title: Psychiatric comorbidity and acculturation stress among Puerto Rican substance abusers.
abstract: BACKGROUND
  Although acculturation to the United States has been associated with an increase in substance, mood, and anxiety disorders in Latino populations, few studies have examined this concept relative to comorbidity among these syndromes.
  
  
  METHODS
  This study compares the prevalence and patterns of psychiatric comorbidity among Puerto Ricans with substance use disorders living in San Juan (Puerto Rico) to those who have migrated to New Haven (Connecticut) and examines the association between acculturation-related stress and the prevalence and patterns of psychiatric comorbidity among those who have migrated to New Haven.
  
  
  RESULTS
  Lifetime levels of nearly all comorbid psychiatric disorders among respondents with substance use disorders were generally similar across sites. However, the risk of any co-occurring psychiatric disorder was higher among substance use disorder cases in New Haven who reported high levels of total acculturation stress and family-specific acculturation stress. These findings were generally accounted for by associations between affective disorders and high scores on these indicators of acculturation stress.
  
  
  CONCLUSIONS
  The overall prevalence and patterns of psychiatric comorbidity are remarkably similar among Puerto Rican substance abusers whether they live in San Juan or have migrated to New Haven, thereby demonstrating robustness to differences in geographic location. Nevertheless, the degree of acculturation-related family stress is positively associated with co-occurring substance and psychiatric disorders, particularly affective disorders. Intervention in family strain related to the acculturation process may diminish the development of comorbid mental disorders and assist in implementing successful treatment of substance abuse.
authors.affiliation: Division of Clinical Neuroscience and Behavioral Research, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-9589, USA. kconway@nida.nih.gov
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Conway
authors.forename: Joel D
authors.initials: JD
authors.lastname: Swendsen
authors.forename: Lisa
authors.initials: L
authors.lastname: Dierker
authors.forename: Glorisa
authors.initials: G
authors.lastname: Canino
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Merikangas
mesh_terms: D000069:Acculturation; D000328:Adult; D015897:Comorbidity; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D011647:Puerto Rico / Q000208:ethnology; D013315:Stress, Psychological / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*