American Journal of Epidemiology Copyright 13 Annual household income (dollars) 0-4,999 5,000-9,999 10,000-14.999 15,000-19,999 220,000 Unemployed Spanish language of interview
95% Logistic !Standard Odds confidence coefficient error ratio interval ••I Iwl V Ul -2.60 0.40 n m U.U 1
0.36* 0.20 n OA u.uo
1.49 1.01-2.17 1 nn n AH 1 1 A U.OO~ 1. 1 O
0.36 0.32
0.21 0.24
1.43 0.94-2.15 1.38 0.87-2.18
0.56 0.64 0.52
0.36 0.31 0.31
1.75 0.86-3.53 1.90 1.03-3.45 1.67 0.91-3.06
0.95 0.60 0.70 -0.09
0.32 0.29 0.29 0.33
2.60 1.82 2.02 0.92
0.48
0.21
1.62 1.07-2.42
0.03
0.20
0.97 0.66-1.43
* Dpcion pffert not i f * I/4AH t Age divided by 10
Downloaded from https://academic.oup.com/aje/article-abstract/134/5/502/131126 by Frankfurt Univesity Library user on 21 February 2018
1.38-4.87 1.03-3.19 1.14-3.59 0.48-1.73
Depressive Symptoms among Puerto Ricans
women, were in a disrupted marriage, were less educated, were living in lower-income households, and were unemployed had higher levels of depressive symptoms than did their counterparts. There are marked similarities between these results and those of various investigations of other ethnic and racial groups in which the same measure of depressive symptoms was used. For samples of Mexicans and Mexican Americans from California (2, 6, 8), rates of high depressive symptoms varied between 25 and 30 percent, although other studies report lower rates (9, 11). The risk of high depressive symptomatology for Puerto Ricans was appreciably higher than that for non-Hispanic whites and blacks, which has been reported to be 15-21 percent (2, 6, 29). The specific factors identified as contributing to high risk of depressive symptomatology among Puerto Ricans are consistent with those identified for other ethnic and racial groups. Both groups of Puerto Rican women have a higher risk of depressive symptoms than do men, similar to results in other studies (8, 29). Associations between marriage and depression scores replicate the findings of other studies (7-9, 14, 30). Specifically, disrupted marriages are associated with elevated depressive symptomatology among Puerto Ricans, particularly those on the Island. The association found here of education, income, and employment status with high levels of depressive symptoms confirms the findings of other researchers (1,7, 8, 12,29,31,32). High prevalence rates of depressive symptoms have been related with ethnicity, suggesting that factors associated with cultural orientation contribute to high symptoms of depression (33-35). In univariate analysis, a strong association between interviewing in Spanish and high risk of depressive symptoms was identified for Puerto Ricans living in the New York City area. However, when the data were controlled for sex and social and economic factors, language of interview was not a significant predictor of risk for high depressive symptomatology. Various researchers (3, 7, 10) argue that
509
socioeconomic factors instead of ethnicity play a major role in the high rate of depressive symptomatology observed for Hispanics. The economic situation of Puerto Ricans on the Island has been identified as the principal factor in the high migration to the United States. A higher migration has been observed among Puerto Ricans from the lower socioeconomic positions (36). Since Puerto Ricans live in a commonwealth and have American citizenship, their travel to the United States is unrestricted. The mobility between the Island and the mainland has been characterized by a circular migration contingent on economic changes taking place. Thus, the similarity in socioeconomic position between migrants and the Island poor could be a possible explanation for the similarity in prevalence rates and sociodemographic patterns of depressive symptoms observed in these two groups of Puerto Ricans. This paper is one of the first efforts to examine the patterns of depressive symptoms among community samples of Puerto Ricans residing on the Island and in the United States. Both samples are comprised mainly of respondents from the lower socioeconomic levels with income and education levels below what is considered normal for the United States and Puerto Rico. These respondents seem to be at a greater risk for depressive symptoms than do their counterparts. However, more meaningful statements about the relation between high levels of depressive symptoms and the influence of socioeconomic and culture-specific factors will require studies that include Puerto Ricans with more varied socioeconomic characteristics. This will allow for a better understanding of the factors associated with high levels of depressive symptoms.
REFERENCES 1. Mirowsky J, Ross CR. Minority status, ethnic culture and distress: a comparison of blacks, whites and Mexican Americans. Am J Sociol 1980; 86:474-95. 2. Vernon SW, Roberts RE. Prevalence of treated and untreated psychiatric disorders in three ethnic groups. Soc Sci Med 1982; 16:1575-82.
Downloaded from https://academic.oup.com/aje/article-abstract/134/5/502/131126 by Frankfurt Univesity Library user on 21 February 2018
510
Veraetal.
3. Vega W, Warheit G, Buhl-Auth J, et al. The prevalence of depressive symptoms among Mexican Americans and Anglos. Am J Epidemiol 1984; 120:592-607. 4. US Bureau of the Census. Statistical abstracts of the United States: 1985. 105th ed. Washington, DC: US GPO, 1984:34. 5. Quesada GM, Spears W, Ramos P. Inter-racial depressive epidemiology in the Southwest. J Health SocBehav 1978;19:77-85. 6. Frerichs RR, Aneshensel CS, Clark VA. Prevalence of depression in Los Angeles County. Am J Epidemiol 1981;113:691-9. 7. Vega WA, Kolody B, Valle R, et al. Depressive symptoms and their correlates among immigrant Mexican women in the United States. Soc Sci Med 1986;22:645-52. 8. Vega WA, Kolody B, Hough R, et al. Depressive symptomatology in Northern Mexican adults. Am J Public Health I987;77:1215-18. 9. Mendes de Leon CF, Markides KS. Depressive symptoms among Mexican Americans: a threegeneration study. Am J Epidemiol 1988; 127:15060. 10. Moscicki EK, Rae DS, Regier DA, et al. The Hispanic Health and Nutrition Examination Survey: depression among Mexican Americans, Cuban Americans, and Puerto Ricans. In: Gaviria M, Arana JD, eds. Health and behavior: research agenda for Hispanics. The Simon Bolivar Research Monograph Series no. 1. Chicago, IL: The University of Illinois, 1987:145-59. 11. Moscicki EK, Locke BZ, Rae DS, et al. Depressive symptoms among Mexican Americans: the Hispanic Health and Nutrition Examination Survey. Am J Epidemiol 1989;I30:348-60. 12. Golding JM, Burnam MA. Immigration, stress, and depressive symptoms in a Mexican-American community. J Nerv Ment Dis 1990; 178:161 -71. 13. Abbey A, Abramis DJ, Caplan RD. Effects of different sources of social support and social conflict on emotional well-being. Basic Appl Sci Psychol 1985;6:111-29. 14. Aneshensel C, Frerichs R, Clark V. Family roles and sex differences in depression. J Health Soc Behav 1981;22:379-93. 15. Vega WA, Warheit G, Palacio R. Psychiatric symptomatology among Mexican-American farmworkers. Soc Sci Med 1985;20:39-45. 16. National Center for Health Statistics. Plan and operation of the Hispanic Health and Nutrition Survey, 1982-84. Washington, DC: US GPO, 1985. (Vital and health statistics. Series 1. Programs and collection procedures no. 19) (DHHS publication no. (PHS)85-1321). 17. Alegria M, Robles R, Freeman D, et al. Patterns of mental health utilization among island Puerto Rican poor. Am J Public Health 1991;81:875-79. 18. Kish L. Survey sampling. New York: John Wiley & Sons, 1965.
19. Aneshensel CS, Clark VA, Frerichs RR. Race, ethnicity, and depression: a confirmatory analysis. J Pers Soc Psychol 1983,44:385-98. 20. Roberts RE. Reliability of the CES-D Scale in different ethnic contexts. Psychiatry Res 1980; 2:125-34. 21. Vernon SW. An investigation of the reliability and validity of the Center for Epidemiologic Studies Depression Scale in three ethnic groups. PhD dissertation. University of Texas School of Public Health, Houston, TX, 1980. 22. Mahard RE. The CES-D as a measure of depressive mood in the elderly Puerto Rican population. J Gerontol 1988;43:24-5. 23. Myers TK, Weissman MM. Use of a self-report symptom scale to detect depression in a community sample. Am J Psychiatry 1980;137:1081-4. 24. Roberts RE, Vernon SW. The Center for Epidemiologic Studies Depression Scale: its use in a community sample. Am J Psychiatry 1983; 140:416. 25. Breslau N. Depressive symptoms, major depression, and generalized anxiety: a comparison of selfreports on CES-D and results from diagnostic interviews. Psychiatry Res 1985; 15:219-29. 26. Fuller WA, Kennedy W, Schell D, et al. PC Carp version 1.0. Ames, IA: Iowa State University, Statistical Laboratory, 1989. 27. National Center for Health Statistics. Measures of depression, ages 20-74 years. Version 2. Hispanic Health and Nutrition Examination Survey, 198284. Hyattsville, MD: US Department of Health and Human Services, 1988. 28. Joyner SP. ed. SUGI: Supplemental Library User's Guide. Cary, NC: SAS Institute 1983:181-202. 29. Eaton WW, Kessler LG. Rates of symptoms of depression in a national sample. Am J Epidemiol 1981;114:528-38. 30. Iwata N, Okuyama Y, Kawakami Y, et al. Prevalence of depressive symptoms in a Japanese occupational setting: a preliminary study. Am J Public Health 1989;79:1486-9. 31. Warren LW, McEachren L. Psychosocial correlates of depressive symptomatology in adult women. J Abnormal Psychol 1983;92:151-60. 32. Comstock GW, Helsing KJ. Symptoms of depression in two communities. Psychol Med 1976; 6:551-63. 33. Angel R, Guarnaccia PJ. Mind, body, and culture: somatization among Hispanics. Soc Sci Med 1989;28:1229-38. 34. Escobar JI, Gomez J, Tuason VB. Depressive phenomenology in North and South American patients. Am J Psychiatry 1983; 140:47-51. 35. Kleinman A. Depression, somatization and the "new cross-cultural psychiatry." Soc Sci Med 1977;11:3-10. 36. Vazquez JL. La Poblacion de Puerto Rico y su Trayectoria Historica (in Spanish). Universidad de Puerto Rico, Recinto de Ciencias Medicas, 1988.
Downloaded from https://academic.oup.com/aje/article-abstract/134/5/502/131126 by Frankfurt Univesity Library user on 21 February 2018
95% Logistic !Standard Odds confidence coefficient error ratio interval ••I Iwl V Ul -2.60 0.40 n m U.U 1
0.36* 0.20 n OA u.uo
1.49 1.01-2.17 1 nn n AH 1 1 A U.OO~ 1. 1 O
0.36 0.32
0.21 0.24
1.43 0.94-2.15 1.38 0.87-2.18
0.56 0.64 0.52
0.36 0.31 0.31
1.75 0.86-3.53 1.90 1.03-3.45 1.67 0.91-3.06
0.95 0.60 0.70 -0.09
0.32 0.29 0.29 0.33
2.60 1.82 2.02 0.92
0.48
0.21
1.62 1.07-2.42
0.03
0.20
0.97 0.66-1.43
* Dpcion pffert not i f * I/4AH t Age divided by 10
Downloaded from https://academic.oup.com/aje/article-abstract/134/5/502/131126 by Frankfurt Univesity Library user on 21 February 2018
1.38-4.87 1.03-3.19 1.14-3.59 0.48-1.73
Depressive Symptoms among Puerto Ricans
women, were in a disrupted marriage, were less educated, were living in lower-income households, and were unemployed had higher levels of depressive symptoms than did their counterparts. There are marked similarities between these results and those of various investigations of other ethnic and racial groups in which the same measure of depressive symptoms was used. For samples of Mexicans and Mexican Americans from California (2, 6, 8), rates of high depressive symptoms varied between 25 and 30 percent, although other studies report lower rates (9, 11). The risk of high depressive symptomatology for Puerto Ricans was appreciably higher than that for non-Hispanic whites and blacks, which has been reported to be 15-21 percent (2, 6, 29). The specific factors identified as contributing to high risk of depressive symptomatology among Puerto Ricans are consistent with those identified for other ethnic and racial groups. Both groups of Puerto Rican women have a higher risk of depressive symptoms than do men, similar to results in other studies (8, 29). Associations between marriage and depression scores replicate the findings of other studies (7-9, 14, 30). Specifically, disrupted marriages are associated with elevated depressive symptomatology among Puerto Ricans, particularly those on the Island. The association found here of education, income, and employment status with high levels of depressive symptoms confirms the findings of other researchers (1,7, 8, 12,29,31,32). High prevalence rates of depressive symptoms have been related with ethnicity, suggesting that factors associated with cultural orientation contribute to high symptoms of depression (33-35). In univariate analysis, a strong association between interviewing in Spanish and high risk of depressive symptoms was identified for Puerto Ricans living in the New York City area. However, when the data were controlled for sex and social and economic factors, language of interview was not a significant predictor of risk for high depressive symptomatology. Various researchers (3, 7, 10) argue that
509
socioeconomic factors instead of ethnicity play a major role in the high rate of depressive symptomatology observed for Hispanics. The economic situation of Puerto Ricans on the Island has been identified as the principal factor in the high migration to the United States. A higher migration has been observed among Puerto Ricans from the lower socioeconomic positions (36). Since Puerto Ricans live in a commonwealth and have American citizenship, their travel to the United States is unrestricted. The mobility between the Island and the mainland has been characterized by a circular migration contingent on economic changes taking place. Thus, the similarity in socioeconomic position between migrants and the Island poor could be a possible explanation for the similarity in prevalence rates and sociodemographic patterns of depressive symptoms observed in these two groups of Puerto Ricans. This paper is one of the first efforts to examine the patterns of depressive symptoms among community samples of Puerto Ricans residing on the Island and in the United States. Both samples are comprised mainly of respondents from the lower socioeconomic levels with income and education levels below what is considered normal for the United States and Puerto Rico. These respondents seem to be at a greater risk for depressive symptoms than do their counterparts. However, more meaningful statements about the relation between high levels of depressive symptoms and the influence of socioeconomic and culture-specific factors will require studies that include Puerto Ricans with more varied socioeconomic characteristics. This will allow for a better understanding of the factors associated with high levels of depressive symptoms.
REFERENCES 1. Mirowsky J, Ross CR. Minority status, ethnic culture and distress: a comparison of blacks, whites and Mexican Americans. Am J Sociol 1980; 86:474-95. 2. Vernon SW, Roberts RE. Prevalence of treated and untreated psychiatric disorders in three ethnic groups. Soc Sci Med 1982; 16:1575-82.
Downloaded from https://academic.oup.com/aje/article-abstract/134/5/502/131126 by Frankfurt Univesity Library user on 21 February 2018
510
Veraetal.
3. Vega W, Warheit G, Buhl-Auth J, et al. The prevalence of depressive symptoms among Mexican Americans and Anglos. Am J Epidemiol 1984; 120:592-607. 4. US Bureau of the Census. Statistical abstracts of the United States: 1985. 105th ed. Washington, DC: US GPO, 1984:34. 5. Quesada GM, Spears W, Ramos P. Inter-racial depressive epidemiology in the Southwest. J Health SocBehav 1978;19:77-85. 6. Frerichs RR, Aneshensel CS, Clark VA. Prevalence of depression in Los Angeles County. Am J Epidemiol 1981;113:691-9. 7. Vega WA, Kolody B, Valle R, et al. Depressive symptoms and their correlates among immigrant Mexican women in the United States. Soc Sci Med 1986;22:645-52. 8. Vega WA, Kolody B, Hough R, et al. Depressive symptomatology in Northern Mexican adults. Am J Public Health I987;77:1215-18. 9. Mendes de Leon CF, Markides KS. Depressive symptoms among Mexican Americans: a threegeneration study. Am J Epidemiol 1988; 127:15060. 10. Moscicki EK, Rae DS, Regier DA, et al. The Hispanic Health and Nutrition Examination Survey: depression among Mexican Americans, Cuban Americans, and Puerto Ricans. In: Gaviria M, Arana JD, eds. Health and behavior: research agenda for Hispanics. The Simon Bolivar Research Monograph Series no. 1. Chicago, IL: The University of Illinois, 1987:145-59. 11. Moscicki EK, Locke BZ, Rae DS, et al. Depressive symptoms among Mexican Americans: the Hispanic Health and Nutrition Examination Survey. Am J Epidemiol 1989;I30:348-60. 12. Golding JM, Burnam MA. Immigration, stress, and depressive symptoms in a Mexican-American community. J Nerv Ment Dis 1990; 178:161 -71. 13. Abbey A, Abramis DJ, Caplan RD. Effects of different sources of social support and social conflict on emotional well-being. Basic Appl Sci Psychol 1985;6:111-29. 14. Aneshensel C, Frerichs R, Clark V. Family roles and sex differences in depression. J Health Soc Behav 1981;22:379-93. 15. Vega WA, Warheit G, Palacio R. Psychiatric symptomatology among Mexican-American farmworkers. Soc Sci Med 1985;20:39-45. 16. National Center for Health Statistics. Plan and operation of the Hispanic Health and Nutrition Survey, 1982-84. Washington, DC: US GPO, 1985. (Vital and health statistics. Series 1. Programs and collection procedures no. 19) (DHHS publication no. (PHS)85-1321). 17. Alegria M, Robles R, Freeman D, et al. Patterns of mental health utilization among island Puerto Rican poor. Am J Public Health 1991;81:875-79. 18. Kish L. Survey sampling. New York: John Wiley & Sons, 1965.
19. Aneshensel CS, Clark VA, Frerichs RR. Race, ethnicity, and depression: a confirmatory analysis. J Pers Soc Psychol 1983,44:385-98. 20. Roberts RE. Reliability of the CES-D Scale in different ethnic contexts. Psychiatry Res 1980; 2:125-34. 21. Vernon SW. An investigation of the reliability and validity of the Center for Epidemiologic Studies Depression Scale in three ethnic groups. PhD dissertation. University of Texas School of Public Health, Houston, TX, 1980. 22. Mahard RE. The CES-D as a measure of depressive mood in the elderly Puerto Rican population. J Gerontol 1988;43:24-5. 23. Myers TK, Weissman MM. Use of a self-report symptom scale to detect depression in a community sample. Am J Psychiatry 1980;137:1081-4. 24. Roberts RE, Vernon SW. The Center for Epidemiologic Studies Depression Scale: its use in a community sample. Am J Psychiatry 1983; 140:416. 25. Breslau N. Depressive symptoms, major depression, and generalized anxiety: a comparison of selfreports on CES-D and results from diagnostic interviews. Psychiatry Res 1985; 15:219-29. 26. Fuller WA, Kennedy W, Schell D, et al. PC Carp version 1.0. Ames, IA: Iowa State University, Statistical Laboratory, 1989. 27. National Center for Health Statistics. Measures of depression, ages 20-74 years. Version 2. Hispanic Health and Nutrition Examination Survey, 198284. Hyattsville, MD: US Department of Health and Human Services, 1988. 28. Joyner SP. ed. SUGI: Supplemental Library User's Guide. Cary, NC: SAS Institute 1983:181-202. 29. Eaton WW, Kessler LG. Rates of symptoms of depression in a national sample. Am J Epidemiol 1981;114:528-38. 30. Iwata N, Okuyama Y, Kawakami Y, et al. Prevalence of depressive symptoms in a Japanese occupational setting: a preliminary study. Am J Public Health 1989;79:1486-9. 31. Warren LW, McEachren L. Psychosocial correlates of depressive symptomatology in adult women. J Abnormal Psychol 1983;92:151-60. 32. Comstock GW, Helsing KJ. Symptoms of depression in two communities. Psychol Med 1976; 6:551-63. 33. Angel R, Guarnaccia PJ. Mind, body, and culture: somatization among Hispanics. Soc Sci Med 1989;28:1229-38. 34. Escobar JI, Gomez J, Tuason VB. Depressive phenomenology in North and South American patients. Am J Psychiatry 1983; 140:47-51. 35. Kleinman A. Depression, somatization and the "new cross-cultural psychiatry." Soc Sci Med 1977;11:3-10. 36. Vazquez JL. La Poblacion de Puerto Rico y su Trayectoria Historica (in Spanish). Universidad de Puerto Rico, Recinto de Ciencias Medicas, 1988.
Downloaded from https://academic.oup.com/aje/article-abstract/134/5/502/131126 by Frankfurt Univesity Library user on 21 February 2018
