Mental health articles

Anxiety disorders are generally characterized by excessive worry and apprehension about the future. Specific anxiety disorders include obsessive-compulsive disorder, panic disorder, simple phobias, and posttraumatic stress disorder. Compared to schizophrenia and depression, we know little about the way culture influences anxiety disorders. This may be due to the rare occurrence of ‘‘pure’’ anxiety disorders. Because anxiety often co-occurs with other disorders such as depression, it may be obscured by these other disorders.

In general, findings from epidemiological studies suggest that groups that are under significant stress have higher prevalence rates of anxiety disorders. The ECA study found that generalized anxiety disorder was more common among females than males, among individuals of lower income than of higher income, and among African-Americans than White Americans when panic and depression were excluded. In a separate analysis of the Los Angeles ECA data, however, Karno and colleagues  found that Mexican-Americans had lower rates of generalized anxiety disorder than White Americans. The Mexican American Prevalence and Services Survey (MAPSS) found further differences in prevalence rates for anxiety disorder among specific Mexican-American groups. The lowest rates of ‘‘any anxiety disorder’’ were found for recent Mexican immigrants (7.6%); a higher rate was found for immigrants who lived in the United States for 13 years or more (17.1%), and the highest rate was found for U.S.-born Mexicans (24.1%), which was similar to the rate for the entire NCS sample (25.0%). Vega and colleagues (1998) propose that traditional aspects of Mexican culture may protect individuals from these disorders.

Although the NCS study also found sex differences in rates of generalized anxiety disorder, none of the ethnic differences found in the ECA study emerged. Although there are many possible explanations for the discrepancy in findings between the ECA and NCS studies, it is possible that levels of stress among ethnic groups were less similar during the ECA study than during the NCS study. This possibility is consistent with findings that prevalence rates of depression and related disorders are increasing across the world. Ethnic differences were also found in prevalence rates of specific anxiety disorders. In the ECA study, African-Americans demonstrated nearly twice the rate of simple phobia and agoraphobia than White Americans. In a separate analysis of the Los Angeles ECA data, American-born Mexicans had higher rates of simple phobia and agoraphobia than White Americans or immigrant MexicanAmericans. These f indings were not replicated in the NCS study. In both the ECA and NCS studies, ethnic differences were not found for panic disorder; however, across ethnic groups, females demonstrated higher rates of panic disorder than males.

Differences in rates of obsessive-compulsive disorder were also found among ethnic American populations in the ECA study. Specifically, rates of obsessive-compulsive disorder were highest among White American females and lowest among Hispanic males. Although Asian-Americans were not included in either the ECA or NCS studies, other studies suggest that they have higher levels of anxiety symptoms than White Americans, especially those related to social concerns. Because these findings were based on levels of symptomatology, it is unclear whether White and Asian-American groups would differ in prevalence rates of diagnosable anxiety disorders. Regardless, these differences have been attributed to higher levels of acculturative stress and language difficulties among Asian-American populations, although no studies have assessed whether this is in fact the case. Very little is known across cultures about prevalence and incidence rates of most types of anxiety, except obsessive-compulsive disorder. Lifetime prevalence rates of obsessive-compulsive disorder are similar across a number of Western and nonWestern countries, including Taiwan, Uganda, Puerto Rico, Greece, Italy, New Zealand, Korea, and Hong Kong, and range from 1 to 3%.

In summary, cultural and ethnic variation have been found in prevalence rates of general anxiety disorder and specific phobias. These differences have been attributed to cultural and ethnic differences in life circumstances and stress. Prevalence rates for disorders such as panic disorder and obsessive-compulsive disorder, however, demonstrate few cultural and ethnic differences. Because relatively few studies have examined the prevalence rates of anxiety disorders across cultural and ethnic groups, more studies are needed before more definitive statements can be made.

Tags: anxiety, anxiety disorder, disorder, symptoms