Original article| Volume 24, ISSUE 3, e345-e352, May 2014

Download started.


Family Factors Contribute to General Anxiety Disorder and Suicidal Ideation Among Latina Americans

Published:March 31, 2014DOI:



      Despite a rapidly growing Latina/o American population, little is known about modifiable factors that could protect Latinas against major psychiatric disorders. The present study explored psychosocial risk (Negative Interaction) and protective factors (Family Cohesion, Social Support, Religious Involvement, Racial and Ethnic Identity) for major depressive disorder (MDD), general anxiety disorder (GAD), and suicidal ideation (SI) among Latinas participating in the first national mental health epidemiological survey of Latina Americans.


      We conducted three sets of logistic regressions, predicting outcomes for 1,427 Latinas identified in the National Latino and Asian American Study (NLAAS), the first nationally representative, epidemiological study of Latino and Asian Americans living in the United States. These analyses followed preplanned steps: Model 1 used known predictors as controls and Model 2 added psychosocial risk and predictive factors beyond the known predictors.


      For each outcome examined, psychosocial risk and protective factors produced a significantly better model fit in Model 2 than sociodemographic and acculturation variables known to predict mental health outcomes in Model 1. Negative Interactions were associated with increased likelihood of GAD and SI, whereas Family Cohesion seemed to be protective against GAD. No psychosocial factors predicted MDD.


      Differential protective and risk factors for major psychiatric disorders suggest that assessment and intervention may need certain sex-specific components in order to improve health care and prevention for Latinas.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ai L.A.
        • Aisenberg E.
        • Weiss H.
        • Salazar D.
        Racial/ethnic identity and subjective physical and mental health of Latino Americans: An asset within?.
        American Journal of Community Psychology. 2014;
        • Ai L.A.
        • Appel H.B.
        • Hung B.
        • Lee K.
        Overall health and health care utilization among Latino American women in the United States.
        Journal of Women's Health. 2012; 21: 878-885
        • Ai L.A.
        • Pappas C.
        • Simonsen E.
        Risk and protective factors for three major mental health problems among Latino-American men nationwide.
        American Journal of Men's Health. 2014;
        • Ai A.L.
        • Rollman B.L.
        • Berger C.S.
        Co-morbid mental health symptoms and heart diseases: Can health care and mental health care professionals collaboratively improve the assessment and management?.
        Health & Social Work. 2010; 35: 27-38
        • Alegría M.
        • Canino G.
        • Shrout P.
        • Woo M.
        • Duan N.
        • Vila D.
        Prevalence of mental illness in immigrant and non-immigrant U.S. groups.
        American Journal of Psychiatry. 2008; 165: 359-369
        • Alegría M.
        • Mulvaney-Day N.
        • Woo M.
        • Torres M.
        Correlates of past-year mental health service use among Latinos: Results from the national Latino and Asian American study.
        American Journal of Public Health. 2007; 97: 76-83
        • Alegría M.
        • Shrout P.E.
        • Woo M.
        • Guarnaccia P.
        • Sribney W.
        • Vila D.
        • et al.
        Understanding differences in past year psychiatric disorders for Latinos living in the US.
        Social Science & Medicine. 2007; 65: 214-230
        • Alegría M.
        • Takeuchi D.
        • Canino G.
        • Duan N.
        • Shrout P.
        • Meng X.L.
        Considering context, place and culture: the National Latino and Asian American Study.
        International Journal of Methods in Psychiatric Research. 2004; 13: 208-220
      1. American Heart Association (2013). Heart disease and stroke statistics–2013 update: A report from the AHA, 2013. Available at:

      2. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

        • Andersons R.J.
        • Freedland K.E.
        • Clouse R.E.
        • Lustman P.J.
        The prevalence of comorbid depression in adults with diabetes: A meta-analysis.
        Diabetes Care. 2001; 24: 1069-1078
        • Asnaani A.
        • Richey J.A.
        • Dimaite R.
        • Hinton D.E.
        • Hofmann S.G.
        A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders.
        Journal of Nervous and Mental Disease. 2010; 198: 551-555
        • Borges G.
        • Orozco R.
        • Rafful C.
        • Miller E.
        • Breslau J.
        Suicidality, ethnicity and immigration in the USA.
        Psychological Medicine. 2012; 42: 1175
        • Gavin A.
        • Walton E.
        • Chae D.
        • Alegría M.
        • Jackson J.
        • Takeuchi D.
        The associations between socioeconomic status and major depressive disorder among Blacks, Latinos, Asians, and Non-Hispanic Whites: Findings from the Collaborative Psychiatric Epidemiology Studies.
        Psychological Medicine. 2010; 40: 51-61
        • Fortuna L.R.
        • Perez D.J.
        • Canino G.
        • Sribney W.
        • Alegría M.
        Prevalence and correlates of lifetime suicidal ideation and suicide attempts among Latino subgroups in the United States.
        Journal of Clinical Psychiatry. 2007; 68: 572-581
        • Galanti G.
        The Hispanic family and male-female relationships: An overview.
        Journal of Transcultural Nursing. 2003; 14: 180-185
        • González H.M.
        • Tarraf W.
        • Whitfield K.E.
        • Vega W.A.
        The epidemiology of major depression and ethnicity in the United States.
        Journal of Psychiatric Research. 2010; 44: 1043-1051
        • Harnois C.E.
        • Ifatunji M.
        Gendered measures, gendered models: Toward an intersectional analysis of interpersonal racial discrimination.
        Ethnic and Racial Studies. 2011; 34: 1006-1028
        • Heeringa S.G.
        • Wagner J.
        • Torres M.
        • Duan N.
        • Adams T.
        • Berglund P.
        Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES).
        International Journal of Methods in Psychiatric Research. 2004; 13: 221-240
        • Kessler R.C.
        • Andrews G.
        • Mroczek D.
        • Ustun T.B.
        • Wittchen H.
        The World Health Organization Composite International diagnostic Interview Short Form.
        International Journal of Methods in Psychiatric Research. 1998; 7: 171-185
        • Kessler R.
        • Berglund P.
        • Chiu W.T.
        • Demler O.
        • Heeringa S.
        • Hiripi E.
        • et al.
        The U.S. National Comorbidity Survey Replication (NCS-R): An overview of designing and field procedures.
        International Journal of Methods in Psychiatric Research. 2004; 13: 69-92
        • Kessler R.C.
        • Ustun T.B.
        The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).
        International Journal of Methods in Psychiatric Research. 2004; 13: 93-121
        • Lincoln K.D.
        • Chae D.H.
        Emotional support, negative interaction and major depressive disorder among African Americans and Caribbean Blacks: Findings from the National Survey of American Life.
        Social Psychiatry and Psychiatric Epidemiology. 2012; 47: 361-372
        • Lincoln K.D.
        • Taylor R.J.
        • Chatters L.M.
        • Joe S.
        Suicide, negative interaction and emotional support among black Americans.
        Social Psychiatry and Psychiatric Epidemiology. 2012; 47: 1947-1958
        • Mulvaney-Day N.E.
        • Alegría M.
        • Sribney W.
        Social cohesion, social support, and health among Latinos in the United States.
        Social Science & Medicine. 2007; 64: 477-495
        • Ortega A.N.
        • Canino G.
        • Alegría M.
        Lifetime and 12-month intermittent explosive disorder in Latinos.
        American Journal of Orthopsychiatry. 2008; 78: 133-139
        • Pan A.
        • Sun Q.
        • Okereke O.I.
        • Rexrode K.M.
        • Hu F.B.
        Depression and risk of stroke morbidity and mortality: A meta-analysis and systematic review.
        JAMA. 2011; 306: 1241-1249
        • Pérez D.J.
        • Fortuna L.
        • Alegría M.
        Prevalence and correlates of everyday discrimination among U.S. Latinos.
        Journal of Community Psychology. 2008; 36: 421-433
        • Pilver C.E.
        • Kasl S.
        • Desai R.
        • Levy B.R.
        Exposure to American culture is associated with premenstrual dysphoric disorder among ethnic minority women.
        Journal of Affective Disorders. 2011; 130: 334-341
        • Priest J.B.
        • Denton W.
        Anxiety disorders and Latinos the role of family cohesion and family discord.
        Hispanic Journal of Behavioral Sciences. 2012; 34: 557-575
        • Rivera F.
        • Guarnaccia P.
        • Mulvaney-Day N.
        • Lin J.
        • Torres M.
        • Alegria M.
        Family cohesion and its relationship to psychological distress among Latino groups.
        Hispanic Journal of Behavioral Sciences. 2008; 30: 357-378
        • Robinson J.A.
        • Bolton J.M.
        • Rasic D.
        • Sareen J.
        Exploring the relationship between religious service attendance, mental disorders, and suicidality among different ethnic groups: Results from a nationally representative survey.
        Depression and Anxiety. 2012; 29: 983-990
        • Vivo R.P.
        • Krim S.R.
        • Cevik C.
        • Witteles R.M.
        Heart failure in Hispanics.
        Journal of the American College of Cardiology. 2009; 53: 1167-1175
        • Spiegel D.
        • Giese-Davis J.
        Depression and cancer: Mechanisms and disease progression.
        Biological Psychiatry. 2003; 54: 1 269-1 282
      3. U.S. Census Bureau. (2010). An older and more diverse nation by midcentury. Available at:

        • Vega W.A.
        • Canino G.
        • Cao Z.
        • Alegría M.
        Prevalence and correlates of dual diagnoses in U.S. Latinos.
        Drug & Alcohol Dependence. 2009; 100: 32-38
        • Vega W.A.
        • Kolody B.
        • Aguilar-Gaxiola S.
        • Alderete E.
        • Catalano R.
        • Caraveo-Anduaga J.
        Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California.
        Archives of General Psychiatry. 1998; 55: 771-778
        • Whooley M.A.
        • de Jonge P.
        • Vittinghoff E.
        • Otte C.
        • Moos R.
        • Carney R.M.
        • et al.
        Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease.
        JAMA. 2008; 300: 2379e 2388


      Amy L. Ai, PhD, is Florida State University Professor (Social Work, Psychology, Behavioral Science/Social Medicine, and Nursing). She received her PhD at the University of Michigan. She is Fellow, American Psychological Association, American Psychological Sciences, and Gerontological society of America.


      Saskia I. Weiss, PhD, is a Florida State University graduate student in the College of Social Work. She received her PhD at Ohio State University in Sociology prior to pursuing a Master of Social Work.


      Frank D. Fincham, PhD, is Florida State University Professor (Human Science) and a family scientist. He received his PhD at Oxford University. He is Fellow, American Psychological Association and American Psychological Sciences.