Anxiety Symptomatology in Mexican-American Adolescents

Journal of Child and Family Studies, Vol. 8, No. 1,1999, pp. 47-57

Anxiety Symptomatology in Mexican-AmericanAdolescents

Saundra H. Glover, Ph.D.,1 Andres J. Pumariega, M.D.,2, 6 Charles E. Holzer,III, Ph.D.,3 Brian K. Wise, B.S., B.A.,4 and Moises Rodriguez, M.D.5

Mexican-American adults and adolescents in general have been reported to havehigh levels of anxiety symptomatology. In our study of a tri-ethnic sample of 2528junior and senior high school students, the Youth Self Report (YSR) version of theChild Behavior Checklist (CBCL) and a sociodemographic questionnaire was usedto assess the anxiety symptoms of Hispanic youth. We compared the ratings on anx-iety symptoms, using Achenbach 's anxiety subscale on the YSR, between two pop-ulations. The anxiety levels of youth in coastal southeast Texas (Galveston County)were compared to the anxiety levels of youth in the lower Rio Grande Valley. Wefound that Mexican-Americans of the Lower Rio Grande Valley scored higher onanxiety symptoms than the tri-ethnic population of Galveston County. Other factorsassociated with higher anxiety scores for Mexican-American youths included beingborn outside the US, linguistic fluency, father absent from the home, mother's educ-ation, and household size. Multiple regression analyses showed that socio-econom-ic status (SES), family composition, and linguistic fluency had a greater relativeimpact on anxiety symptomatology than all other factors, both for the total sam-ple as well as for the Mexican-American sample. These results parallel previousfindings, with Mexican-American adults, which suggest either higher risk for anx-iety symptomatology or a culturally related bias in the reporting of such symptoms.

KEY WORDS: anxiety; adolescents; Mexican-American; cultural differences; family dynamics.

1Assistant Professor of Health Administration, School of Public Health, University of South Carolina,Columbia, SC.

2Professor and Chair, Department of Psychiatry and Behavioral Sciences, James H. Quillen Collegeof Medicine, East Tennessee State University, Johnson City, TN.

3 Associate Professor of Psychiatry and Behavioral Sciences and Director, Psychiatric EpidemiologyLaboratory University of Texas Medical Branch at Galveston, TX.

4Second-year Medical Student, University of South Carolina, School of Medicine, Columbia, SC.5Private Practitioner, Alamo Psychiatric Group San Antonio, TX.6Correspondence should be directed to Andres J. Pumariega, Department of Psychiatry and BehavioralSciences, James H. Quillen College of Medicine, East Tennessee State University, Box 70567, JohnsonCity, TN 37614-0567.

47

1062-1024/99/0300-0047$16.00/0 © 1999 Human Sciences Press, Inc.

Few studies have examined the mental health status of Mexican-Americanyouth in the US. This population is of interest due to their rapid growth andlack of access and low utilization of mental health services (Hough et al., 1987;Roberts, Trevino, & Holzer, 1990). Furthermore, recent reports have indicatedthat anxiety disorders appear to be more frequent in Mexican-American adults.Mexican-American women over 40 years of age were found to have the highestsix-month prevalence for phobia found in the Los Angeles sample for the Epidemi-ological Catchment Area Study (ECA; Burnham et al., 1987). In the same sample,Mexican-American males had a higher lifetime prevalence of phobia than non-Hispanic white males, while Mexican-American females over 40 years of age hadhigher lifetime prevalences for both phobia and panic disorder (Karno et al., 1987).On the other hand, a high prevalence of anxiety disorders has been found in variousstudies involving community samples of adolescents, ranging from 13.8% using aparent-rated instrument, 21% using a self-rated youth instrument, and 17.3% usinga structured diagnostic instrument (Kashani & Orvaschel, 1988, 1990; Stavrakaki& Gaudet, 1989).

Unfortunately, little is known about anxiety symptoms specifically inMexican-American youth. Studies with this population have focused on depressionand substance abuse (Pumariega, Swanson, Holzer, Linskey, & Quintero-Salinas,1992; Swanson, Linskey, Quintero-Salinas, Pumariega, & Holzer, 1992). Suchstudies, however, have pointed to some strong cultural factors associated withsymptomatic expression in this population, with lower rates of substance abuseand suicidality in both Mexicans and less acculturated Mexican-Americans in spiteof equivalent levels of depressive symptomatology.

We conducted a study of behavioral and psychiatric symptoms in adolescentsin two regions of Texas: the Galveston County area (south of metropolitan Houston)and the lower Rio Grande Valley, along the US-Mexico border. The lower RioGrande Valley had the largest concentration of Hispanics in the US, with over90% Mexican-Americans. It is an extremely impoverished area, with close to 30%of families living below the poverty line. It is also a region in desperate need ofmental health services particularly for children and adolescents. In this paper, weexamine levels of anxiety symptomatology as well as factors associated with suchsymptomatology in our study population.

METHODS

Subjects

Two samples were obtained. One sample included 838 junior and senior highschool students in grades 7 to 12 from a moderate-sized school district in an indus-trial area of southeast Texas. The sample had a tri-ethnic composition, including

48 Glover, Pumariega, Holzer, Wise, and Rodriguez

488 non-Hispanic whites, 194 Hispanics (primarily of Mexican-American origin),and 102 African-Americans. The second sample, which included 1690 junior andsenior high school students, was recruited from two predominantly rural schooldistricts in the lower Rio Grande Valley region of Texas, next to the US-Mexicoborder. Over 94% of this sample were Hispanics, primarily of Mexican origin.The samples were selected through stratified classroom sampling of the Englishclass rosters of each district, controlling for the proportion of students in specialclasses.

Instruments

The self administered instrument packet used in this study included two sec-tions: (a) The Youth Self-Report (YSR), an instrument which includes both a socialcompetence section as well as a 113-item problem behavior section (Achenbach& Edelbrock, 1987). The problem behavior section yields both a total behaviorscore as well as internalizing, externalizing, and multiple problem scales withdifferent items for males and females, (b) A Youth Questionnaire, developedby our research team, which focused on socio-demographic variables, patternedafter the Life History form of the Diagnostic Interview Schedule (Robins, Helzer,Croughan, & Ratcliff, 1981), included the following items: age, race/ethnicity(White, Hispanic, or African-American), mother's education-a proxy socioeco-nomic status variable (Holzer et al., 1986), number of household members, andthe presence of a male parenting figure in the household. Hispanic youth wereasked additional items which are associated with acculturation: their place of birth(US or outside), their rating of their spoken fluency of English, and their rating oftheir reading and writing ability in English. The instruments were phrased at the 5th

and 6th grade literacy level and the instrument package was presented in a bilingualformat to all students who were not English fluent, with the Spanish version onthe left and corresponding English section on the right of the booklet. The Spanishversion was developed out of a forward-and-back translation process with paneladjudication, oriented to produce a version in the regional Spanish dialect.

Anxiety symptomatology was measured using the anxiety subscale devel-oped by Achenbach and Edelbrock (1987). We examined the mean score on theanxiety scale in relation to a number of variables including age, gender, ethnic-ity, socioeconomic status, family size and composition, and linguistic fluency inMexican-American youth.

Procedures

After recruitment in classroom sessions, parental consent was obtainedthrough a letter sent to the home and a postcard mechanism for response. The

Anxiety Symptomatology in Mexican-American Adolescents 49

self-administered instrument packet was completed in a 45 to 50-minute class-room period during English classes. A research assistant distributed and collectedthe instrument booklets, monitored their completion, and offered assistance asneeded. Special assistance and longer testing periods were arranged for studentswith special learning problems. Instrument booklets were assigned code numbersfor identification, with names and addresses kept separately.

Analysis

The dependent variable was defined as the mean anxiety score as derived fromthe anxiety subscale of the CBCL. Mean anxiety was examined along with all ofthe independent variables examined, both for the total sample as well as for theHispanic sub-sample in both the Valley and Galveston sample. The completionrate on any of the items or instruments analyzed never fell below 96% in thetotal sample (for ethnicity and age). Exploratory dispersion analyses (t-tests) wereperformed within some categories. Multiple regression analyses for mean anxietysymptomatology were performed for both the total sample as well as the Valley andGalveston County subsamples to examine the relative effects of the independentvariables.

RESULTS

We first examined the mean score on the anxiety subscale for the total sample.This score was significantly higher for the predominantly Mexican-American stu-dents in the lower Rio Grande Valley, F (1,2521) = 8.31, p < .001, (see Table 1).There were other significant differences in mean anxiety score along the inde-pendent variables. Younger students in the Valley had significantly higher meananxiety scores than older students. This could indicate a developmental difference,but could also be related to the high school dropout rate in the Valley biasing theolder samples. Those students born outside the US had significantly higher meananxiety scores than US-born students. There was progressive anxiety symptoma-tology with level of mother's education suggesting socioeconomic influence onanxiety. Similarly, there was increased anxiety with an increase in size of house-hold. Students whose fathers were absent had significantly higher mean anxietyscore than those whose fathers were present in the household. These differencesare indicative of possible cultural effects on the experience or expression of anxietysymptoms.

Our next analysis was to compare the Valley and Galveston County groups onsome key sociodemographic variables (see Table 2). The first major point is thatfor all of the factors, the anxiety scores were greater for the Valley group than forthe Galveston County group (with one exception of African-American ethnicity;



Table 1. Mean Anxiety Scores by Sociodemographic Variable: Total

Variable

Total Sample:

Valley:Rio GrandeGalveston

Gender:MaleFemale

Age:11-1213-1415-1617-18

Ethnicity:WhiteAfri-AmericanMex-American

US Born:NoYes

Speak Fluent English:NoYes

Read/Write Fluent English:NoYes

Mother's Education:Grade SchoolSome High SchoolHigh School GraduateSome CollegeCollege Graduate

Father Absent:NoYes

Number In Household:<22-45+

N

2528

1690838

11911303

215917758498

545104

1695

3262134

1242404

5361991

418127365210824

5701957

4771790

175

X

20.03

24.83*10.34

19.4119.58

25.4125.3017.629.99

10.4914.3322.71

27.6118.38

38.8019.06

15.4021.28

16.9518.8119.3229.5621.04

11.0422.65

10.8619.8233.73

SD

33.9828.84

37.3736.9028.4617.46

18.1326.1434.43*

39.39*30.01

44.02*31.15

25.43*33.66

28.6030.6530.9540.6013.81

19.2331.22*

17.0819.82*33.73*

Sample

Sheffe's Test forIntravariable Significance

F-Statistic

8.31

33.44

24.42

45.16

14.15

58.70

38.58

p- value

.001

.000

.0000

.0000

.0002

.000

.0000

*Denoles Intra-variable Significance Levels Between Groups.*p < .05.**p< .01.***p< .001.


Table 2. Mean Anxiety Scores by Sociodemographic Variable: Valley and Galveston County

Variables

Total Sample:

Gender:MaleFemale

Age:11-1213-1415-1617-18

Ethnicity:WhiteAfrican-AmericanMex-American

US Born:NoYes




Father Absent:NoYes


Valley

N

1690

801862

142627500313

572

1520

2571379

1101580

3041386

2628764277411

741616

2211264

143

X

24.83

24.49***24.09***

34.01***31.72***21.49***11.11

24.167.00

24.34

31.36***23.27***

41.0123.70***

20.84***25.70

22.87***23.17***24.15***35.18*25.81

24.7626.42***

13.81**24.37***36.45

Galveston County

SD

38.5632.86

42.8940.7532.6719.14

35.328.48

35.79

41.4934.76

44.8935.43

31.9037.22

34.4334.6135.4245.4017.85

31.9837.49

20.0235.2848.09

N

838

390441

73290258185

488102194

69755

14824

232605

1563972253413

49696

256526

32

X

10.34

8.9810.76

8.6811.4310.118.11

8.8914.478.54

13.649.44

21.4310.15

8.2711.13

7.009.19

10.1617.3517.00

12.198.75

8.308.89

21.56

SD

17.6715.16

10.9220.8915.0914.03

14.1126.3611.31

26.1114.70

32.7017.42

8.5620.23

6.8415.4316.3823.677.84

21.5213.32

13.5812.5825.38

* Denotes Significance Levels for Difference Between Samples.*p < .05.**p< .01.***p<.001.

however, this is not significant as there were only two African-Americans sampledin the Valley population). Also, the mean anxiety scores were higher for the Valleygroup independent of gender and place of birth (variable US born). The fatherbeing absent contributed significantly more to the mean anxiety scores for theValley adolescents than for the Galveston County adolescents (26.42 versus 8.75,p < .001). There were also noticeable trends. For the Valley group, as the age ofthe adolescents increased, the mean anxiety score decreased as did the differencebetween them and the Galveston County adolescents until by the time they are17-18, there is no significant difference between the two groups (see Table 3 andTable 4).

In addition, in both groups the mean anxiety score increased as mother'seducation increased but only until the level of being a college graduate when theanxiety scores decreased. Although significant differences among the level of werenot found, the trend should still be noted. Also, as the mother's education levelincreased, the significance of the difference between the two groups decreaseduntil at some college level the p value is less than .05 and at college graduate thereis no significant difference (whereas in the lower three levels of education, thedifference was significant at p < .001). Concerning the usage of English language,it was interesting to note that a significant difference was obtained for when theycould speak fluent English as well as when they could not read or write fluentEnglish. The last factor that was considered was the number of people in thehousehold.

Multiple regression analysis was performed on the data for the total sampleand the two population groups, Valley and Galveston County, with mean anxietybeing the dependent variable. At an alpha level of .05, the model was signif-icant, F (9, 2517) = 27.54, p < .0000; however, the variables included in themodel accounted for only 9% of the variance of the mean anxiety scores. Thevariables that demonstrated significance include gender, ethnicity, speaks fluentEnglish, reads/writes fluent English, father absent, mother's education and num-ber in household. However, in comparing the regression results between the twogroups, we find that even though both groups provide us with significant F values,there seems to be a considerable difference between them. For the Valley group,F (9, 1680) = 10.62 the significant variables accounted for 5% (R2 = .05) of thevariance in mean anxiety scores. The factors which proved to be significant at p <.05 include gender, absent father, mother's education, number in the household,and speaks fluent English. In comparison, the Galveston County group had a muchlarger F (9, 827) = 27.82 and an R2 of .23. The significant predictor factors forGalveston County were identical to those for the Valley group with only one majordifference; we found that in contrast to the Valley group, being born in the USwas a significant factor in predicting mean anxiety scores for the Galveston sam-ple. Therefore, acculturation differences could be the major factor on differencesbetween the anxiety scores for the two samples. Here, as in the previous analysis,


Glover, Pumariega, Holzer, Wise, and Rodriguez

Table 3. Mean Anxiety Scores by Sociodemographic Variable: Valle;

Variable

Total Sample:

Gender:MaleFemale

Age:11-1213-1415-1617-18

US Born:NoYes




Father Absent:NoYes


N

1690

801862

142627500313

2571379

1101580

3041386

2628764277411

741616

2211264

143

X

24.83

24.4924.09

34.0131.7221.4911.11

31.3623.27

41.0023.70

20.8425.70

22.8723.1724.1535.1725.82

10.8619.82

13.8224.3636.45

SD

38.5632.86

42.8940.7532.6719.14

41.49*34.76

44.89*35.43

31.90*37.22

34.4334.6035.4245.4017.85

17.0831.22

20.0235.28*48.09

1 Sample


F-Statistic

7.06

23.61

4.46

19.87

p- value

.0009

.0000

.0348

.0000

* Denotes Intra-variable Significance Levels Within Group.*p < .05.**p<.01.***p<.001.

we found significant differences between them for there being one to four childrenin the household. However, a point of interest is that for the Valley group, themean anxiety scores increased in linear fashion with the number of adolescents,whereas in the Galveston County group, there is not a noticeable difference untilthe number equals five or more.

54


Table 4. Mean Anxiety Scores by Sociodemographic Variable: Galveston County

Variable

Total Sample:

Gender:MaleFemale

Age:11-1213-1415-1617-18

US Born:NoYes




Father Absent:NoYes


N

838

390441

73290258185

69755

14824

232605

1563972253413

49625

256526

32

X

10.34

8.9910.76

8.6811.4310.118.11

13.649.44

21.4310.15

8.2711.13

7.019.19

10.1617.3517.00

8.7513.28

8.308.89

21.56

SD

17.6815.17

10.9220.8915.0914.03

26.1114.70

32.7017.42

8.5620.23

6.8415.4216.3823.67*7.84

13.3225.42

13.5812.5825.39*


F-Statistic

4.46

13.91

p-value

.000

.0000

* Denotes Intra-variable Significance Levels Within Group.*p < .05.**p<.01.***p<.001.

DISCUSSION

Our findings suggest higher levels of anxiety symptomatology being re-ported by the predominantly Mexican-American youth of the lower Rio GrandeValley. These findings are consistent with those from previous studies of Mexican-

American adults (Burnham et al., 1987; Karno et al., 1987) and studies of adoles-cents (Kashani & Orvaschel, 1988, 1990).

While these findings may be of clinical significance, we cannot dismiss therole of cultural factors in these differences. This is further supported by the find-ings for youth not born in the US, Mexican-American youth in Galveston County,and for English fluency. A plausible hypothesis may be that Hispanics, especiallyHispanic females, undergoing the process of acculturation are more expressiveof internalized emotional distress, particularly through somatic expressions. Suchcultural factors may bias the results of anxiety ratings toward a seemingly more"pathological" direction or range. On the other hand, the ratings did have somedegree of external reliability and validation through their relationship to schoolperformance and global self-rating of mental health. The higher ratings of anxietysymptomatology may be indicative of higher levels of distress among Mexican-American youth in the lower Valley and Hispanic youth in general. This is sup-ported by previous studies of this population.which also point to higher levels ofdistress (Swanson et al., 1992). The lower Rio Grande Valley is possibly the mosteconomically disadvantaged region in the US, and Hispanic adolescents in thisregion are generally exposed to high levels of poverty.

Although there were no significant differences in mean anxiety scores alongdifferent levels of maternal education, this may have been due to the narrow rangeof this variable-approximately 57% had less than a high school education. Thepressures of dealing with conflicts in cultural values and roles across two culturesmay also account for higher levels of anxiety symptomatology, with special pres-sures on female adolescents around conflicts in gender roles as reflected by theincrease in anxiety symptoms with an increase in SES. These results suggest apossible threshold anxiety score for Mexican-Americans as to a certain degree ofacculturation before it can offset the differences in anxiety scores and differencesdue to ethnicity.

Further research is needed to examine these two distinct hypotheses aroundthe significance of these results. Such research should be comprised of other instru-ments as well as other populations of Hispanic youth. Results from such studieswould serve to improve the norms for screening and diagnostic instruments and/orsupport the rationale for improved levels of treatment services. Findings in eitherdirection would serve to improve the cultural competence of mental health ser-vices for this rapidly growing and increasingly important segment of our adolescentpopulation.

ACKNOWLEDGMENTS

This study was supported by R01-MH 44214: Center for Cross CulturalResearch and by the NASMHPD Research Institute Fellows Program, University


of South Carolina/S. C. Department of Mental Health Site, both funded by theNational Institute of Mental Health.

REFERENCES

Achenbach, T. M., and Edelbrock, C. (1987). Manual for the Youth Self Report and Profile Burlington,Vermont, University of Vermont, Department of Psychiatry.

Bumham, M. A., Hough, R. L., Escobar, J. I., Karno, M., & Timbers, D. M. (1987). Six monthprevalence of specific psychiatric disorders among Mexican-Americans and non-Hispanic whitesin Los Angeles. Archives of General Psychiatry, 44, 687-694.

Hough, R. L., Landsverk, J. A., Karno, M., Bumham, M. A., & Timbers D. M. (1987). Utilization ofhealth and mental health services by Los Angeles Mexican-Americans and non-Hispanic whites.Archives of General Psychiatry, 44, 702-709.

Kamo, M., Hough, R. L., Burnham, M. A., Escobar, J. I., & Timbers, D. M. (1987). Lifetime prevalenceof specific psychiatric disorders among Mexican-Americans and non-Hispanic whites in LosAngeles. Archives of General Psychiatry, 44, 695-701.

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Roberts, R. E., Trevino, F. M., & Holzer, C. E. (1990). Research on the mental health of minoritiesin Texas: Past, present, and future. In Bonjean, C. M., and Foss, D. J., (eds.): Mental HealthResearch in Texas: Retrospect and Prospect. Hogg Foundation for Mental Health, University ofTexas, Austin, Texas, pp. 267-285.

Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). National Institute of Mental HealthDiagnostic Interview Schedule. Archives of General Psychiatry 38:381-389.

Stavrakaki, C., & Gaudet, M. (1989). Epidemiology of affective and anxiety disorders in children andadolescents. Psychiatric Clinics of North America, 12, 791-802.

Swanson, J. E., Linskey, A. O., Quintero-Salinas, R., Pumariega, A. J., & Holzer, C. E. (1992). A bi-national survey of depressive symptoms, drug use, and suicidal ideation. Journal of the AmericanAcademy of Child and Adolescent Psychiatry, 31, 669-678.


Anxiety Symptomatology in Mexican-American Adolescents

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