Cultural expression of psychiatric symptoms: Idioms of anger among Puerto Ricans.

Increasing attention is being focused on the role of culture in psychological assessment and psychiatric diagnosis. In the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994), there are cultural considerations in applying the criteria of psychiatric disorders, as well as a glossary of culture-bound syndromes. There is a need for further research to clarify the cultural roots of expressive symptomatology. In the present study, focus groups conducted with Puerto Rican adults revealed that idioms of anger are salient to the mental health among a low socioeconomic status, inner-city population. Community and clinical samples of respondents (N = 531) were administered the idioms in a rating scale format. Factor analysis yielded dimensions expressive of aggression, assertiveness, and vindictiveness. These subscales correlated significantly with depressive and anxiety symptomatology, as measured by standardized instruments, and predicted clinical status. Results suggest that taking cultural expression of symptomatology into account enhances standard assessment of mental health.