When psychologically distressed Hispanics enter the mental health service system, they are likely to confront """"""""cultural distance"""""""" stemming largely from language and ethnic differences between themselves and mainstream service providers. A common allegation in the Hispanic mental health literature is that biases intrude into psychiatric evaluation because of such cultural distance. However, studies have been atheoretical, limited in focus on symptom severity (not diagnosis), and have produced methodologically unsound and equivocal findings. The proposed research focuses on 384 adult first-generation, Spanish- dominant Puerto Rican patients to examine the impact of cultural distance on psychiatrists' judgments of symptom severity and DSM-III-R diagnoses rendered in structured interviews as compared with the customary clinical practice of unstructured interviews. The study's first aim is to determine the independent and interactive effects of interview language (English or Spanish) and interviewer ethnicity (Hispanic or nonHispanic) on psychiatric evaluations while controlling for selected individual differences among patients. The study is theoretically driven by the second aim; i.e., to examine how behavior emerging in the interaction between patient and clinician mediates between cultural distance and psychiatric evaluations. Patients will be screened upon intake into a psychiatric hospital and matched on sex, type of disorder and other individual differences. Matched patients will be randomly assigned to the Language by Ethnicity situations and interviewed twice by bilingual psychiatrists, who will rate symptoms and diagnose using the structured interviewor customary practice. Videotapes of verbal and nonverbal interview behavior will be content analyzed and a conceptual model of the interview process will be tested through structural equation modeling. The study seeks to overcome the theoretical and methodological limitations of previous research on how cultural distance directly affects psychiatric evaluations and to uncover mediating processes linking cultural distance to psychiatric evaluations.
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