title: Cross-cultural study of idioms of distress among Spanish nationals and Hispanic American migrants: susto, nervios and ataque de nervios.
abstract: OBJECTIVE
  Susto (fright), nervios (nerves) and ataque de nervios (attack of nerves) are idioms of distress widely experienced amongst Hispanic Americans, often associated with psychiatric disorders. This study explores understanding of these idioms of distress and attitudes to help seeking amongst indigenous Spanish and Hispanic American residents in Spain.
  
  
  METHODS
  A population survey was undertaken in four adult education centres in Spain. Hypothetical case vignettes of individuals suffering from the idioms of distress were used to investigate understanding and help seeking by a Spanish sample compared with Hispanic American migrants to Spain. 350 questionnaires were obtained (94.6% response rate).
  
  
  RESULTS
  The idioms ataque de nervios and nervios were recognised by the majority of the Spanish group but by significantly more of the Hispanic American migrants. However, susto was infrequently recognised by the Spanish group but it was recognised by half of the Hispanic Americans. Hispanic Americans were also more likely to recommend consultation with a psychiatrist/psychologist than Spanish respondents for ataque de nervios and nervios. The Spanish group were more likely to recommend non-medical sources of support such as relatives and priest than Hispanic Americans. Hispanic Americans, more recently arrived, did not show greater recognition of the three idioms than those who have been in Spain longer. Regression analysis showed that being Hispanic American and having lower educational attainment was associated with greater use of susto.
  
  
  CONCLUSIONS
  The study suggests that people hold multiple models of distress and disorder. This may influence clinical presentations and help seeking behaviour in Spanish as well as Hispanic American populations.
authors.affiliation: Research Department of Mental Health Sciences, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK. duravila@doctors.org.uk
authors.forename: Glòria
authors.initials: G
authors.lastname: Durà-Vilà
authors.forename: Matthew
authors.initials: M
authors.lastname: Hodes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000208:ethnology / Q000523:psychology*; D001294:Attitude to Health; D003431:Cross-Cultural Comparison; D005260:Female; D015438:Health Behavior; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007802:Language; D008297:Male; D001523:Mental Disorders / Q000208:ethnology / Q000523:psychology*; D008875:Middle Aged; D011159:Population Surveillance; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000523:psychology / Q000706:statistics & numerical data; D014481:United States / Q000208:ethnology; D044465:White People / Q000523:psychology*; D055815:Young Adult