The Effect of Acculturation and Immigration on the Victimization and Psychological Distress Link in a National Sample of Latino Women

Abstract

Distinct bodies of research have examined the link between victimization and psychological distress and cultural variables and psychological health, but little is known about how cultural variables affect psychological distress among Latino victims. Substantial research has concluded that Latino women are more likely than non-Latino women to experience trauma-related symptoms following victimization. In addition, examination of different types of cultural adaptation has found results supporting the idea that maintaining ties with one’s culture of origin may be protective against negative mental health outcomes. The present study evaluates the effect of victimization, immigrant status, and both Anglo and Latino orientation on psychological distress in a national sample of Latino women. Results indicate that along with the total count of victimization experiences, Anglo and/or Latino orientation were strong predictors of all forms of psychological distress. Anglo orientation also functioned as a moderator between victimization and psychological distress measures for anger, dissociation, and anxiety. The results suggest a more nuanced and complex interaction between cultural factors, victimization, and psychological distress.

Keywords

interpersonal violence Latinas acculturation SALAS immigrant

Interpersonal violence is a common form of victimization among women, with approximately one in four women experiencing some type of interpersonal violence in their lifetime (World Health Organization, 2005). Research has shown that more than 50% of Latino women are exposed to some form of interpersonal violence during their lifetime (Cuevas, Sabina, & Milloshi, in press; Tjaden & Thoennes, 2000). Considering that Latinos comprise the largest and fastest growing ethnic minority population in the United States (Pew Research Center, 2005), the issue of interpersonal victimization among this group is a significant one. Although research on the effects of interpersonal violence among Latino women has increased in recent years, this is still a substantially understudied area, leaving us with gaps in the literature and important research questions.

In addition, the evaluation of the link between victimization and psychological distress among Latinos has been limited. An extensive body of research has examined the association between victimization and various psychological distress variables among adult women showing that interpersonal victimization has been associated with depression, anxiety, posttraumatic stress disorder (PTSD), dissociation, low self-esteem, and substance abuse (Basile, Arias, Desai, & Thompson, 2004; Briere & Conte, 1993; Briere & Elliott, 2003; Briere & Jordan, 2004; Golding, 1999; Goodman, Koss, Fitzgerald, & Russo, 1993; Hanson, 1990; Saunders, Villeponteaux, Lipovsky, Kilpatrick, & Veronen, 1992). However, much of this research has neither focused on Latino women nor taken into account cultural factors salient to Latinos.

The Sexual Assault Among Latinas (SALAS) study was developed with the limitations and gaps of previous research in mind to examine various forms of interpersonal violence among Latino women in the United States. One of the major goals of the SALAS study was to examine psychological symptomatology and its relationship with victimization experiences. The goals of the current analysis are to evaluate the role of victimization and cultural factors, specifically acculturation and immigrant status, on psychological distress and to assess the relationship of cultural factors on the link between victimization and psychological distress.

Victimization and Psychological Distress Among Latino Women

A growing area of research within the literature on victimization and psychological distress among Latino populations is the issue of multiple victimization experiences. This has been termed polyvictimization (Finkelhor, Ormrod, & Turner, 2007), multitype maltreatment (Higgins & McCabe, 2000), or complex trauma (Herman, 1992), with each generally describing the experience of multiple different forms of victimization or prolonged victimization experiences. Most research on Latino women to date has focused on specific forms of victimization, such as sexual assault or intimate partner violence, or on a single victimization incident (Cuevas et al., in press). Research has shown, however, that women who have experienced multiple episodes of violence (regardless of type of violence) are more likely to experience PTSD symptoms, poorer adjustment, less stable lifestyles, sexual disorders, depression, and suicide attempts (Arata, 1999; Banyard, Williams, & Siegel, 2001; Ellis, Atkeson, & Calhoun, 1982; Maker, Kemmelmeier, & Peterson, 2001; Miller et al., 1978; Miner, Flitter, & Robinson, 2006; Nishith, Mechanic, & Resick, 2000). Studies examining Latino samples have found results consistent with the broader literature. In a study on multiple childhood victimizations and psychological distress, Latino women who had experienced multiple childhood victimizations were prone to more negative outcomes (Clemmons, DiLillo, Martinez, DeGue, & Jeffcot, 2003). A more recent study of victimization and psychopathology using the SALAS data found that Latinas with multiple victimization experiences were at significantly increased risk of experiencing psychopathology (Cuevas, Sabina, & Picard, 2010). Given this evidence, evaluating the impact of victimization on psychological distress needs to assess the full scope of victimization experiences.

Substantial research has concluded that Latino women are more likely than non-Latino women to experience trauma-related symptoms following victimization. Latino women who have been victims of domestic violence and sexual abuse are more likely than non-Latino women to experience greater levels of depression and lower self-esteem (Edelson, Hokoda, & Ramos-Lira, 2007; Sanders-Phillips, Moisan, Wadlington, Morgan, & English, 1995) and experience distress symptoms for longer periods of time than their non-Latino counterparts (Pole, Best, Metzler, & Marmar, 2005). Several cultural factors have been hypothesized to play a role in these increased levels of psychological distress among Latina victims, including the dominant male role and submissive female role in Latino families, the values instilled in Latino youth such as respecting one’s parents, and religious views supporting virginity among unmarried females (Levy, 1988; Morrow & Sorell, 1989; Sanders-Phillips et al., 1995). The gender roles present in Latino families may also lead some Latino women to develop accepting attitudes about abuse, perhaps preventing them from seeking help. Similarly, the cultural values emphasized in Latino families may also prevent victims from outwardly dealing with the problems of abuse, potentially exacerbating trauma symptoms (Morrow & Sorell, 1989; Sanders-Phillips et al., 1995).

However, not all research has found that Latino women are more prone to psychological distress than other ethnic groups following interpersonal victimization. Some research has found no difference in PTSD and depression symptoms between Latino, White, and African American women (Mennen, 1995), whereas others have found an opposite effect, with Latino women who have been victims of childhood sexual abuse or intimate partner violence developing less severe symptoms of psychological distress and PTSD than non-Latino victims (Andrés-Hyman, Cott, & Gold, 2004; Newcomb, Munoz, & Carmona, 2009; Torres & Han, 2000). In this case, the large social support networks of Latino women have been hypothesized to function as a protective factor against the negative sequelae of abuse (Andrés-Hyman et al., 2004; Axelrod, Myers, Durvasula, Wyatt, & Cheng, 1999).

Furthermore, recent findings have suggested that Latino victims present different symptom profiles than non-Latino victims. Some have hypothesized that higher levels of PTSD in Latinos are due to the fact that they display more “positive” symptoms (e.g., excess of normal functions such as hypervigilance) as opposed to negative symptoms (e.g., a deficit in normal functioning; Marshall, Schell, & Miles, 2009) or that differences in severity may actually reflect expressive style rather than true severity of symptoms (Ortega & Rosenheck, 2000). The conflicting results of this body of literature call for additional research in this area to better understand the relationship between victimization and psychological distress among Latinas.

Cultural Factors and Psychological Distress

Immigrants face many challenges while trying to adjust to life in a new country. With this in mind, it was originally hypothesized that immigrants would display higher levels of psychological distress than their U.S.-born counterparts. Research examining the psychological well-being of Latino immigrants, however, has shown what is called the immigrant paradox. Immigrants generally exhibit similar, or even better, mental health than U.S.-born Latinos (Burnam, Hough, Karno, & Escobar, 1987; Ortega, Rosenheck, Alegria, & Desai, 2000; Vega et al., 1998), showing that maintaining cultural traditions may lead to better psychological outcomes. This may be a result of avoiding the potential stressors associated with adapting to new cultural norms and expectations (e.g., by living in ethnic enclaves) or the comforting effect of maintaining cultural traditions during the changes associated with engaging within a different culture.

Building on the literature of the immigrant paradox, researchers have examined key determinants of adjustment in immigrant groups. One of these variables, acculturation, refers to the cultural changes that result at both the group level and the individual psychological level from sustained contact between two or more distinct cultures (Berry, Trimble, & Olmedo, 1986). In past research, acculturation has been viewed as a unidimensional process in which members of an immigrant group adopt the attitudes and values of the dominant group (Coatsworth, Maldonado-Molina, Pantin, & Szapocznik, 2005). Early studies used preferred language, generational status, immigrant status, time residing in the United States, or some combination of these factors (Cabassa, 2003; Griffith, 1983; Ortiz & Arce, 1984; Vega, Warheit, & Meinhardt, 1984) as proxy measures for acculturation. More recently, however, acculturation has been viewed as a multidimensional process where one maintains aspects of their culture of origin while also adopting views and practices of the new culture (Berry, 1997; Cabassa, 2003; Coatsworth et al., 2005; Rogler, Cortes, & Malgady, 1991) as well as developing acculturation across various domains including behavioral practices, values, and identification (Schwartz, Unger, Zamboanga, & Szapocznik, 2010).

Examination of different types of cultural adaptation has found results supporting the idea that maintaining ties with one’s culture of origin may be protective against negative mental health outcomes. Higher levels of “Americanism” or Anglo orientation have been related to negative outcomes for Latino immigrants, including substance abuse, depression, phobias, and PTSD (Burnam, Hough, Escobar, & Karno, 1987; Kaplan & Marks, 1990; Ortega & Rosenheck, 2000). Biculturalism, however, has been associated with lower rates of these problems, the best adaptive patterns, and higher levels of competence, adjustment, and achievement styles in Latino immigrant youth (Birman, 1998; Coatsworth et al., 2005; Gomez & Fassinger, 1994; Szapocznik, Kutines, & Fernandez, 1980).

There are few studies that examine how cultural adaptation affects distress among victims of violence. The limited number of studies on this topic has used both unidimensional and multidimensional measures of acculturation with mixed results. A study using preferred language as a measure of acculturation found that higher levels of acculturation were associated with lower levels of peritraumatic dissociation in victims of community violence (Marshall & Orlando, 2002). Another study using a similar measure of acculturation found that Latino middle school students with higher English language fluency reported being exposed to more violence and also reported higher levels of PTSD symptoms than students with lower levels of fluency (Kataoka et al., 2009). Although these two studies possess measurement limitations in their operationalization of acculturation, a more recent study using a multidimensional measure of acculturation supports the findings that higher levels of Anglo orientation may be associated with more severe psychological symptomatology among victims of peer violence (Bauman & Summers, 2009). Results indicated that Anglo-oriented participants exhibited more depressive symptoms than their bicultural counterparts. Overall, these studies show that cultural factors are likely to play a role in symptomatology or emotional expression associated with victimization.

An aspect that is absent in these studies is the exploration of possible interactions between victimization and cultural variables in their relationship to psychological distress. Given some evidence that suggests that cultural variables are associated with victimization (Brown et al., 2003; Caetano, Schafer, Clark, Cunradi, & Raspberry, 2000; Frias & Angel, 2005; Garcia, Hurwitz, & Kraus, 2005; Harris, Firestone, & Vega, 2005) as well as psychological distress (Burnam, Hough, Karno, et al., 1987; Ortega et al., 2000; Vega et al., 1998), it would follow that interaction effects might be present when evaluating the role of cultural variables on psychological distress. In essence, this would allow for the examination of a potential moderating effect by cultural variables in the relationship between victimization and distress. Although this would be an exploratory assessment of the role of cultural variables, the limited empirical evidence indicates that this merits attention, as it may address potentially more nuanced aspects of the interplay between these variables.

The Present Study

It is clear from the literature on Latinos, psychological distress, and victimization that many questions regarding the relationships among these variables still remain. Distinct bodies of research have examined the link between victimization and psychological distress and cultural variables and psychological health, but little is known about how cultural variables affect psychological distress among Latino victims. In addition, although different types of violence (e.g., community or peer violence) and exposure to violence have been studied, research has not examined Latino women victims of interpersonal violence. The goal of the present analysis is to use data from the SALAS study to bridge the gap in the literature among cultural variables, psychological distress, and victimization experiences. Most research on the mental health of Latino samples has not incorporated victimization, but some research has indicated that cultural variables may be important predictors of mental health among Latino victims (Bauman & Summers, 2009; Kataoka et al., 2009; Marshall & Orlando, 2002). The current analysis adds to this research by evaluating the effect of victimization, immigration status, and both Anglo and Latino orientation on psychological distress in a national sample of Latino women. In addition, the analysis will incorporate interaction effects, to evaluate the moderating effect of cultural variables.

The present study will not only bridge a gap in the literature but also address limitations of previous research in both areas. As mentioned, the SALAS study uses a national sample to address the questions at hand. Most prior studies have used community-based and geographically restricted samples (e.g., Bauman & Summers, 2009; Clemmons et al., 2003; Coatsworth et al., 2005; Kataoka et al., 2009; Marshall & Orlando, 2002; Marshall et al., 2009; Sanders-Phillips et al., 1995), limiting the generalizability of the results. In addition, we deployed a measure of acculturation that takes into account both Anglo and Latino culturally based behavior, and given the potential complexity of the relationship among these variables, we evaluate both direct effects and interactions to provide a more nuanced analysis of the role of victimization and cultural variables on psychological distress.

Method

Participants

This analysis uses data from the SALAS study, designed to understand a range of interpersonal victimization experiences, including prevalence, help-seeking responses, and associated psychosocial ramifications, among Latino women. The study, conducted between May and September 2008, assessed the victimization experiences of a national sample of 2,000 Latino women living in the United States. The interviews were conducted over the phone using computer-assisted telephone interviewing (CATI) in either English or Spanish by trained professionals from an experienced survey research firm. The minimum response rate (i.e., ratio of completed and screen-out interviews to complete, screen-outs, partial interviews, refusals, break-offs, and no contact) for the sample was 30.7%, while the minimum cooperation rate (i.e., ratio of completed and screen-out interviews to complete, screen-outs, partial interviews, refusals, and break-offs) was 53.7%. Detailed description of the response rate calculations can be obtained from the final technical report (Cuevas & Sabina, 2010), which follows the standard definitions for response rates established by the American Association for Public Opinion Research (2009).

The study entrance criteria required that participants be women above the age of 18 who self-identified as Latino (either foreign- or U.S.-born) and whose primary language was either English or Spanish. The total sample consisted of 2,000 participants with the majority of participants (90%) living in high-density Latino areas (80% or higher) based on Census 2000 data. The average age of the participants was 47.76 years. Approximately, 62% of the sample had a high school education or above. The majority of participants (61%) were U.S. citizens (either U.S.-born or naturalized), with a small proportion of the sample not reporting any legal status and thus considered undocumented (4.7%). Approximately, 56% of the participants were married, with smaller percentages for cohabitating (7.6%), divorced (10.1%), and widowed (10.1%). Victimized and nonvictimized participants differed significantly across all demographic variables, with victimized women being significantly younger, having higher levels of education, being more likely to be employed, and having a higher household income. Detailed sample descriptives are presented in Table 1.

Table 1.

Sample Descriptives (N = 2,000)

	M	SD	Range
Age	47.76	16.24	18-95
Anglo orientation	3.14	0.95	1-5
Latino orientation	4.23	1.02	1-5
TSI Scale scores
Depression	49.18	9.51	38-82
Anger	48.27	10.13	37-86
Dissociation	50.65	11.91	39-99
Anxiety	50.64	11.45	35-82
	n	%
Victimization count
0	1,130	56.5
1	321	16.1
2	182	9.1
3	146	7.3
4	105	5.3
5+	116	5.8
Education level
Less than high school	760	38.3
High school grad/GED	495	24.9
Some college/trade school	278	14.0
2-year college graduate	137	6.9
4-year college graduate	205	10.3
Some graduate school	25	1.3
Graduate degree	84	4.2
Immigration status
U.S.-born citizen	549	28.5
Naturalized citizen	628	32.6
Permanent resident	533	27.7
Current visa	80	4.2
Refugee/asylum	2	0.1
Awaiting status	44	2.3
None of the above/undocumented	91	4.7
Preferred language
English	379	19.1
Spanish	1,518	76.4
Both Spanish and English	87	4.4
Other	3	0.2
Relationship status
Single (never married)	261	13.2
Married	1,115	56.3
Cohabitating/committed relationship	151	7.6
Divorced	199	10.1
Widowed	200	10.1
Other	54	2.7
Employment status
Employed full-time	548	27.7
Employed part-time	217	11.0
Unemployed	197	9.9
Retired	250	12.6
Homemaker	585	29.6
Other (students, public assistance, etc.)	181	9.1
Household income
Below US$9,999	367	26.1
US$10,000-US$19,999	366	26.0
US$20,000-US$29,999	229	16.3
US$30,000-US$39,999	133	9.4
US$40,000-US$49,999	95	6.7
US$50,000-US$59,999	57	4.0
US$60,000-US$69,999	39	2.8
US$70,000-US$79,999	30	2.1
US$80,000 or more	92	6.5
Sexual orientation
Straight/heterosexual	1,926	98.7
Lesbian	13	0.7
Bisexual	13	0.7

The sample, for both immigrants and nonimmigrants, was predominantly of Mexican descent (89.5% and 67.1%, respectively). In comparison with U.S. Census figures, our sample is somewhat older, more educated, with the sample having a greater proportion of individuals of Mexican or Cuban background, less likely to be U.S.-born or a naturalized citizen, and approximately on par in regard to marital status. For detailed demographic comparison between this sample and national census figures as well as detailed ethnic background, readers should see Cuevas et al. (in press).

Measures

Demographic information

Participant background information consisted of personal characteristics including age, country of origin, immigrant status (i.e., whether someone was born in the United States or not), preferred language, sexual orientation, educational level, employment status, household income, housing status, and relationship status.

Lifetime Trauma and Victimization History Instrument (LTVH)

The LTVH evaluates lifetime trauma and victimization history in reference to 30 various traumatic experiences (Widom, Dutton, Czaja, & DuMont, 2005). The full version of the LTVH includes questions about natural disasters, combat experience, property loss, interpersonal violence, and witnessed victimization. As the focus of this study was on interpersonal victimization, we limited LTVH questions to stalking, physical assaults, weapon assaults, physical assaults in childhood (with a small wording change from the original LTVH), threats, threats with weapons, sexual assault, attempted sexual assault, sexual fondling, and witnessed victimization. Each affirmative incident on the LTVH was followed up with questions regarding the age of occurrence, duration, frequency, perpetrator, injury, and posttraumatic reaction (e.g., being in danger of death or serious injury and experiencing intense fear, helplessness, or horror). Furthermore, due to the national backgrounds of the study participants, participants were asked whether the victimization took place while the participant lived in the United States. For each affirmative victimization type, respondents were asked if anyone else ever did that to them. If so, respondents completed a second loop with regard to the victimization type. Due to time constraints in the survey, only the follow-up questions of age of occurrence and number of times were asked for witnessed violence questions with no second loops pursued. All questions on the LTVH are behaviorally anchored and do not ask the participant whether they characterize the experience as being abusive. The questions for each victimization incident were then consolidated into five categories: physical assaults, sexual assaults, stalking, threat victimization, and witnessed victimization. A “victimization” is operationalized as having experienced victimization in one of the consolidated categories within a developmental period (i.e., either in childhood or adulthood). Total victimization is therefore a count of each “victimization” as described. For example, someone who was physically and sexually assaulted in childhood would have a total of two victimizations, whereas someone who was physically and sexually assaulted in childhood and then revictimized by being physically assaulted in adulthood would have a total of three victimizations. The original LTVH found adequate predictive, criterion, and convergent validity (Widom et al., 2005).

Trauma Symptom Inventory (TSI)

The TSI is a 100-item instrument that evaluates posttraumatic and trauma-related symptomatology in adults. The TSI consists of 3 validity scales and 10 clinical scales (Briere, 1995). Each item asks about the frequency of occurrence of each symptom on a 4-point Likert-type scale ranging from 0 (never) to 3 (often). The TSI has been normed with men and women above the age of 18. For the purposes of this study, only the Anxious Arousal, Depression, Anger/Irritability, and Dissociation scales were used. These scales have been found to have excellent reliability, with alphas ranging between .82 (Dissociation) and .91 (Depression; Briere, 1995; Briere, Elliott, Harris, & Cotman, 1995). Reliability (Cronbach’s alpha) of the TSI scales for our sample was .86 for Anxious Arousal, .86 for Depression, .89 for Anger/Irritability, and .86 for Dissociation. Validity has also been supported for the TSI across various samples (Briere, 1995; Briere et al., 1995; McDevitt-Murphy, Weathers, & Adkins, 2005). All scale raw scores were converted to their published T-scores, where scores of 65 or above are considered to be clinically significant (Briere, 1995).

Brief Acculturation Rating Scale of Mexican Americans–II (Brief ARSMA-II)

The Brief ARSMA-II assesses both minority and majority cultural identity (Bauman, 2005) and includes items from the complete ARSMA-II (Cuellar, Arnold, & Maldonado, 1995). Participants report the degree to which each statement accurately describes them on a scale of 1 (not at all) to 5 (almost always). The items include linguistic ability (e.g., “I speak Spanish”) and preference (e.g., “My thinking is done in the English language”), as well as personal associations (e.g., “I associate with Anglos”). Both the Anglo Orientation and Mexican Orientation scales are composed of six nonoverlapping items. The instrument is often used with the Latino population in general (Cuellar et al., 1995) and none of the items refer to Mexican culture in particular. Therefore, we will refer to Mexican Orientation as Latino Orientation throughout the article. Reported alpha coefficients for the Mexican Orientation Scale and the Anglo Orientation Scale on a sample of middle school and elementary school students were .91 and .73, respectively. Acculturation score also significantly correlated to language chosen to respond to the scale. For our sample, we found high internal consistency (alpha) for both the Anglo Orientation Scale (.78) and Mexican Orientation Scale (.86).

Procedures

The participants were contacted using Random Digit Dial (RDD) telephone survey methodology targeted to high-density Latino areas in the United States based on Census 2000 tracts and were interviewed using a CATI system. In an RDD sample, a listing is constructed of all one hundred block numbers or the first 8 digits of a 10-digit phone number (e.g., 202-571-12XX) to which residential numbers are assigned. A random sample of these hundred blocks is drawn. This constitutes the first stage in the probability sample. The second stage involves creating the full 10-digit telephone number by adding two randomly generated digits to the end of the hundred-block prefix. For SALAS, the sample was stratified based on the Latino household density for the hundred blocks, so that a random sample of all blocks meeting the density criteria was drawn, from which then the random dialing was conducted to those blocks, resulting in a stratified random sampling procedure. Telephone interviewing has been found to be comparable with in-person interviews in its reliability and validity (Bajos, Spira, Ducot, & Messiah, 1992; Bermack, 1989; Czaja, 1987; Martin, Duncan, Powers, & Sawyer, 1989). CATI methodology provides a number of benefits, including the minimization of errors, substantial quality control, and a smoother flowing interview. The interviews were conducted by a survey research firm with bilingual capabilities and extensive experience performing surveys that ask about sensitive subjects (e.g., interpersonal violence). The interviewers were specifically trained on the SALAS survey and closely supervised during the data collection process. Only female interviewers were used because previous surveys (e.g., NVAW, Tjaden & Thoennes, 2000) showed that potential respondents were more likely to participate in the study if the interviewer is a woman. An initial attempt and four callbacks were made to reach a specific household, and then an additional three calls were made once a case was reached until final disposition was obtained (e.g., a completed survey or refusal). On average, the interviews lasted 28 min.

An adult respondent at each number was asked about the total number of age-eligible Latino females in the household. If there was only one eligible individual, that individual was asked to participate. If there was more than one eligible participant, then the “most recent/next birthday” method was used to decide which individual to interview. In this method, interviewers asked the respondent whose birthday was the most recent or the next closest to the date of the phone interview. This is a widely used procedure because it permits unbiased systematic selection of respondents (Salmon & Nichols, 1983). Participants were asked whether they preferred to conduct the interview in English or Spanish, with 72% of participants choosing to respond in Spanish. If the interviewer was bilingual, she would interview the participant in their preferred language; if the interviewer was only English-speaking and the participant chose Spanish, the participant was called back by one of the bilingual interviewers.

Once a respondent was selected, they were read the informed consent and asked if they were willing to participate in the study. If they agreed to participate, they were interviewed at the current time or asked if they wished to be called back at a more convenient time. Participants were then asked the various study instruments which included questions about state of social issues, demographic information, acculturation, lifetime victimization, help-seeking behaviors, religiosity, gender role ideology, psychological symptoms, and posttraumatic symptoms. All instruments had been translated into Spanish for the study, with the exception of those that already had established versions in Spanish. On completing the survey, participants were asked if they felt distressed and were offered a support hotline or callback to follow up with them. On follow-up calls, it was ensured that the individual was no longer distressed and they were provided with additional support information if needed (e.g., local social service agencies, etc.). Approximately, 1% of the sample required follow-up. After completing the survey, participants were paid US$10 for their participation. The institutional review board (IRB) of Northeastern University authorized all study procedures with subsequent analyses also being approved by the IRB of the Pennsylvania State University.

Analysis Strategy

Prior to conducting the analyses, interaction variables were constructed for use in the regression models. Total victimization, Anglo orientation, Latino orientation, and immigrant status were standardized (converted to z scores) and then each standardized cultural variable (acculturation types and immigration) was multiplied by the standardized victimization variable to create three interaction terms for use in the regression models. This process of standardizing variables (or centering) prior to creating the interaction terms helps prevent multicollinearity problems when including interaction terms in regression models (Aiken & West, 1991).

Correlations were then conducted to evaluate the bivariate relationships between the independent variables and dependent variables in the models. Hierarchical (sequential) regressions were then conducted to evaluate the impact of victimization and cultural variables on each of the psychological distress variables. In all the models, the first step of the regression included victimization, being an immigrant, Anglo orientation, and Latino orientation as predictors. In the second step, the interaction terms were entered in the model. This hierarchical approach allows us to evaluate the change in the models from entering only main effects to entering the main effects and the interaction terms. All regression analyses control for participant age and socioeconomic status. Socioeconomic status was calculated by converting education and household income variables into z scores, adding those values, and then restandardizing the summed values. All analyses were conducted using Stata 11 statistical software package (StataCorp, 2011).

Results

On average, the women in the sample had 1.12 (SD = 1.70) victimizations, with 43.5% of the sample having experienced at least one victimization incident.¹ Average TSI scores ranged from 49.18 (Depression) to 50.65 (Dissociation). For the full sample, 8.9% of the women had clinically significant Depression scores, 9.0% for Anger, 14.0% for Dissociation, and 12.9% for Anxiety. Detailed variable descriptives are presented in Table 1.

Bivariate Relationships

Bivariate results show that Anglo orientation is positively associated with both Anger (r = .13, p < .001) and Dissociation (r = .05, p < .05), meaning that Latino women with higher Anglo orientation had higher levels of anger and dissociation. Latino orientation is negatively associated with Anger (r = –.09, p < .001), showing that women with higher Latino orientation tended to have lower levels of anger, while it is also associated with increased levels of anxiety (r = .05, p < .05). Women who were immigrants to the United States tended to have lower levels of anger (r = –.11, p < .001). For all of the dependent variables, total victimization had the strongest bivariate relationships, with rs ranging from .17 to .26 (all ps < .001). Detailed bivariate correlation results are presented in Table 2.

Table 2.

Bivariate Correlations for Variables in the Regression Models (N = 1,910)

Variable	1	2	3	4	5	6	7	8	9	10
Age	–
Socioeconomic status	−.11***	–
Anglo orientation	−.12***	.45***	–
Latino orientation	.05*	−.37***	−.42***	–
Immigrant	.11***	−.28***	−.51***	.46***	–
Total victimization	−.19***	.19***	.25***	−.26***	−.23***	–
Depression	.09***	−.12***	.01	−.00	.02	.20***	–
Anger	−.06*	.02	.13***	−.09***	−.11***	.26***	.68***	–
Dissociation	−.02	−.08***	.05*	−.04	−.02	.24***	.75***	.72***	–
Anxiety	.07**	−.08**	.00	.05*	.05*	.17***	.76***	.69***	.74***	–

p < .05. **p < .01. ***p < .001.

Linear Regression Models

Linear regression models first looked to see the relationship of victimization, Anglo orientation, Latino orientation, and immigration status on the four psychological distress variables. In the second step of the regression models, interaction terms were entered into the regressions to evaluate the interaction of victimization with both types of acculturation and immigration status. In the final models, Anglo orientation is a significant unique predictor of depression, anger, and dissociation (β = .05, p = .03; β = .08, p = .004; and β = .06, p = .03, respectively) in addition to total victimization (βs .26, .28, and .29, respectively, all ps < .01). Anxiety, in addition to being significantly predicted by victimization (β = .24, p < .001), is significantly predicted by Latino orientation (β = .06, p = .03).

In examining the interactions effects, depression was not significantly predicted by any of the interactions. Anger (β = –.07, p = .02), dissociation (β = –.06, p = .03), and anxiety (β = –.06, p = .03) were significantly predicted by the Anglo orientation by victimization interaction, indicating that Anglo orientation functions as a moderator for the relationship between victimization and each of the emotional distress variables. This suggests that the relationship between victimization and these psychological distress variables differs as the level of Anglo orientation changes. Detailed regression results are presented in Table 3.

Table 3.

Multiple Regression Models Predicting Psychological Distress (N = 1,910)

	Dependent variables
	Depression				Anger				Dissociation				Anxiety
Predictors	B (SE B)	β	B (SE B)	β	B (SE B)	β	B (SE B)	β	B (SE B)	β	B (SE B)	β	B (SE B)	β	B (SE B)	β
Step 1
Age	0.07 (.01)	.12***	0.07 (.01)	.12***	0.00 (.01)	.00	0.00 (.01)	−.00	0.01 (.02)	.01	0.01 (.02)	.01	0.07 (.02)	.10***	0.07 (.02)	.10***
SES	−1.57 (.24)	−.17***	−1.58 (.24)	−.16***	−0.78 (.26)	−.08**	−0.78 (.26)	−.08**	−1.85 (.30)	−.16***	−1.87 (.30)	−.16***	−1.04 (.29)	−.09***	−1.06 (.29)	−.09***
Total vic.	1.37 (.13)	.25***	1.45 (.14)	.26***	1.45 (.14)	.24***	1.59 (.15)	.28***	1.77 (.16)	.25***	1.99 (.18)	.29***	1.48 (.16)	.22***	1.63 (.17)	.24***
Immigrant	1.17 (.57)	.06*	1.06 (.57)	.05	−0.73 (.61)	−.03	−0.79 (.62)	−.04	0.88 (.73)	.03	0.65 (.72)	.02	1.49 (.69)	.06*	1.31 (.70)	.05
Anglo or.	0.61 (.26)	.07*	0.58 (.26)	.05*	0.86 (.28)	.09**	0.81 (.28)	.08**	0.79 (.33)	.07*	0.72 (.33)	.06*	0.59 (.32)	.05	0.54 (.32)	.05
Latino or.	−0.07 (.26)	−.01	−0.07 (.27)	−.01	−0.04 (.28)	.00	−0.11 (.29)	−.01	−0.27 (.33)	−.02	−0.39 (.33)	−.03	0.69 (.32)	.06*	0.68 (.32)	.06*
Step 2
Imm. × Vic.			0.18 (.23)	.02			−0.07 (.25)	−.01			0.35 (.29)	.03			0.30 (.28)	.03
Ang. or. × Vic.			−0.46 (.26)	−.05			−0.65 (.28)	−.07*			−0.71 (.33)	−.06*			−0.70 (.32)	−.06*
Lat. or. × Vic.			−0.21 (.21)	−.03			0.07 (.23)	.01			0.11 (.27)	.01			−0.24 (.26)	−.03
ΔR²				.00				.00				.01**				.01*
Model R²		.08***		.08***		.08***		.08***		.08***		.08***		.06***		.06***

Note: Variables in Step 1 of the model include age, socioeconomic status, total victimization, immigrant status, Anglo orientation, and Latino orientation. Variables in Step 2 include all variables from Step 1 plus the interaction terms of immigration status and victimization, Anglo orientation and victimization, and Latino orientation and victimization. ΔR² is incremental change from Step 1 to Step 2.

p < .05. **p < .01. ***p < .001.

To specifically evaluate moderator effects, categorizing the moderating variables into varying levels is recommended to be able to determine how the moderating effect works (Tabachnick & Fidell, 2007). Figure 1 shows the B coefficients (raw regression weights) between victimization and each psychological distress variable split by whether someone had a high or low Anglo orientation score (using a mean split). The results indicate that the relationship between victimization and psychological distress is stronger for those with lower levels of Anglo orientation.

Figure 1.

Differences on victimization—distress B coefficients for those with high and low Anglo orientation showing the interaction effects from the regression models

Discussion

Consistent with prior research (Finkelhor et al., 2007; Higgins & McCabe, 2001; Turner, Finkelhor, & Ormrod, 2010), including previous analyses with this sample (Cuevas et al., 2010), the total count of victimization experiences was the strongest predictor of each of the psychological distress variables. However, acculturation also played a significant role in both predicting psychological distress and moderating the victimization–psychological distress relationship. The role of cultural variables was consistent in its impact on symptoms of depression, anger, and dissociation. Specifically, higher Anglo orientation was associated with higher levels of depression, anger, and dissociation, whereas higher levels of Latino orientation was associated with higher levels of anxiety.

For anger, dissociation, and anxiety, Anglo orientation also functioned as a moderator in the regression models. Subsequent analyses examining the moderating effects showed that increased levels of Anglo orientation result in a weaker relationship between victimization and psychological distress. In other words, as levels of Anglo orientation increase, the strength of the relationship between victimization and psychological distress weakens.

A conclusion that can be drawn from these results is that acculturation plays a role in the experience and/or expression of emotions; specifically, the shift and integration into the host culture can result in increased feelings of depression, anger, and dissociation. We suggest three ways of interpreting this result. First, it is possible that increased Anglo orientation contributes to experiencing greater feelings of depression, anger, and dissociation. Perhaps, incorporating components of the host culture makes it more acceptable for Latino women to experience these emotions. Another potential interpretation is that depression, anger, and dissociation are particularly salient emotions associated with the process of adjusting to the social status in the United States. Second, as others have argued, the relationship may be pointing to emotional expression rather than emotional experience (Lewis-Fernandez, 1994; Ortega & Rosenheck, 2000). This would indicate that increased Anglo orientation contributes to Latino women feeling more comfortable in expressing characteristics of depression, anger, and dissociation, which may not be as acceptable in their culture of origin or more culturally endorsed in the United States. Third, the acculturation effect on psychological distress may in part be serving as a proxy for acculturative stress (Williams & Berry, 1991). This notion is consistent with research that has shown a connection between acculturative stress and psychological variables including depression (Torres, 2010) and anxiety (Hovey & Magaña, 2002), as well as other violence-related outcomes (Caetano, Ramisetty-Mikler, Vaeth, & Harris, 2007). These three alternative ways of interpreting these particular results, emotional experience, emotional expression, or acculturative stress are not mutually exclusive and perhaps are, in combination, the reasons why acculturation increases feelings of depression, anger, and dissociation. In contrast, and contrary to what Hovey and Magaña (2002) found, having Latino orientation result in increased levels of anxiety suggests that women who are more connected to their culture of origin are more likely to experience or express feelings of anxiety. This may indicate that anxiety is a more culturally accepted emotion for those who continue to report being connected to their culture of origin, which is to some degree consistent with the culturally bound notion of ataque de nervios (Baer et al., 2003; Hinton, Chong, Pollack, Barlow, & McNally, 2008; Lewis-Fernandez et al., 2002; Schechter et al., 2000).

In evaluating potential moderating effects, the results show a more complex role for Anglo orientation in its relationship to victimization and psychological distress. For anger, dissociation, and anxiety, Anglo orientation functioned as a moderator between victimization and each of these forms of psychological distress. For all three emotional variables, those with higher Anglo orientation had a weaker relationship between victimization and psychological distress. In essence, for these emotions, Anglo orientation attenuates the impact of victimization on anger, dissociation, and anxiety. These results, in conjunction with the direct relationship between Anglo orientation and psychological distress, suggest that even though Anglo orientation contributes to psychological distress, it also provides a protective role on the impact of victimization. There are various explanations for the underlying mechanisms of these relationships. It is possible that increased integration into the Anglo culture is accompanied by the development of coping skills that can positively serve victims of violence in managing the impact of victimization. For example, individuals who are better able to learn the customs of a new culture, learn a new language, and associate more with individuals outside of their cultural group may be psychologically better equipped to manage the impact of victimization.

An alternative interpretation of the moderation effect is that Anglo orientation may be a proxy for other factors that may decrease the impact of victimization. In prior analyses with this data, we have found that Anglo orientation is associated with both overall formal help seeking and informal help seeking, specifically talking to a friend (Sabina, Cuevas, & Schally, 2011). Perhaps, the moderating impact of Anglo orientation is due to the increased likelihood that Latino women with a greater level of acculturation are more likely to be receiving support that can help them manage psychological distress. Hence, the decreased impact of victimization is not directly a function of Anglo orientation, but rather a function of women who are getting therapeutic services or seeking legal remedies, which in turn may attenuate the negative sequelae of their victimization experiences.

A notable result is that neither Latino orientation nor being an immigrant was associated with psychological distress or, in the case of anxiety, Latino orientation was associated with an increased risk of psychological distress. This is contrary to prior research that suggests that maintaining cultural traditions is associated with improved mental health outcomes (Bauman & Summers, 2009; Burnam, Hough, Escobar, et al., 1987; Kaplan & Marks, 1990; Ortega & Rosenheck, 2000). The seemingly contradictory findings may in part be associated with sampling issues, as many of these samples are convenience samples or consist solely of immigrant women and are not a national sample of Latino women. Also, this may be explained due to measurement issues. Prior research has used various methods for measuring acculturation, including preferred language, immigration status, length of time residing in the United States, or some combination of these variables (Cabassa, 2003). Otherwise, the studies that use acculturation instruments often use only measures of the degree of Anglo acculturation and not the level of Latino cultural maintenance. This assumes that acculturation is a unidimensional construct and perhaps oversimplifies how acculturation may function and how it relates to victimization and psychological variables. Schwartz and colleagues (Schwartz et al., 2010) have recently argued that acculturation is a multidimensional process, which would suggest that proxy and/or unidimensional measures may miss key components of acculturation.

There are a number of clinical implications associated with our results. Given the impact of Anglo and Latino orientation on emotional functioning, our findings suggest that the degree of acculturation will play a role in the individual’s emotional experience and expression. In working with Latino women, some evaluation of acculturation should be incorporated, as it may provide insight into how Latino women experience emotions, particularly in the context of victimization. Keeping in mind the moderating effects, one should consider an individual’s Anglo orientation as a potential resource to help attenuate the impact of victimization. Specifically, emotional and behavioral resources that may stem from their integration into Anglo orientation can be explored as potential coping mechanisms to moderate the sequelae of victimization. Consistent with prior results from this study, total victimization count is the strongest predictor of negative psychological outcomes and, as previously reported, usually beyond the impact of any single form of victimization (Cuevas et al., 2010). As such, intervention and prevention efforts need to be made to address victimization among Latino women, specifically by evaluating and addressing the full scope of victimization, recognizing the negative sequalae of multiple victimization experiences, and providing culturally appropriate services to help victims of violence.

Our study points to a number of potential future research directions. In studying victimization, the field needs to continue to expand into examining additional forms of victimization, beyond partner and sexual violence, which have been the focus of much of the research until this point. Furthermore, violence research among Latinos needs to incorporate acculturation in the investigation of the consequences of victimization. This speaks to a number of overall issues that are salient to the study of the Latino community, specifically the issues of cultural influences and beliefs, immigration status, nation of origin, and other culture-specific characteristics that speak to the heterogeneity of this population. Finally, future research should improve on the measurement of acculturation by moving away from proxy measures such as immigration status and preferred language and toward a multidimensional evaluation of acculturation that takes into account the various ways that acculturation has been conceptualized (Schwartz et al., 2010).

There are a number of limitations in this study that merit note. Our research relies on retrospective reports of victimization, which are susceptible to memory deterioration and recall distortion. In addition, the cross-sectional design prevents making causal inferences about the presented relationships, in part, because of temporal ambiguity. Also, telephone methodology that solely targets landlines risks systematically missing younger participants and groups that may be at increased risk of victimization and psychopathology, such as the homeless and transient populations. Finally, sampling from high-density Latino areas may affect the range of acculturation experiences in the sample.

In spite of the limitations, this research contributes to the study of acculturation on psychological distress and the connection between victimization and psychological distress among Latino women, highlighting the complexity of acculturation and the role it plays in these relationships.

Footnotes

Points of view in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by Grant No. 2007-WG-BX-0051 awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice.

Notes

References

Aiken

L. S.

West

S. G.

(1991). Multiple regression: Testing and interpreting interactions. Thousand Oaks, CA: SAGE.

American Association for Public Opinion Research. (2009). Standard definitions: Final dispositions of case codes and outcome rates for surveys (6th ed.). Deerfield, IL: Author.

Andrés-Hyman

R. C.

Cott

M. A.

Gold

S. N.

(2004). Ethnicity and sexual orientation as PTSD mitigators in child sexual abuse survivors. Journal of Family Violence, 19, 319-325.

Arata

C. M.

(1999). Repeated sexual victimization and mental disorders in women. Journal of Child Sexual Abuse, 7, 1-17.

Axelrod

Myers

H. F.

Durvasula

R. S.

Wyatt

G. E.

Cheng

(1999). The impact of realtionship violence, HIV, and ethnicity on adjustment in women. Cultural Diversity and Ethnic Minority Psychology, 5, 263-275.

Baer

R. D.

Weller

S. C.

de Alba Garcia

J. G.

Glazer

Trotter

Pachter

Klein

R. E.

(2003). A cross-cultural approach to the study of the folk illness nervios. Culture, Medicine, and Psychiatry, 27, 315-337.

Bajos

Spira

Ducot

Messiah

(1992). Analysis of sexual behaviour in France (ACSF): A comparison between two modes of investigation: Telephone survey and face-to-face survey. AIDS, 6, 315-323.

Banyard

V. L.

Williams

L. M.

Siegel

J. A.

(2001). The long-term mental health consequences of child sexual abuse: An exploratory study of the impact of multiple traumas in a sample of women. Journal of Traumatic Stress, 14, 697-715.

Basile

K. C.

Arias

Desai

Thompson

M. P.

(2004). The differential association of intimate partner physical, sexual, psychological, and stalking violence and posttraumatic stress symptoms in a nationally representative sample of women. Journal of Traumatic Stress, 17, 413-421.

10.

Bauman

(2005). The reliability and validity of the Brief Acculturation Rating Scale for Mexican Americans–II for Children and Adolescents. Hispanic Journal of Behavioral Sciences, 27, 426-441.

11.

Bauman

Summers

J. J.

(2009). Peer victimization and depressive symptoms in Mexican American middle school students: Including acculturation as a variable of interest. Hispanic Journal of Behavioral Sciences, 31, 515-535.

12.

Bermack

(1989). Effect of telephone and face-to-face communication on rated extent of self-disclosure by female college students. Psychological Reports, 65, 259-267.

13.

Berry

J. W.

(1997). Immigration, acculturation, and adaptation. Applied Psychology: An International Review, 46, 5-34.

14.

Berry

J. W.

Trimble

J. E.

Olmedo

E. L.

(1986). Assessment of acculturation. In Lonner

W. J.

Berry

J. W.

(Eds.), Field methods in cross-sectional research (pp. 291-324). Beverly Hills, CA: SAGE.

15.

Birman

(1998). Biculturalism and perceived competence of Latino immigrant adolescents. American Journal of Community Psychology, 26, 335-354.

16.

Briere

(1995). Trauma Symptom Inventory (TSI) professional manual. Odessa, FL: Psychological Assessment Resources.

17.

Briere

Conte

(1993). Self-reported amnesia for abuse in adults molested as children. Journal of Traumatic Stress, 6, 21-31.

18.

Briere

Elliott

D. M.

(2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse & Neglect, 27, 1205-1222.

19.

Briere

Elliott

D. M.

Harris

Cotman

(1995). Trauma Symptom Inventory: Psychometrics and association with childhood and adult victimization in clinical samples. Journal of Interpersonal Violence, 10, 387-401.

20.

Briere

Jordan

C. E.

(2004). Violence against women: Outcome complexity and implications for assessment and treatment. Journal of Interpersonal Violence, 19, 1252-1276.

21.

Brown

N. L.

Wilson

S. R.

Kao

Y.-M.

Luna

Kuo

E. S.

Rodriguez

Lavori

P. W.

(2003). Correlates of sexual abuse and subsequent risk taking. Hispanic Journal of Behavioral Sciences, 25, 331-351.

22.

Burnam

M. A.

Hough

R. L.

Escobar

J. I.

Karno

(1987). Six-month prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic Whites in Los Angeles. Archives of General Psychiatry, 44, 687-694.

23.

Burnam

M. A.

Hough

R. L.

Karno

Escobar

J. I.

(1987). Acculturation and lifetime prevalence of psychiatric disorders among Mexican Americans in Los Angeles. Journal of Health and Social Behavior, 28, 89-102.

24.

Cabassa

L. J.

(2003). Measuring acculturation: Where we are and where we need to go. Hispanic Journal of Behavioral Sciences, 25, 127-146.

25.

Caetano

Ramisetty-Mikler

Vaeth

P. A. C.

Harris

T. R.

(2007). Acculturation stress, drinking, and intimate partner violence among Hispanic couples in the U.S. Journal of Interpersonal Violence, 22, 1431-1447.

26.

Caetano

Schafer

Clark

C. L.

Cunradi

C. B.

Raspberry

(2000). Intimate partner violence, acculturation and alcohol consumption among Hispanic couples in the United States. Journal of Interpersonal Violence, 15, 30-45.

27.

Clemmons

J. C.

DiLillo

Martinez

I. G.

DeGue

Jeffcot

(2003). Co-occurring forms of child maltreatment in adult adjustment reported by Latina college students. Child Abuse & Neglect, 27, 751-767.

28.

Coatsworth

J. D.

Maldonado-Molina

Pantin

Szapocznik

(2005). A person-centered and ecological investigation of acculturation strategies in Hispanic immigrant youth. Journal of Community Psychology, 33, 157-174.

29.

Cuellar

Arnold

Maldonado

(1995). Acculturation Rating Scale for Mexican Americans–II: A revision of the original ARSMA Scale. Hispanic Journal of Behavioral Sciences, 17, 275-304.

30.

Cuevas

C. A.

Sabina

(2010). Final report: Sexual Assault Among Latinas (SALAS) study (230445). Washington, DC: U.S. Department of Justice, National Institute of Justice.

31.

Cuevas

C. A.

Sabina

Milloshi

(in press). Interpersonal victimization among a national sample of Latino women. Violence Against Women.

32.

Cuevas

C. A.

Sabina

Picard

(2010). Interpersonal victimization patterns and psychopathology among Latino women: Results from the SALAS study. Psychological Trauma: Theory, Research, Practice, and Policy, 2, 296-306.

33.

Czaja

S. J.

(1987). Human factors in office automation. In Salvendy

(Ed.), Handbook of human factors (pp. 1587-1616). Oxford, UK: John Wiley.

34.

Edelson

M. G.

Hokoda

Ramos-Lira

(2007). Differences in effects of domestic violence between Latina and non-Latina women. Journal of Family Violence, 22, 1-10.

35.

Ellis

E. M.

Atkeson

B. M.

Calhoun

K. S.

(1982). An examination of differences between multiple- and single-incident victims of sexual assault. Journal of Abnormal Psychology, 91, 221-224.

36.

Finkelhor

Ormrod

R. K.

Turner

H. A.

(2007). Poly-victimization: A neglected component in child victimization. Child Abuse & Neglect, 31, 7-26.

37.

Frias

S. M.

Angel

R. J.

(2005). The risk of partner violence among low-income Hispanic subgroups. Journal of Marriage and Family, 67, 552-564.

38.

Garcia

Hurwitz

E. L.

Kraus

J. F.

(2005). Acculturation and reported intimate partner violence among Latinas in Los Angeles. Journal of Interpersonal Violence, 20, 569-590.

39.

Golding

J. M.

(1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14, 99-132.

40.

Gomez

M. J.

Fassinger

R. E.

(1994). An initial model of Latina achievement: Acculturation, biculturalism, and achieving styles. Journal of Counseling Psychology, 41, 205-215.

41.

Goodman

L. A.

Koss

M. P.

Fitzgerald

L. F.

Russo

N. F.

(1993). Male violence against women: Current research and future directions. American Psychologist, 48, 1054-1058.

42.

Griffith

(1983). Relationship between acculturation and psychological impairment in adult Mexican Americans. Hispanic Journal of Behavioral Sciences, 5, 431-459.

43.

Hanson

R. K.

(1990). The psychological impact of sexual assault on women and children: A review. Annals of Sex Research, 3, 187-232.

44.

Harris

R. J.

Firestone

J. M.

Vega

W. A.

(2005). The interaction of country of origin, acculturation, and gender role ideology on wife abuse. Social Science Quarterly, 86, 463-483.

45.

Herman

J. L.

(1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377-391.

46.

Higgins

D. J.

McCabe

M. P.

(2000). Multi-type maltreatment and the long-term adjustment of adults. Child Abuse Review, 9, 6-18.

47.

Higgins

D. J.

McCabe

M. P.

(2001). Multiple forms of child abuse and neglect: Adult retrospective reports. Aggression and Violent Behavior, 6, 547-578.

48.

Hinton

D. E.

Chong

Pollack

M. H.

Barlow

D. H.

McNally

R. J.

(2008). Ataque de nervios: Relationship to anxiety sensitivity and dissociation predisposition. Depression and Anxiety, 25, 489-495.

49.

Hovey

J. D.

Magaña

C. G.

(2002). Psychosocial predictors of anxiety among immigrant Mexican migrant farmworkers: Implications for prevention and treatment. Cultural Diversity and Ethnic Minority Psychology, 8, 274-289.

50.

Kaplan

M. S.

Marks

(1990). Adverse effects of acculturation: Psychological distress among Mexican American young adults. Social Science & Medicine, 31, 1313-1319.

51.

Kataoka

Langley

Stein

Jaycox

Zhang

Sanchez

Wong

(2009). Violence exposure and PTSD: The role of English language fluency in Latino youth. Journal of Child and Family Studies, 18, 334-341.

52.

Levy

(1988). “Taking care of me”: Preventing child sexual abuse in the Hispanic community. In Walker

L. E. A.

(Ed.), Handbook on sexual abuse of children: Assessment and treatment issues (pp. 387-401). New York, NY: Springer.

53.

Lewis-Fernandez

(1994). Culture and dissociation: A comparison of ataque de nervios among Puerto Ricans and possession syndrome in India. In Spiegel

(Ed.), Dissociation: Culture, mind, and body (pp. 123-167). Washington, DC: American Psychiatric Association.

54.

Lewis-Fernandez

Garrido-Castillo

Bennasar

M. C.

Parrilla

E. M.

Laria

A. J.

Petkova

(2002). Dissociation, childhood trauma, and ataque de nervios among Puerto Rican psychiatric outpatients. American Journal of Psychiatry, 159, 1603-1605.

55.

Maker

A. H.

Kemmelmeier

Peterson

(2001). Child sexual abuse, peer sexual abuse, and sexual assault in adulthood: A multi-risk model of revictimization. Journal of Traumatic Stress, 14, 351-368.

56.

Marshall

G. N.

Orlando

(2002). Acculturation and peritraumatic dissociation in young adult Latino survivors of community violence. Journal of Abnormal Psychology, 111, 166-174.

57.

Marshall

G. N.

Schell

T. L.

Miles

J. N. V.

(2009). Ethnic differences in posttraumatic distress: Hispanics’ symptoms differ in kind and degree. Journal of Consulting and Clinical Psychology, 77, 1169-1178.

58.

Martin

W. S.

Duncan

W. J.

Powers

T. L.

Sawyer

J. C.

(1989). Costs and benefits of selected response inducement techniques in mail survey research. Journal of Business Research, 19, 67-79.

59.

McDevitt-Murphy

M. E.

Weathers

F. W.

Adkins

J. W.

(2005). The use of the Trauma Symptom Inventory in the assessment of PTSD symptoms. Journal of Traumatic Stress, 18, 63-67.

60.

Mennen

F. E.

(1995). The relationship of race/ethnicity to symptoms in childhood sexual abuse. Child Abuse & Neglect, 19, 115-124.

61.

Miller

Moeller

Kaufman

A. B.

DiVasto

Pathak

Christy

(1978). Recidivism among sex assault victims. American Journal of Psychiatry, 135, 1103-1104.

62.

Miner

M. H.

Flitter

J. M. K.

Robinson

B. E.

(2006). Association of sexual revictimization with sexuality and psychological functioning. Journal of Interpersonal Violence, 21, 503-524.

63.

Morrow

K. B.

Sorell

G. T.

(1989). Factors affecting self-esteem, depression, and negative behaviors in sexually abused female adolescents. Journal of Marriage & the Family, 51, 677-686.

64.

Newcomb

M. D.

Munoz

D. T.

Carmona

J. V.

(2009). Child sexual abuse consequences in community samples of Latino and European American adolescents. Child Abuse & Neglect, 33, 533-544.

65.

Nishith

Mechanic

M. B.

Resick

P. A.

(2000). Prior interpersonal trauma: The contribution to current PTSD symptoms in female rape victims. Journal of Abnormal Psychology, 109, 20-25.

66.

Ortega

A. N.

Rosenheck

(2000). Posttraumatic stress disorder among Hispanic Vietnam veterans. American Journal of Psychiatry, 157, 615-619.

67.

Ortega

A. N.

Rosenheck

Alegria

Desai

R. A.

(2000). Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics. Journal of Nervous and Mental Disease, 188, 728-735.

68.

Ortiz

Arce

C. H.

(1984). Language orientation and mental health status among persons of Mexican descent. Hispanic Journal of Behavioral Sciences, 6, 127-143.

69.

Pew Research Center. (2005). Hispanics: A people in motion. Washington, DC: Author.

70.

Pole

Best

S. R.

Metzler

Marmar

C. R.

(2005). Why are Hispanics at greater risk for PTSD? Cultural Diversity and Ethnic Minority Psychology, 11, 144-161.

71.

Rogler

L. H.

Cortes

D. E.

Malgady

R. G.

(1991). Acculturation and mental health status among Hispanics: Convergence and new directions for research. American Psychologist, 46, 585-597.

72.

Sabina

Cuevas

C. A.

Schally

J. L.

(2011). Cultural influences on help-seeking among a national sample of victimized Latino women. American Journal of Community Psychology. Advance online publication. doi: 10.1007/s10464-011-9462-x10.1007/s10464-011-9462-x

73.

Salmon

C. T.

Nichols

J. S.

(1983). The next-birthday method of respondent selection. Public Opinion Quarterly, 47, 270-276.

74.

Sanders-Phillips

Moisan

P. A.

Wadlington

Morgan

English

(1995). Ethnic differences in psychological functioning among Black and Latino sexually abused girls. Child Abuse & Neglect, 19, 691-706.

75.

Saunders

B. E.

Villeponteaux

L. A.

Lipovsky

J. A.

Kilpatrick

D. G.

Veronen

(1992). Child sexual assault as a risk factor for mental disorders among women: A community survey. Journal of Interpersonal Violence, 7, 189-204.

76.

Schechter

D. S.

Marshall

Salman

Goetz

Davies

Liebowitz

M. R.

(2000). Ataque de nervios and history of childhood trauma. Journal of Traumatic Stress, 13, 529-534.

77.

Schwartz

S. J.

Unger

J. B.

Zamboanga

B. L.

Szapocznik

(2010). Rethinking the concept of acculturation: Implications for theory and research. American Psychologist, 64, 237-251.

78.

StataCorp. (2011). Stata (Version 11.2) [Computer software]. College Station, TX: Author.

79.

Szapocznik

Kutines

W. M.

Fernandez

(1980). Bicultural involvement and adjustment in Hispanic-American youths. International Journal of Intercultural Relations, 4, 353-365.

80.

Tabachnick

B. G.

Fidell

L. S.

(2007). Using multivariate statistics (5th ed.). Boston, MA: Pearson Education.

81.

Tjaden

Thoennes

(2000). Full report of the prevalence, incidence, and consequences of violence against women (NCJ 183781). Washington, DC: U.S. Department of Justice, Office of Justice Programs.

82.

Torres

(2010). Predicting levels of Latino depression: Acculturation, acculturative stress, and coping. Cultural Diversity and Ethnic Minority Psychology, 16, 256-263.

83.

Torres

Han

H.-R.

(2000). Psychological distress in non-Hispanic White and Hispanic abused women. Archives of Psychiatric Nursing, 14, 19-29.

84.

Turner

H. A.

Finkelhor

Ormrod

(2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38, 323-330.

85.

Vega

W. A.

Kolody

Aguilar-Gaxiola

Alderete

Catalano

Caraveo-Anduaga

(1998). Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry, 55, 771-778.

86.

Vega

W. A.

Warheit

G. J.

Meinhardt

(1984). Marital disruption and the prevalence of depressive symptomatology among Anglos and Mexican Americans. Journal of Marriage and Family, 46, 817-824.

87.

Widom

C. S.

Dutton

M. A.

Czaja

S. J.

DuMont

K. A.

(2005). Development and validation of a new instrument to assess lifetime trauma and victimization history. Journal of Traumatic Stress, 18, 519-531.

88.

Williams

C. L.

Berry

J. W.

(1991). Primary prevention of acculturative stress among refugees: Application of psychological theory and practice. American Psychologist, 46, 632-641.

89.

World Health Organization. (2005). WHO multi-country study on women’s health and domestic violence against women: Summary report of initial results on prevalence, health outcomes, and women’s responses. Geneva, Switzerland: Author.