Coraje, Nervios, and Susto: Culture-Bound Syndromes and Depression Among Mexican Migrants

Purpose

The DSM-IV-TR (APA, 2000), in the Glossary of Cultural-Bound Syndromes, states “the term culture-bound syndrome denotes recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category” (p.898). This study explored inter-relationships among three culture-bound syndromes, "coraje" (rage), "nervios" (nerves), or "susto" (fright or soul-loss), commonly found among Latino populations, and associations with depression as measured by the Patient Health Questionnaire-9 (PHQ-9), which scores each of the DSM-IV criteria for depression. Associations of each syndrome to a range of indicators of health, culture, and sociodemographic background were tested.

Methods

During health promotion activities in migrant farmworker camps in rural Oregon, 179 Mexican-origin migrants were interviewed using a Spanish language questionnaire. Indigenous cultural status was determined by asking participants if they self-identified as indigenous, or if they, their parents or grandparents, spoke indigenous languages. Participants were asked whether they currently suffered from "coraje," "nervios," or "susto." Inter-relationships between culture-bound syndromes were tested using phi correlation. Associations of each syndrome with dichotomous variables of indigenous status, gender, emotional and instrumental support, and living status (with/without family) were tested using chi-square test. Relationships between each syndrome with (a) each item contained in the PHQ-9, and (b) other health related and sociodemographic variables were tested using independent samples t-test.

Results

Fifty-eight respondents (32%) reported having susto, coraje, nervios, or combinations of these syndromes. Inter-relationships of syndromes were tested and found to be positively correlated (phi = .27 between susto and coraje; phi = .31 between nervios and susto; and phi = .44 between coraje and nervios).

Results indicated significantly higher prevalence of coraje and nervios (x2 = 13.12, p < .001; x2 = 10.97, p < .001 respectively) among females. Indigenous status, living status, instrumental support, and emotional support were not associated with prevalence of any of the syndromes.

Among health related and sociodemographic variables, only self-rated physical and mental health, and depression-related functional impairment were significantly associated with prevalence of coraje and nervios. PHQ-9 total score was positively associated with prevalence of coraje and nervios. Among the nine items comprising the PHQ-9, anhedonia, depressed mood, low energy, low self-esteem, and concentration difficulty were associated with prevalence of coraje and nervios. Sleep problems was associated only with coraje. Language conflict stress was only associated with susto, while legal status stress was only associated with coraje.

Conclusions/Implications

This study provides new empirical evidence on three culture-bound syndromes known to be prevalent among Mexican-origin individuals. Findings indicated two of these syndromes were positively associated with female gender, PHQ-9 measured depression severity, and depression-related functional impairment, and negatively related with self-rated mental and physical health. Results shed light on the complex relationship between these ethnospecific maladies and individual criteria employed by the DSM-IV to diagnose depression. Results indicated that none of these syndromes were “bound” to participants' indigenous cultures. Findings offer evidence for how social workers providing mental health services to Mexican-origin individuals can interpret the practical meaning of these cultural idioms of distress.