title: Association of a culturally defined syndrome (nervios) with chest pain and DSM-IV affective disorders in Hispanic patients referred for cardiac stress testing.
abstract: BACKGROUND
  Hispanics have a high prevalence of cardiovascular risk factors, most notably type 2 diabetes. However, in a large public hospital in Houston, Texas, Hispanic patients referred for cardiac stress testing were significantly more likely to have normal test results than were Whites or non-Hispanic Blacks. We undertook an exploratory study to determine if nervios, a culturally based syndrome that shares similarities with both panic disorder and anginal symptoms, is sufficiently prevalent among Hispanics referred for cardiac testing to be considered as a possible explanation for the high probability of a normal test result.
  
  
  METHODS
  Hispanic patients were recruited consecutively when they presented for a cardiac stress test. A bilingual interviewer administered a brief medical history, the Rose Angina Questionnaire (RAQ), a questionnaire to assess a history of nervios and associated symptoms, and the PRIME-MD, a validated brief questionnaire to diagnose DSM-IV defined affective disorders.
  
  
  RESULTS
  The average age of the 114 participants (38 men and 76 women) was 57 years, and the average educational attainment was 7 years. Overall, 50% of participants reported a history of chronic nervios, and 14% reported an acute subtype known as ataque de nervios. Only 2% of patients had DSM-IV defined panic disorder, and 59% of patients had a positive RAQ score (ie, Rose questionnaire angina). The acute subtype, ataque de nervios, but not chronic nervios, was related to an increased probability of having Rose questionnaire angina (P=.006). Adjusted for covariates, a positive history of chronic nervios, but not Rose questionnaire angina, was significantly associated with a normal cardiac test result (OR=2.97, P=.04).
  
  
  CONCLUSIONS
  Nervios is common among Hispanics with symptoms of cardiac disease. Additional research is needed to understand how nervios symptoms differ from chest pain in Hispanics and the role of nervios in referral for cardiac workup by primary care providers and emergency room personnel.
authors.affiliation: Baylor College of Medicine, Department of Family and Community Medicine, Houston, Texas 77098-3926, USA. vpavlik@bcm.tmc.edu
authors.forename: Valory N
authors.initials: VN
authors.lastname: Pavlik
authors.forename: David J
authors.initials: DJ
authors.lastname: Hyman
authors.forename: Juliet A
authors.initials: JA
authors.lastname: Wendt
authors.forename: Claudia
authors.initials: C
authors.lastname: Orengo
mesh_terms: D000208:Acute Disease; D002637:Chest Pain / Q000208:ethnology*; D002908:Chronic Disease; D005080:Exercise Test; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000208:ethnology*; D015999:Multivariate Analysis; D015995:Prevalence; D013577:Syndrome; D013781:Texas / Q000453:epidemiology