyvictimization, income, and ethnic differences in trauma-related mental health during adolescence. Social Psychiatry and Psychiatric Epidemiology, 50, 1223–1234. https://doi.org/10.1007/s00127-015-1077-3

Berry, J. W. (2006). Acculturation: A conceptual overview. In M. H. Bornstein & L. R Cote (Eds.), Acculturation and parent-child relationships: Measurement and development (pp. 13-30). Lawrence Erlbaum Associates Publishers.

Cervantes, R. C., Fisher, D. G., Padilla, A. M., & Napper, L. E. (2016). The Hispanic stress inventory version 2: Improving the assessment of acculturation stress. Psychological Assessment, 28, 509–522. https://doi.org/10.1037/pas0000200

Cervantes, R. C., Goldbach, J. T., Varela, A., & Santisteban, D. A. (2014). Self-harm among Hispanic adolescents: Investigating the role of culture-related stressors. Journal of Adolescent Health, 55, 633-639. https://doi.org/10.1016/j.jadohealth.2014.05.017

Cleary, S. D., Snead, R., Dietz-Chavez, D., Rivera, I., & Edberg, M. C. (2018). Immigrant trauma and mental health outcomes among Latino youth. Journal of Immigrant and Minority Health, 20, 1053–1059. https://doi-org/10.1007/s10903-017-0673-6

Cuevas, C. A., Sabina, C., & Bell, K. A. (2012). The effect of acculturation and immigration on the victimization and psychological distress link in a national sample of Latino women. Journal of Interpersonal Violence, 27, 1428–1456. https://doi.org/10.1177/0886260511425797

Edelson, M. G., Hokoda, A., & Ramos-Lira, L. (2007). Differences in effects of domestic violence between Latina and non-Latina women. Journal of Family Violence, 22, 1–10. https://doi.org/10.1007/s10896-006-9051-1

Grieco, E., Acosta, Y., de la Cruz, G., Gambino, C., Gryn, T., Larsen, L., Trevelyan, L. E., Walters, N. (2012). The foreign-born population in the United States: 2010. U.S. Census Bureau

Hall-Clark, B., Sawyer, B., Golik, A., & Asnaani, A. (2016). Racial/ethnic differences in symptoms of posttraumatic stress disorder. Current Psychiatry Review, 12, 124-138 http://dx.doi.org/10.2174/1573400512666160505150257.

Hinton, D. E. & Lewis-Fernandez, R. (2011). The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-5. Depression and Anxiety, 28, 783-801.

Llabre, M. M., Schneiderman, N., Gallo, L. C., Arguelles, W., Daviglus, M. L., Gonzalez, F., II, Isasi, C. R., Perreira, K. M., & Penedo, F. J. (2017). Childhood trauma and adult risk factors and disease in Hispanics/Latinos in the US: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. Psychosomatic Medicine, 79, 172–180.

López, I. (2008). But you don’t look Puerto Rican: The buffering effects of ethnic identity on the relation between skin color and self-esteem among Puerto Rican women. Cultural Diversity and Ethnic Minority Psychology, 14, 102–108. doi:10.1037/1099-9809.14.2.102

Meyer, I.H., Schwartz, S., & Frost, D.M. (2008). Social patterning of stress and coping: Does disadvantaged social statuses confer more stress and fewer coping resources? Social Science & Medicine, 67, 368-379.

Nadal, K. L. (2018). Concise guides on trauma care series. Microaggressions and traumatic stress: Theory, research, and clinical treatment. American Psychological Association. https://doi.org/10.1037/0000073-000.

Nadal, K. L., Mazzula, S. L., Rivera, D. P., & Fujii-Doe, W. (2014). Microaggressions and Latina/o Americans: An analysis of nativity, gender, and ethnicity. Journal of Latina/o Psychology, 2, 67–78. https://doi-org/10.1037/lat0000013

Pérez Benítez, C. I., Yen, S., Shea, M. T., Edelen, M. O., Markowitz, J. C., McGlashan, T. H., Ansell, E. B., Grilo, C. M., Skodol, A. E., Gunderson, J. G., & Morey, L. C. (2010). Ethnicity in trauma and psychiatric disorders: Findings from the collaborative longitudinal study of personality disorders. Journal of Clinical Psychology, 66, 583–598.

Rivera, D. P., Forquer, E. E., & Rangel, R. (2010). Microaggressions and the life experience of Latina/o Americans. In D. W. Sue (Ed.), Microaggressions and marginality: Manifestation, dynamics, and impact (p. 59–83). John Wiley & Sons Inc.

Rodriguez, N., Myers, H. F., Mira, C. B., Flores, T., & Garcia-Hernandez, L. (2002). Development of the Multidimensional Acculturative Stress Inventory for adults of Mexican origin. Psychological Assessment, 14, 451–461. 10.1037/1040-3590.14.4.451

Romero, A. J. & Roberts, R. E. (2003). Stress within a bicultural context for adolescents of Mexican descent. Cultural Diversity and Ethnic Minority Psychology, 9, 171-184. https://doi.org/10.1037/1099-9809.9.2.171

Sabina, C., Cuevas, C. A., & Schally, J. L. (2012). The cultural influences on help-seeking among a national sample of victimized Latino women. American Journal of Community Psychology, 49, 347–363. https://doi.org/10.1007/s10464-011-9462-x

Schwartz, S. J., Unger, J. B., Zamboanga, B. L., & Szapocznik, J. (2010). Rethinking the concept of acculturation: Implications for theory and research. American Psychologist, 65, 237-251.

Ulibarri, M. D., Ulloa, E. C., & Salazar, M. (2015). Prevention and outcomes for victims of childhood sexual abuse: Associations between mental health, substance use, and sexual abuse experiences among Latinas. Journal of Child Sexual Abuse, 24, 35–54. https://doi.org/10.1080/10538712.2015.976303

Zvolensky, M. J., Jardin, C., Rogers, A. H., Bakhshaie, J., Mayorga, N. A., Viana, A. G., Walker, R. L., Cardoso, J. B., & Garey, L. (2018). Anxiety sensitivity and acculturative stress among trauma exposed Latinx young adults. Cultural Diversity & Ethnic Minority Psychology, 4, 470-476. https://doi.org/10.1037/cdp0000208.