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Psychosocial stress, social inequality, and mental health in Puerto Rican women in upstate New York.

ACCORDING TO THE 2010 U.S. CENSUS, PUERTO RICAN WOMEN COMPRISE ABOUT 51 PERCENT OF THE PUERTO RICAN POPULATION (4.8 MILLION) IN THE U.S. MAINLAND. These estimated 2.48 million Puerto Rican women account for about 10 percent of all Latina women (U.S. Census 2011). In the state of New York, Puerto Rican women comprise 52.3 percent of the Puerto Rican population (U.S. Census 2011). Historically, they have concentrated in New York City, but more recently they have been increasingly represented in smaller cities across New York State (Bose 2006). These include the upstate cities of Albany and Amsterdam, both located in a geographic area where the Latino population has increased 18.5 percent from 1980 to 2000 (City Data 2005). Here, Latina women comprised 52 percent of the total Latino population and 66.7 percent of these Latina women self-identified as Puerto Rican (Ramos and Jurkowski 2009; U.S. Census 2001).

Data depicting the sociodemographic characteristics of Puerto Rican women in the mainland are scarce. Bose (2006) provides some data on the socioeconomic status of Puerto Rican women in New York State, including Albany. For example, their unemployment rates are higher in Albany (19.3 percent) than at the state level (13.9 percent). A similar disparity is found between poverty rates of the two groups, with 41.8 percent for Puerto Rican women in Albany as compared with 36.1 percent for New York State overall. Interestingly, the individual median income is higher for Albany ($19,592) than for New York State ($14,464), but household income is lower for Puerto Rican women in Albany with a median of $25,400 compared to $29,300 for New York State. Finally, the percentage of Puerto Rican female-headed households is lower in Albany at 50.8 percent, as compared with 55.1 percent for Puerto Rican women in New York State as a whole (Bose 2006). In sum, the figures for Puerto Rican women in the Albany area depict a comparatively depressed socioeconomic profile.

This picture becomes even bleaker when the figures for Puerto Rican women are compared to those for non-Puerto Rican Latina women in Albany. For example, a higher percentage of Puerto Rican women (41.8 percent) live in poverty compared to 38.9 percent of non-Puerto Rican Latina women. They also experience a higher unemployment rate (13.9 percent) compared to 11.9 percent for non-Puerto Rican Latina women. Puerto Rican women have a higher rate of female-headed households (50.8 percent) compared to 15.9 percent for all non-Puerto Rican Latina women in Albany. Published data on the socioeconomic status of Puerto Rican women in the city of Amsterdam are currently unavailable.

Theoretical Framework

The underlying framework for this study derives from the stress process paradigm, one of the most widely used to conceptualize and study the relationships between stress, coping, and manifestations of stress (Avison and Gotlib 1994; Katerndahl and Parchman 2002; Rao 2009). There are various models of the stress process, including the stress-coping theory (Lazarus and Folkman 1984) and the Stress Process Model (Pearlin, Mullan, Semple, and Skaff 1990), which guide this research. From these perspectives, stress is viewed as a person-environment relationship that exceeds available resources and endangers a person's well-being (Lazarus and Folkman 1984). The sources of stress, stressors, are any problematic experience, condition, or activity that is threatening, inhibiting, or frustrating (Pearlin et al. 1990). These stressors can be present at the individual, family, and community levels (Pearlin 1999; Katerndahl and Parchman 2002).

A central concept in the stress process paradigm is coping, a person's cognitive and behavioral efforts to manage specific stressful situations (Lazarus and Folkman 1984). Coping responses are contingent on a person's psychosocial resources and can potentially mediate the way stressors are experienced and how mental health distress is expressed (Avison and Gotlib 1994). Psychosocial resources for coping include social support, which refers to the informational, instrumental, or emotional assistance provided by significant others such as family members, friends, and coworkers (Thoits 1995).

The stress process framework is suitable for the study of stress and mental health among Puerto Rican women. It goes beyond a focus on women as individuals, recognizing the critical role of environmental contexts in the stress-mental distress relationship. For Puerto Rican women, the stress process takes place within a context of social inequality and systematic oppression, characterized by unequal distribution of resources, disempowerment, social exclusion, and differential treatment. The stress process framework can accommodate these underlying ideological and socioeconomic structures as well as the relevant ethno-cultural factors in which stress and mental health are embedded for Puerto Rican women.

Psychosocial Stress, Social Support and Mental Health in Puerto Rican Women Psychosocial Stress

Puerto Rican women in the U.S. mainland, like other Latina women, experience a broad variety of stressful situations that place them at risk for mental distress (Farley, et al. 2005; Goodkind et al. 2008). The social disadvantages and systematic oppression Puerto Rican women face because of their gender and ethnicity exacerbate the stressors and generate new demands and constraints. Gender inequality creates the conditions under which women are exposed to a host of stressful situations that have been linked with mental distress (Yee and Schulz 2000; Williams 2005). Although gender inequality is inherent to patriarchal family structures in general, culture plays an important role in shaping the nature and dynamics of the stress process, that is, the nature and intensity of the related stressors and prescriptions for the appropriate coping mechanisms. For example, in Puerto Rican society, the cultural value of familism defines gender roles and prescribes norms of filial piety that underscore the centrality of the family and promotes loyalty, interdependence, affiliation, and reciprocity (Marin and Marin 1991). Familism is at the heart of a woman's gender identity and sense of womanhood underscoring its pivotal role in her psychosocial functioning (Flores Ortiz 1993).

For Puerto Rican women in the U.S. mainland, particularly among those who have recently migrated from the Island, the value of familism still persists, although current practices and changes in family structures reflect adaptations to continuous person-environment interactions that can be stressful (Alegria et al. 2007; Ramos 2005). For example, Puerto Rican women in the workforce are less available to fulfill familism housework and family care expectations, facing stressors associated with role strain as they respond to these multiple demands. In a qualitative study of Puerto Rican women caring for older kin, participants consistently expressed feelings of guilt and blamed themselves for not being able to better fulfill the idealized roles and expectations that come with housework, family care, and, for some, outside the home employment (Ramos 2004). Thus, despite changes in gender role ascriptions, Puerto Rican women are still exposed to the myriad stressors that accompany unpaid housework and caregiving for family members in roles such as mothers, wives, partners, daughters, and daughters-in-law (Aranda and Knight 1997; Delgado and Tennstedt 1997; Ramos and Carlson 2004). Many may fulfill these roles with comparatively meager financial resources. As previously indicated, Puerto Rican women tend to have low incomes: about 25 percent nationally, 36.1 percent in New York State, and 41.8 percent in Albany live in poverty (Bergard 2010; Bose 2006). In 2010 the poverty rate for Puerto Rican female-headed households with no husband present was 38.7 percent nationally and 41.2 percent for New York State (U.S. Census 2011).

Unemployment rates are often worrisome for Puerto Rican women who in 2000 already had unemployment rates of 13.9 percent in New York State and 19.3 percent in Albany (Bose 2006). Research has demonstrated that unemployment is a highly stressful, negative event for workers and their families (Broman, Hamilton and Hoffman 2001). Some Puerto Rican women find themselves relegated to low-status, low-skill, low-paying jobs that are highly demanding and offer little opportunity for advancement. Others may be successful in transcending the boundaries of such occupational segregation, but as research with high-achieving women has found, feelings of vulnerability, instability, and lack of entitlement often persist (Williams 2005).

As members of an ethnic minority group, the social disadvantages Puerto Rican women face as women are overlaid by racism, ethnic prejudice, and discrimination at both the individual and institutional levels. In addition to economic hardship and depressed social status, Puerto Rican women often live in deteriorated housing that is likely to be smaller, of substandard quality, and located in unsafe neighborhoods (Krivo 1995; Ramos 2007; Schaefer 1996; Vega 1995). In a Latino national survey, 30 percent of the Puerto Rican respondents had experienced discrimination in jobs, housing, or public services (De la Garza 1993). In a qualitative study in upstate New York, dark-skinned older Puerto Rican women shared experiences of housing discrimination, which they attributed primarily to prejudicial attitudes toward being both Puerto Rican and "black" (Ramos 2004). According to Williams, Neighbors and Jackson (2003), systematic exposure to discrimination-specific stressors may have long-term consequences for mental health.

Social Support

Social support can be an important environmental resource for coping with stress, including the stress associated with social disadvantage (Avison and Gotlib 1994; Kawachi and Berkman 2001; Stockdale et al. 2007). Traditionally, Puerto Rican women have relied on large informal social networks comprised of family, friends, and church representatives for emotional and financial support. For some Puerto Rican women, a scarcity of financial resources can undermine alternative coping options by limiting access to relaxation, social activities, and professional mental health services. Puerto Rican women also draw on religion-based environmental resources, including those provided by the Catholic Church and Evangelical Protestant denominations and Pentecostal churches (Solivan 1996; Garcia-Preto 2006). Puerto Ricans in the mainland may not always have access to extensive kin networks due to recent social trends that have led to changes in the structure and size of Puerto Rican families (Delgado and Tennstedt 1997; Garcia-Preto 2006; Ramos 2007). For women who migrate alone, the development of new interpersonal relationships may not take place as quickly, resulting in feelings of loneliness and isolation (Comas-Diaz 1994). As such, some Puerto Rican women may not have adequate access to an informal network that can provide social support.

Mental Health

Nationally representative figures on the mental health status of Puerto Rican women are rarely available. Information on the Puerto Rican Latino subgroup is often presented in an aggregated form and is not distinguished by gender. For example, earlier studies based on data from the Hispanic Health and Nutrition Examination Survey found higher rates of depression among Puerto Rican men and women compared to Mexican and Cuban Americans (Guarnaccia, Angel and Worobey 1991; Moscicki et al. 1987).

More recently, the National Longitudinal Asian American and Latino Study (NLAAS) gathered mental health data on Puerto Ricans, Mexican and Cuban Americans, and other Latino subgroups. For Puerto Ricans, these data showed a high prevalence of overall lifetime and past-year year psychiatric conditions including depression and anxiety, and the highest rate compared to non-Puerto Rican Latinos (Alegria et al. 2007). In a subsequent analysis of the NLAAS data, ataque de nervios was prominent among Puerto Ricans, who were also significantly more likely to report ataques than other Latinos in the sample (Guarnaccia et al. 2010). With regard to gender differences, ataque de nervios was more frequent in women, but information specific to Puerto Rican women is not provided separetely (Guarnaccia et al. 2010).

Even less is known about the mental health of Puerto Rican women residing in small cities, although there are a number of environmental variations between small and large cities that can differentially impact their emotional well-being. For example, those residing in small cities may be living in environments with fewer economic resources, where they comprise only a small fraction of the local population, are less visible, and have less political leverage. These differences may translate into fewer mental health programs, limited or no public transportation, greater marginalization, and fewer social supports from culturally prescribed sources. Furthermore, family and social networks from the Puerto Rican or Latino communities are often limited, as size and lack of resources prevent their developing into fully functioning ethnic enclaves. Overall, mental health information specific to Puerto Rican women is needed to inform professional and public awareness, as well as health and social policy.

In sum, Puerto Rican women in general may be exposed to a wide range of psychosocial stressors associated with social inequality. For many, traditional environmental resources, including informal social supports, may not be readily available. In the face of all of these stressors, ethnic pride and culture may be the bedrock of Puerto Rican women's strength and resilience. For many, they offer the means to manage the stress and oppression with which they live. The purpose of this study is to explore the presence of (1) psychosocial stress associated with social inequality, (2) social support, and (3) mental health symptoms in a small sample of Puerto Rican women in upstate New York.

Methods

Sample and Data Collection

This study was approved by the institutional review board of the University at Albany, New York. The study used a cross-sectional survey design. Data were collected from a convenient sample of 153 community-dwelling adult Puerto Rican women residing in Albany and Montgomery counties in Upstate New York. This sample size was determined based on the financial resources available to conduct the research. Participants were recruited with the support of non-profit agencies, church officials, and Latino community advocates for a period of two months.

Women 18 years and older who self-identified as Puerto Rican completed a 30- to 45-minute-long anonymous survey. The survey asked about their sociodemographic characteristics, psychosocial stressors, social supports, and emotional well-being. Bilingual Puerto Rican women and non-Puerto Rican Latina women members of the research team assisted participants in completing the survey in English or Spanish in community agencies, churches, and other settings accessible to Puerto Rican women. Participants received a $10 cash stipend as an incentive for completing the survey.

Measures

To ascertain the sociodemographic characteristics of the sample, information was gathered on the participants' birthplace, age, religion, educational level, marital status, household income, employment status, and number of years living in the U.S.

The presence of psychosocial stressors was explored using items from the Hispanic Women's Social Stressor Scale (HWSSS; Goodkind et al. 2008). These included items related to financial, family, and prejudice/discrimination sources of stress. Respondents were asked to rate on a 4-point Likert-type scale how stressful each of these experiences had been during the previous year. The HWSSS is adopted from two standardized instruments, the Hispanic Stress Inventory (Cervantes, Padilla and Salgado de Snyder 1991) and the Latin American Stress Inventory (Salgado de Snyder 1987).

The availability and roles of social supports for coping was ascertained using items from the Social Provisions Scale (SPS; Cutrona and Russell 1987). The SPS examines whether respondents' social relationships provide various dimensions of social support received within the context of social interpersonal relationships.

Mental health status was assessed using depression, ataque de nervios, and anxiety measures. The Center for Epidemiologic Studies Depression Scale (CESD) measured the frequencies of depressive symptoms during the previous seven days (Ensel 1986; Radloff 1977). The score was derived by summing the values for each item on the scale. Previous research has used a cut-off score of 16 or more to indicate potentially clinically significant depressive symptoms (Bromberger et al. 2004).

Ataque de nervios was assessed with an initial YES or NO screen question followed by a list of 14 symptoms developed by Guarnaccia et al. (2010). Respondents who answered YES to the screener and to 4 or more of the symptoms met the criteria for ataque de nervios.

The Anxiety Sensitivity Index (ASI) is a 16-item scale that asks questions about possible negative consequences to the experience of anxiety (Reiss et al. 1986). The ASI yields one total score from the sum of all 16 items. Scores can range from 0-64 with higher scores indicating higher levels of sensitivity to the fear of anxious feelings.

Analytic Strategy

Data were entered and analyzed using the SPSS 18 statistical package. Data analyses included basic descriptive statistics, such as frequencies and percentages.

Results

Sociodemographic Characteristics

Table 1 presents the sociodemographic characteristics of the sample. Most of the participants were born in Puerto Rico (71.2 percent). Almost 30 percent (28.8) had lived in the U.S. for fewer than 10 years while slightly more than half (50.9 percent) had been in the U.S. for more than 20 years. Ages were 18 to 65 and their frequencies were nearly evenly distributed. About half (49.0 percent) were Catholic, 44.5 percent were Protestant, and 6.5 percent answered "other". Women in this sample tended to have a low socioeconomic status (SES). For example, only 1.4 percent had post-baccalaureate schooling, and 50.3 percent did not complete high school. This is considerably higher than the 2010 census national (24.9 percent) and New York State (31.0 percent) figures for Puerto Ricans as a whole (U.S. Census 2011). More than 70 percent had an annual household income of less than $24,999 (74.4 percent) which is lower than the median household income for Puerto Rican women in Albany ($25,400). Nearly 43 percent (42.2 percent) were either married (27.9 percent) or living with a partner (14.3 percent) and 26.5 percent were single, never married. Less than 40 percent were employed (38.7 percent) either full or part-time. When offered the option, 47.7 percent participants chose to complete the survey in English, and 52.3 percent in Spanish. Less than 40 percent were employed (38.7 percent) either full- or part-time, and 61.3 percent were not employed.

Social Disadvantage and Psychosocial Stress

As shown in Table 2, participants frequently identified financial difficulties as stressful. For example, the majority (65.3 percent) reported "not having enough money to pay debts" and 45.7 percent "not having sufficient money to pay for basic necessities." About 44 percent of study participants found "not being able to afford to live in the neighborhood you want" to be stressful. Many participants reported experiences of prejudice and discrimination due to their Puerto Rican ethnicity as stressful. These included co-workers and supervisors negative stereotypes (35.4 percent), not having the same job opportunities as Anglo women (46.0 percent), poor treatment by doctors or hospital staff (32.4 percent), treated as not deserving of medical or social services (27.2 percent) and being ignored or receiving poor services in stores or offices (35.8 percent). For almost 50 percent feeling isolated and lonely and for 45.9 percent not knowing who to trust for good information or help were stressful.

Stressors related to employment were also identified as sources of stress. Over 39 percent of the participants found "having a hard time finding a job or having to accept a low paying job" (39.9 percent) and feeling dissatisfied with their current job (34.3 percent) to be stressful. Participants also identified having to depend on others for transportation to run simple errands (41.5 percent) and missing the help and support of family in Puerto Rico (34 percent) as stressful.

Social Support

Table 3 shows responses to items related to whether participants had help available. For instance, 39.5 percent reported, "There is no one I can turn to for guidance in times of stress"; 29.9 percent said, "There is no one I can depend on for aid if I really need it"; and 30.7 percent asserted, "There is no one I feel comfortable talking about problems with."

Mental Health

Responses to mental health questions indicate a high presence of depressive symptoms, ataque de nervios, and anxiety in this sample. As shown in Table 4, 101 (66 percent) of the participants scored 16 or above on the CESD, which indicates the presence of potentially clinically significant depressive symptoms. This table also shows that 59 (38.6 percent) of the participants met the criteria for ataque de nervios suggested by Guarnaccia et al. (2010).

Scores on the ASI ranged between 0 and 62, and the frequency distribution approximated a normal curve. As shown in Table 5, the mean was 31.9, which is higher than those previously reported for European-American (19.1), Spanish-speaking (20.0), and Island Puerto Rican (24.6) samples (Cintron et al. 2005; Peterson and Plehn 1999; Sandin, Chorot and McNally 2001).

Discussion

The adverse impact of social inequality on mental health is receiving increased national and international recognition (Office of Minority Health and Health Disparities 2007; Wetzel 2000). This study provides a glimpse into the presence of stress associated with social inequality, the availability of informal social supports for coping, and the presence of mental health distress in Puerto Rican women in small cities. As such, it contributes to a line of inquiry that has received little attention in the literature. The findings provide baseline information for policy and program development and pose intriguing questions for future research.

The presence of psychosocial stress generated by social inequality was high in this sample of Puerto Rican women, who frequently reported concerns with financial disadvantage, employment, prejudice, and discrimination as sources of stress. Most women were of low SES and, for many, insufficient money to pay debts, to purchase basic necessities, to access adequate transportation, or to afford living in the neighborhood of their choice was stressful. Employment-related issues such as difficulty finding a job, having to take a low-paying job, and being dissatisfied with current job were also stressful. A high percentage of women had experienced stress due to perceived prejudice and discrimination attributed to their Puerto Rican ethnicity, particularly in relation to employment and seeking and obtaining services. These findings are consistent with those of previous research that has linked low SES, prejudice, and discrimination to psychological distress in Latinos (Ayon, Marsiglia and Bermudez-Parsai 2010; Moradi and Risco 2006; Panchanadeswaran and Dawson 2011) and in Puerto Ricans (Lee and Ferraro 2009).

As prescribed by traditional Puerto Rican cultural patterns, the majority of participants appeared to have access to informal social supports. At the same time, a large number reported social isolation and loneliness as sources of stress, and many reported missing the help and support of family in Puerto Rico. Interestingly, about 80 percent of the women in this sample were responsible for the care of another person, suggesting adherence to traditional familism values that ascribe to women the role of care providers. In turn, many participants reported not having someone who provided them with practical or emotional support. Geographic mobility, smaller families, and acculturation may be compromising the effectiveness of informal social supports for some Puerto Rican women in the mainland (Delgado and Tennstedt 1997; Garcia-Preto 2006; Ramos 2007).

Lastly, the high presence of mental health symptoms in this sample is alarming. Participants reported clinically significant depressive symptoms (66 percent), anxiety (=31.9), and ataques de nervios (38.6 percent). These results mirror previous nationally representative studies that have found elevated rates of depression, anxiety, and ataque de nervios among Puerto Ricans (Alegria et al. 2007; Alegria at al. 2006; Cintron et al. 2005; Guarnaccia et al. 2010). Yet part of the mental health findings may be an artifact of the small sample size and some of the assessment tools used, which may not have accurately captured culturally specific expressions of mental health. It has been suggested that ethnicity may differentially influence the ways in which psychological distress is manifested (Carter at al. 1999; Cintron et al. 2005; Malgady, Rogler and Cortes 1996). Clearly, for some Puerto Rican women in small cities, their experience in the mainland is marked by myriad hardships associated with racism and oppressive conditions. A better understanding of the complex interplay of social inequality, prejudice, and discrimination with mental health distress is warranted.

This is an exploratory study and has several limitations. First, the sample is not representative of all Puerto Rican women. It is small, participants were recruited from specific geographic areas, and data were collected from Latino community settings and activities. Second, the data are based on self-reports, which increased the likelihood of recall bias, particularly for mental health questions. Thus, the findings should be viewed as primarily descriptive, with limited generalizability to all Puerto Rican women.

Implications for Policy and Program Development

Several recommendations for policy and program development that are specific to a segment of stateside Puerto Rican women, particularly those in smaller cities, can be drawn from the findings of this study. Rivera and Burgos (2010) underscore the need to consider geographic place of residence as an important factor that shapes the mental health status of Puerto Ricans, an ethnic group that is dispersing rapidly from cosmopolitan areas into smaller cities throughout the mainland.

First, most participants reported experiencing stress associated with social inequality, prejudice, and discrimination. Their precarious socioeconomic profile depicts the multiple social disadvantages they face including those related to income, employment, and educational attainment. Culturally responsive programs that ensure high quality education and promote and support educational attainment, particularly high school completion, could help address these interrelated social disadvantages.

Belfield (2010) provides a compelling argument for policies designed to raise the rate of high school graduation for Puerto Ricans, whose absolute education levels tend to be low. He points out that increasing their graduation rates and quality of education can have multiple benefits at the individual and societal levels. These include potential higher earnings and better health and emotional well-being, lower involvement in the welfare and criminal justice systems, and higher tax revenues.

Furthermore, data from the 2003 National Latino and Asian American Survey document the education-mental relationship for Puerto Ricans. Here, 66 percent of those who had dropped out from school reported poor or fair mental health compared to 25 percent of those who had completed high school and 2 percent of college graduates (Belfield and Levin 2007). Social policies that address the inequity gap between low- and middle-income between racial and ethnic groups could help reduce financial stress and, thus, mental distress. More effective anti-discrimination and equality laws that aim to tackle discrimination and inequality in both the workforce and within the provision of goods and services are sorely needed.

Policies that target the mental health needs of Latino women must include provisions to ensure an increase in service utilization. This could be accomplished through quality, physically accessible, and culturally syntonic programs and services (Acevedo et al. 2007). Lastly, epidemiological studies that examine the mental health status and risk and protective factors in Puerto Rican women are urgently needed. Research that identifies systemic barriers to mental health care and tests culturally responsive interventions should inform policy and program development. Federal and state funding should support these lines of inquiry.

In general, the mental health needs of stateside Puerto Rican women, particularly those residing in small cities, have been "invisible" in the public arena. Policies that take into account their distinct psychosocial realities, which are shaped by inequality, prejudice, and discrimination, as sources of mental distress are long overdue. Given the continuous rise of the New York State Puerto Rican population, the results should also inform the work of health and social policymakers, as well as legislators tasked with supporting the well-being of upstate New Yorkers.

ACKNOWLEDGMENT

This study was partially funded by the Puerto Rican Research and Public Policy Initiative, Centro de Estudios Puertorriquenos, Hunter College, City University of New York.

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The author (bramos@albany.edu) is Associate Professor and Director of the Baccalaureate Program in the School of Social Welfare, University at Albany. She holds an affiliate appointment in the Department of Latin American, Caribbean and U.S. Studies. She is past Director of Education of the Center for the Elimination of Minority Health Disparities. Her teaching and scholarly interests include clinical social work, multiculturalism, mental health, domestic violence, immigrants, and gerontology with a focus on Latino women.
TABLE 1. SOCIODEMOGRAPHIC CHARACTERISTICS (N = 153)

CHARACTERISTIC                                N         %

Birthplace
  Puerto Rico                                109      71.2
  U.S. Mainland                              44       28.7
Years living in the US
  1-5                                        15        9.8
  6-10                                       29       19.0
  11-20                                      31       20.3
  >20                                        78       50.9
Age
  18-34                                      56       36.6
  35-49                                      47       30.7
  >49                                        50       32.7
Religion
  Catholic                                   75       49.0
  Protestant                                 68       44.5
  Other                                      10        6.5
Education
  Less than high school degree               77       50.3
  High school graduate or GED                33       21.6
  Some college, no degree                    25       16.3
  Associate's, Bachelor's or higher          18       11.8
Annual household income
  <$25,000                                   114      74.4
  $25,000 to $49,999                         27       17.7
  >$50,000                                   12        7.9
Married status
  Married or living with partne              65       42.2
  Single, widowed, separated, divorced       88       57.8
Employment
  Full or part-time                          59       38.7
  Not employed                               94       61.3

TABLE 2. PSYCHOSOCIAL STRESSORS

                                   SOMEWHAT       VERY
                                  STRESSFUL    STRESSFUL
STRESSOR                            % (N)        % (N)        TOTAL

Financial
  Not enough money to pay debts   21.1 (32)    44.2 (68)    65.3 (100)
  Not enough money for basic
    necessities for you or your
    children                      10.1 (15)    35.6 (55)    45.7 (70)
  Unable to afford to live in
    the neighborhood you want     16.6 (25)    27.6 (42)    44.2 (67)
  Worry about not being able to
    pay for healthcare for your
    children                      10.3 (16)    15.1 (23)    25.4 (39)
Prejudice/Discrimination due to
  Puerto Rican Ethnicity              15          9.8
  Co-workers' or supervisors'
    negative stereotypes          13.9 (21)    21.5 (33)    35.4 (54)
  Paid less, hard time getting
    promotions or raises          13.6 (20)    19.7 (30)    33.3 (50)
  Not having the same job
    opportunities as Anglo
    Women                         14.9 (23)    31.1 (48)    46.0 (71)
  Doctors or hospital staff
    treat you poorly              17.2 (26)    15.2 (23)    32.4 (49)
  Treated as if you don't
    deserve medical or social
    services                      10.8 (17)     9.5 (14)    20.3 (31)
  Your children placed in lower
    classes                       10.8 (17)     9.5 (14)    20.3 (31)
  Ignored or porr service at
    stores or offices             14.9 (22)    20.9 (32)    35.8 (54)
Other
  Feeling your children were
    not safe in your
    neighborhood                   6.8 (10)    23.3 (36)    30.1 (46)
  Feeling lonely and isolated     19.9 (30)    28.8 (44)    48.7 (74)
  Not knowing who to trust for
    good information              21.6 (33)    24.3 (37)     45.9 (70
  Difficulty find a job or
    forced to accept a low pay
    job                           13.5 (21)    26.4 (40)    39.9 (61)
  Depending on others for
    tranportation or to do
    simple errands                 9.9 (15)    31.6 (48)    41.5 (63)
  Dissatisfied with current job    9.1 (14)    25.2 (38)    34.3 (52)
  Missing the help and support
    of family in Puerto Rico      14.0 (21)    20.0 (31)    34.0 (52)

TABLE 3: SOCIAL SUPPORT

ITEMS                                                     YES     NO
                                                           %       %

There are people I can depend on to help me if I
  really need it                                         77.7    22.3
There is no one I can turn for guidance in time of
  stress                                                 39.5    60.5
If something went wrong, no one would come to my
  assistance                                             17.4    82.6
There is someone I could talk to about important
  decisions in my life                                   74.7    25.3
There is a trustworthy person I could turn to for
  advice if I were having problems                       84.0    16.0
There is no one I can depend on for aid if I really
  need it                                                29.9    70.1
There is no one I feel comfortable talking about
  problems with                                          30.7    69.3
There are people who I can count on in an emergency      80.7    19.3

TABLE 4: PERCENTAGE OF SAMPLE MEETING CRITERIA FOR DEPRESSION/ATAQUE
DE NERVIOS (N = 153)

MEASURE                    FREQUENCY         %

Depression (CES-D)
Meets criteria                101          66.0
Does not meet criteria         45          29.4
Missing                        7            4.6

Ataque de Nervios (ADN)
Meets criteria                 59          38.6
Does not meet criteria         94          61.4
Missing                        0

TABLE 5: MEANS AND STANDARD DEVIATIONS OF THE ANXIETY SENSITIVITY
INDEX WITH COMPARISONS FULL SAMPLE (N = 153)

SAMPLE                                                   M        SD

Puerto Rican women in this sample                       31.9     14.6
European-American sample (Peterson & Plehn, 1999)       19.0     9.1
Non-clinical Spanish speaking sample (Sandin et al.,
   2001)                                                20.0     9.0
Island Puerto Rican sample (Cintron et al., 2005)       24.6     13.9
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Author:Ramos, Blanca M.
Publication:CENTRO: Journal of the Center for Puerto Rican Studies
Article Type:Report
Geographic Code:1U2NY
Date:Sep 22, 2012
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