HOW DO HEART CONDITIONS AFFECT HISPANIC AND LATINOS MENTAL HEALTH MISDIAGNOSIS?
HOW DO HEART CONDITIONS AFFECT HISPANIC AND LATINOS MENTAL HEALTH MISDIAGNOSIS?
Cardiovascular diseases (CVD) are considered the first cause of death among all United States cultural groups, except for the Hispanic and Latino population.1 CVD among Latinx patients are considered the second cause of death, and 1 in 3 adults in the United States have at least one type of CVD.1 The most frequent examples of CVD include Coronary Heart Disease, Heart Failure, Peripheral Vascular Disease, and Strokes.2 In 2010, it was estimated that around 1 million children and 1.4 million adults were diagnosed with a Congenital Heart Disease.3
Mental health providers that serve Latinx individuals may explore physical conditions such as CVD because they can have an impact on their quality of life, in the client’s interpersonal support network and general mental health.1 Each heart condition presents a psychological challenge for clients’ families and clinicians’ at the moment of diagnosing, conceptualizing, and developing an effective treatment plan.
HOW DO HEART CONDITIONS AFFECT MENTAL HEALTH?
Research has found that Latinx with heart conditions could experience panic attacks.4 The association between panic disorders and ischemia is that ischemia is the source of chest pain in a panic disorder. Ischemia occurs when a body part does not get enough blood or oxygen and it could be related to a blockage in the arteries.4. Furthermore, a person could have a panic attack due to myocardial ischemia. Panic disorder may promote the development of Coronary Artery Disease.4
After suffering a stroke, Latinx may be vulnerable to experience Pseudobulbar Affect (PBA). It could be misdiagnosed with bipolar disorder or other mood disorders. PBA consists of incongruent behavior that impacts the client’s mental health and social functioning.5 It includes the expression of socially incongruent emotions, like laughing in a funeral, after tragic events, or for no apparent reason. Also, the person can cry at unusual moments and may present difficulties in regulating the expression of emotions.5 Latinx with heart conditions are three times more likely to be depressed than the general population.5 To avoid misdiagnosis among Latinx with heart conditions, mental health providers may take into consideration the duration of crying spells. In PBA episodes, crying spells are brief, and in depressive disorder, it may be experienced for weeks or months.5 Mental health providers can enhance coping skills in Latinx clients with PBA like being open to talk about their behavioral changes with others, deep breathing, changing body position, and focusing on another object before the episode starts.6
LATINX CULTURAL FACTORS
Some cultural factors that may influence misdiagnosis, seeking health care and mental health services include:
- Difficulties regarding speaking English and the meaning they provide to their symptoms.
- Latinx may express anxiety symptoms using words like nervioso, padezco de los nervios o tengo nervios (nervous, I suffer from nerves or I have nerves) or may express somatic complains like: tengo dolor de cabeza (I have a headache). Healthcare professionals may misdiagnose the patient if they do not ask further about client’s explanation of their symptoms.7
- Ataque de nervios is a cultural syndrome and the symptoms may be similar to a panic attack. Latinx may seek health care services with chest pain complains and providers could disregard their symptoms thinking that they only have a psychosomatic cause.4
- Individuals from Latinx culture may present stereotypes and stigma regarding mental health conditions which could lead family members to label the person with PBA as, loco o tiene locura (crazy or madness), without acknowledging the root of the symptoms, relating to a vascular event.1, 7 The stigma may be influenced by low health literacy, which impacts help-seeking behaviors and recovery among Latinx groups.
RISK FACTORS FOR DEVELOPING A CARDIOVASCULAR DISEASE
Hispanic/Latinx communities are exposed to psychosocial risk factors for developing a CVD which include1:
- acculturative stress,
- difficulties with social integration, and
- difficulties or lack of a support network.
7 TIPS TO AVOID MISDIAGNOSING HISPANIC AND LATINOS WITH HEART CONDITIONS
- Explore client’s medical history and monitor the mood of clients with a history of heart conditions.2
- Increase health literacy by interviewing and psychoeducating family members of clients with CVD to understand their behavior and mood changes before diagnosing.5
- Provide adequate referrals for physical checkups and psychiatric evaluations if they present chest pain or panic attacks. Latinx clients could benefit from antidepressant pharmacotherapy like selective serotonin reuptake inhibitors, or other kinds of medications.6
- While providing services to Latinx view mental health conditions with the lens of culture and provide culturally-tailored interventions.8
- Clinicians may take into consideration that patients with chest pain that have a psychiatric diagnosis compared with non-psychiatric patients, may use maladaptive coping skills in order to manage their symptoms like avoiding medical care, blaming and wishful thinking.4
- Use DSM-5 criteria to diagnose a panic disorder because physicians could disregard this condition in a patient with chest pain.4
- Recognize within clients with panic disorder that they could also experience a co-occurring coronary artery disease.4
RESOURCES FOR PROVIDERS
- Hispanic Community Health Study (HCHS/SOL) provides a deeper understanding of the risks of cardiovascular diseases among Latinx.1
For more information, visit https://www2.cscc.unc.edu/hchs/.
- Pathological Laughter and Crying Scale (PLACS) is an interview were clients could provide details about their laughter and crying episodes.9
- The Panic Attack Questionnaire provides a definition of panic attacks; gathers information about the client’s history of panic attacks, the intensity of symptoms and context.10
The questionnaire can be found at http://www.midss.org/sites/default/files/paq.pdf
- Interpersonal Psychotherapy is an Evidence-Based Treatment proven to be effective in treating depression related to medical conditions among Latinx.11
- Balfour, P. C., Jr, Ruiz, J. M., Talavera, G. A., Allison, M. A., & Rodriguez, C. J. (2016). Cardiovascular Disease in Hispanics/Latinos in the United States. Journal of Latina/o psychology, 4(2), 98–113. doi:10.1037/lat0000056
- American Heart Association. (2018). Mental health and heart health. Retrieved on February 4th, 2020 from http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Mental-Health-and-Heart-Health_UCM_438853_Article.jsp
- Centers for Disease Control and Prevention. (2019). Congenital heart defect. Retrieved on February 5th, 2020 from https://www.cdc.gov/ncbddd/heartdefects/data.html
- Katerndahl, D. (2008). Chest Pain and Its Importance in Patients With Panic Disorder: An Updated Literature Review. Journal of Clinical Psychiatric, Vol. 10 (5), 376-383.
- Ahmed, A., & Simmons, Z. (2013). Pseudobulbar affect: Prevalence and management. Therapeutic and Clinical Risk Management, 9, 483-489. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849173/#!po=35.7143
- American Psychological Association. (2020). Mind/body health: Heart disease. Retrieved on February 4th, 2020 from https://www.apa.org/helpcenter/heart-disease
- Martinez, K. (2016). Why It's Difficult To Get Help If You Are A Latino Dealing With Nerves Or Stress. Retrieved from https://www.anxiety.org/latino-language-culture-barriers-to-anxiety-diagnosis-and-treatment
- Substance Abuse and Mental Health Services Administration. (2014). A Treatment Improvement Protocol: Trauma-Informed Care In Behavioral Health Services. Retrieved from https://www.integration.samhsa.gov/clinical-practice/SAMSA_TIP_Trauma.pdf
- American Stroke Association (2018). Pseudobulbar Affect (PBA). Retrieved on February 4th, 2020 fromhttps://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke/pseudobulbar-affect
- Norton, G. R., Harrison, B., Hauch, J., & Rhodes, L. (2012). The Panic Attack Questionnaire. Measurement instrument database for the social science. Retrieved on February 12, 2020 fromhttp://www.midss.org/sites/default/files/paq.pdf
- Stuart, S., & Robertsons, M. (2012). Interpersonal Psychotherapy: A clinician’s guide, (2nd Ed.) Boca Raton, FL: Taylor and Francis Group.