Effect of Acculturation on Social and Mental Health Services

Dana Adams  

The Effect of Acculturation and how it Inhibits the use of Social and Mental Health Services among Mexican-American Elders.

As the United States ages over the next several decades, its older population will become more racially and ethnically diverse (Ortman, Velkoff, & Hogan, 2014). Between 2012 and 2050, it is stated the United States will experience considerable growth in its older population and by year 2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012 (Ortman, Velkoff, & Hogan, 2014) with the largest source of immigration being from Mexico than any other country in the world at a reported level of 12 million immigrants in the U.S. (Ortman, Velkoff, & Hogan, 2014). Per Passel and Cohn, 2011), over half (51%) of Mexican immigrant population are unauthorized, and some 58% of unauthorized immigrants in the U.S. are of Mexican decent. This literature review is directed by asking the question "What is the effect of acculturation and how it does it inhibit the use of social and mental health services among Mexican-American elders? "

As the percentage of the aging Mexican - American population increases, concerns for their financial strength does also. When determining the quality of life of older Mexican- Americans, socioeconomic status is a key factor in their success (Furman, Negi, Iwamoto, Rowan, Shukraft, Gragg, 2009). The U.S. Census Bureau reports that nearly 10 percent of the aging population live below official poverty thresholds (U.S. Census Bureau, 2006). Despite lower socioeconomic status, the Mexican American population enjoy a more favorable mortality profile than non-Hispanics, living to 80 years compared to 78 years for non-Hispanic whites and 73 years for blacks (Angel, Prickett & Angel, 2014).

Within their communities, Elders are considered vital members and are anticipated to actively fulfill essential roles such as those of mentors, cultural transmitters, providers of care for grandchildren, and civic and religious leadership (Ramos & Wright, 2010). The Mexican cultural value of collectivism and communal orientation has the ability to serve as a protective factor in alleviating distress (Furman et al., 2009). In many cultures, such as in Mexico, rapport begins through exchange of conversations or chit-chat before beginning the business of medical history-taking and physical examination (Furman et al, 2009; Gallagher-Thompson, Talamantes, Ramirez, Valverde, 1996; Elliott, 1996). The lack of social and emotional support may influence immigrants to rely solely on themselves to manage their stress (Furman et al. 2009). The effects of the stressors associated with constantly having to adapt to unfamiliar environments, work-related stress (Ramos & Wright, 2010), and lack of social and emotional support may take a psychological and physical toll on many immigrants (Furman et al., 2009). Historically, there has been a lack of mental health services available in many communities where people of color reside (Griner & Smith, 2006; Flaskerud & Hu, 1994; Marger, 2002; Sue, 1988; Sue & Zane, 1987) because services were focused on the needs of the upper and middle-class European Americans (Griner & Smith, 2006; Hall, 2001; Richardson & Molinaro, 1996; Ponterotto & Casas, 1991; Trusty, Davis, & Looby, 2002). Clients of color are sometimes mistrustful of mental health services due to historic racial disparities and a shortage of therapists from their own ethnic background who speak the same native language (Flaskerud & Hu, 1994, Marger, 2002; Sue, 1988; Sue & Zane, 1987).

A diverse group of national origins is represented by Latinos living in the United States Ramos & Wright, 2010),with most of the group being of Mexican origin (Ramos & Wright, 2010; Furman, Negi, Iwamoto, Rowan, Shukraft, & Gragg, 2009). "Migration from Mexico to the United States has been cited as one of the largest mass movements of people in the world "(Furman et al. 2009; Escobar-Latapí, 1999). In late old age, about one-half of Hispanics of Mexican ancestry lives with family in the Southwestern United States and twice as likely as those living alone or with spouse to report more financial strain and receive assistance from children (Espinoza, Jung, & Hazuda, 2012). The modern Mexican-American family consists of grandparents, parents, children, and extended family members stage in life are appreciated because of their wisdom and cherished life-long experiences (Ramos & Wright, 2010). Great value is placed on old age and those who have reached these common characteristics of Mexican-Americans includes the incorporation of friends and extended family (collectivism) with a high level of obligation and responsibility to the members (familism) while putting emphasis on male leadership roles (machismo) and female subordination (Marianismo) (Pedrotti & Edwards, 2014). Mexican Americans are more likely than non-Hispanics to rely on family for their long-term care needs (Angel, Prickett, & Angel, 2014; Glick, 1999; Angel et al. 2004).  Immigrants and especially those who migrate to the U.S. later in life are particularly dependent on their families (VanHook & Glick,2007; Angel, et al., 1999).  Research suggests Mexican-American want to live closer to kin and place a higher value on the provision of support among family members (Sarkisian, Gerena, & Gerstel, 2007; Burr & Mutchler, 1999; Keefe & Padilla, 1987; Mindel, 1980). Hispanic elders are less likely to live alone and more likely to live with other family members, particularly in a multigenerational family where an adult child is the householder (Talamantes, Lindeman., & Mouton, 2005). While a family may want to care for their aging parents, the care that they may need as they age may create a substantial burden on family (Angel, Prickett & Angel, 2014).

Recent research suggests that intergenerational relations (Umberson, 2002) are becoming increasingly important to Mexican - Americans (Swartz, 2009). Mexicans enjoy the intergenerational progress between first-generation immigrants and their second-generation children (Duncan & Trejo, 2011). Relative to their parents, the U.S.-born second generation experiences dramatic increases in English proficiency, educational attainment, and earnings and prefer to speak English rather than Spanish, and by the third generation most Mexican Americans no longer speak Spanish at all. (Duncan & Trejo, 2011).

There are several factors such as social support, fluency in English, and no health insurance, and no translators that can impact the acculturation process in Mexican Americans. Acculturation is viewed as the extent to which a minority group adopts the customs, language, behaviors, and values of the majority population ( Yeo, 2009).  Individuals who have family and peer social supports tend to experience less acculturation stress and those who are experiencing high stress tend to experience fewer symptoms of mental distress (Crockett, Iturbide, Torres Stone, 2007; McGinley, Raffaelli, & Carlo, 2007; Hovey, 2000).

Many Mexican American elders have experienced life -long struggles to overcome discrimination and segregation including punishment for speaking Spanish, restaurant segregation, and job discrimination (Furman, Negi, Iwamoto, Rowan, Shukraft, & Gragg, 2009). Additionally, the Welfare Reform legislation of 1996 brought stressors for many Mexican American elderly who had immigrated to the U.S. at early ages and had never applied for citizenship (Morawetz, 2000). History of this population in the U.S. is characterized by open conflict, social inequality, prejudice, and discrimination and these factors have greatly and dramatically shaped the sociocultural realities of the aging (Ramos & Wright, 2010).

McInnis-Dittrich (2005) states that understanding an Elders spirituality helps to understand the older adult view of the world, subsequent behavior and maintaining a sense of continuity and cohesion in order to face changes that accompany the aging process ( p, ). Many Mexican - American elders who attend church monthly, weekly, and more than weekly tend to exhibit slower rates of cognitive decline than those who do not attend church (Herrera, Lee, Nanyonjo, Laufman, & Torres-Vigil, 2009).

Social workers and mental health providers have a moral and ethical responsibility to provide effective interventions to all clients by accounting for cultural contexts and cultural values (Trimble & Fisher, 2006). Social workers and other professionals are becoming more aware of multicultural issues and the need to improve the accessibility quality of mental health services (Sue, 1998), and method of payment for individuals who have historically been oppressed and provided in the client's favored language (Griner & Smith, 2006; Sue, 1998). An assessment should be completed by the social worker and is a great way of identifying strengths and resilience Elders to solve their challenges (McInnis & Dittrich, 2005). Treatment plans and interventions are then developed by a multidisciplinary team. "Applying a strengths perspective to the assessment and intervention means there is a focus on helping Elders discover and employ their own strengths to help solve problems and achieve their identified goals" (McInnis & Dittrich, 2005).

Limitations this writer identified with this literature review were there was a vast of opinions about what encompasses effective cultural adaptations and some studies varied in the racial/ethnic composition of the intervention groups while other studies had different outcome measures.

References:

Angel, J. L., Prickett, K. C., & Angel, R. J. (2014). Retirement security for black, non-Hispanic white, and Mexican-origin women: the changing roles of marriage and work. Journal of Women, Politics & Policy, 35(3), 222-241.

Crockett, L. J., Iturbide, M. I., Torres Stone, R. A., McGinley, M., Raffaelli, M., & Carlo, G. (2007). Acculturative stress, social support, and coping: Relations to psychological adjustment among Mexican American college students. Cultural Diversity and Ethnic Minority Psychology, 13(4), 347.

Duncan, B., & Trejo, S. J. (2011). Intermarriage and the intergenerational transmission of ethnic identity and human capital for Mexican Americans. Journal of Labor Economics, 29(2), 195-227.

Espinoza, S. E., Jung, I., & Hazuda, H. (2012). Frailty transitions in the San Antonio longitudinal study of aging. Journal of the American Geriatrics Society, 60(4), 652-660.

Furman, R., Negi, N. J., Iwamoto, D. K., Rowan, D., Shukraft, A., & Gragg, J. (2009). Social work practice with Latinos: Key issues for social workers. Social Work, 54(2), 167-174.

Herrera, A. P., Lee, J. W., Nanyonjo, R. D., Laufman, L. E., & Torres-Vigil, I. (2009). Religious coping and caregiver well-being in Mexican-American families. Aging and Mental Health, 13(1), 84-91.

McInnis-Dittrich, K. (2005). Social Work with older adults: A biopsychosocial approach to assessment in intervention. (4^th edition). California: Pearson.

Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014). An aging nation: the older population in the United States. Washington, DC: US Census Bureau, 25-1140.

Passel, J. S., & Cohn, D. (2011). New patterns in US immigration, 2011: Uncertainty for reform. University of California, Davis.

Pedrotti, J. T., & Edwards, L. (2014). Perspectives on the Intersection of Multiculturalism and Positive Psychology. Springer.

Ramos, B. M. & Wright, G. A. (2010). Social work practice with older Latino adults. In R. Furman & N. Negi (Ed.), Social work practice with Latinos: Key issues and emerging themes (233-246). Lyceum: Chicago, Illinois.

Swartz, T. T. (2009). Intergenerational family relations in adulthood: Patterns, variations, and implications in the contemporary United States. Annual Review of Sociology, 35, 191-212.

Talamantes, M., Lindeman, R., & Mouton, C. (2005). Health and health care of Hispanic/Latino American elders.

Van Hook, J., & Glick, J. E. (2007). Immigration and living arrangements: Moving beyond economic need versus acculturation. Demography, 44(2), 225-249.

Yeo, G. (2009). How will the US healthcare system meet the challenge of the ethnogeriatric imperative? Journal of the American Geriatrics Society, 57(7), 1278-1285.