The relationship of race and ethnicity to the etiology and prevalence of mental disorders has been of great interest historically and in the present. From the late 1800s through the middle of the 20th century, both race and ethnicity, usually identified by national origin, were largely seen as constitutional influences on mental health. As we come forward to the present, studies of race and ethnicity have become increasingly linked to the study of ethnic minorities, and particularly those designated as underserved by the mental health services system. In examining race and ethnicity, we will attempt to examine some of the earlier ideas that link national origins and particularly immigration experience to the processes that operate within American society. It is clear that neither race nor ethnicity operate solely or even substantially as constitutional factors in the formation of mental disorders.

Thus any discussion of race or ethnicity with regard to most mental disorders in the United States should include a discussion of culture and the historical

Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations Copyright © 2000 by Academic Press. All rights of reproduction in any form reserved.

experiences of peoples who have come freely or have been brought to this country. Such a discussion should also take into account the range of current experiences, such as acculturation, socioeconomic status, poverty, discrimination, and minority status as well as many individual experiences that may or may not be influenced by group membership. Among these is the availability of treatment for those becoming ill. Thus the prevalence of disorder in a group is a result of many different influences that can only partially be attributed to the group identity. This ambiguity has resulted in many conflicting results and the need for a great deal of caution in interpreting any proffered finding of ethnic or racial differences. We will also see that the results of ethnic comparisons are strongly influenced by research methodologies that have variously relied on treatment records or direct assessments in communities, on sampling methods that compare groups of similar or vastly differing social and economic backgrounds, and on assessment methodologies that may or may not take into account the culture and beliefs about mental health of those being surveyed.

In this chapter we will generally conform to a convention that substitutes current usage for designation of ethnic or racial groups. Thus we will generally refer to persons of African descent as African American or black, although historically studies have used different conventions. The term Hispanic will encompass multiple Spanish-speaking groups, sometimes called Chicano or La Raza, unless the particular studies designate persons of Mexican, Puerto Rican, or Cuban heritage, usually with "-American" appended to differentiate residents of the United States from nationals of the various countries of origin. Asian American will be used as the generic term to refer to persons with cultural origins in Asia, although the vast differences among countries in culture and national origin must be recognized. Native American will be used to include the many tribes of American Indians as well as Aleut, Inuit, and Eskimo peoples. The largest group of persons in the United States, those generally of Caucasian race and European origin will be designated as White or Anglo because European American is too cumbersome and fails to convey a sense of the degree to which the "melting pot" versus "salad bowl" views of these groups apply. Apologies are made in advance to all those who would not choose to be categorized in such a limited scheme, which divides humanity excessively while not capturing the richness of diversity.

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