Depression Often Undetected in Latinos : A meeting of the Psychiatric Assn. highlights the problem of misdiagnoses in patients who complain of physical symptoms. : SCIENCE FILE: An exploration of issues and trends affecting science, medicine and the environment.

MIAMI BEACH, Fla. —  The patient may turn up in the doctor’s office with a litany of complaints, ranging from chronic headaches, racing heartbeat and stomach cramps to paralyzing back pain. But X-rays and sophisticated laboratory tests can’t find a problem.

“At this point,” says Dr. Silvia W. Olarte, “the primary care physician often will tell the patient: ‘Go home and rest. There is nothing wrong with you.’ ”

If the patient is Latino, however, that advice--and that diagnosis--may be what’s wrong.

“In dealing with the Latino population, the medical profession has to remember that even if there is no organic base for physical symptoms, those symptoms may be an expression of mental disorder,” especially depression, according to Olarte, chairwoman of the American Psychiatric Assn.’s Committee of Hispanic Psychiatrists. In comparison to the general U.S. population, Latinos are more likely to express mental stress in terms of physical symptoms, she said.

Latinos and mental health were among the chief topics of conversation here recently when 13,000 people, most of them mental health professionals, gathered for the Psychiatric Assn.’s 148th annual meeting. Of particular interest was the diagnosis of depression, a widespread illness that affects more than 17 million Americans and is blamed for $44 billion in lost productivity, absenteeism and health costs each year.

About 18% of those suffering from depression are Latino, according to Psychiatric Assn. statistics, a rate that is double the percentage of Latinos in the U.S. population. Only about a third of Latinos believed to suffer from depression seek treatment.

Olarte and other professionals who specialize in the treatment of Latino patients say that depression often is viewed more as a personal weakness than a problem of health.

“In many Hispanic communities . . . to be aware of oneself is to be self-centered, egotistical,” said Olarte, a native of Argentina who practices psychiatry in New York City. “The cultural focus is less on individual experience than on the concerns of others. . . . There is a strong emphasis on respect for others, not burdening others with your problems. Therefore, one’s own feelings and emotions are often internalized.”

Thus, a patient who has no apparent physical problems may be sent home “with the feeling that something is wrong morally, and that they are ‘bad’ for having disturbed the doctor for no reason,” says Olarte. “They come home very confused.”

Roberto Lewis-Fernandez, a cultural psychiatrist who is a research fellow at Harvard Medical School with a practice in his native Puerto Rico, warned that misdiagnoses also stem from the failure of doctors to distinguish between the norms of various Spanish-speaking populations in the United States.

For example, Lewis-Fernandez said, in many societies people who see ghosts or hear voices may be exhibiting symptoms of psychosis.

However, when some Puerto Ricans profess to see celajes-- shadows or ghosts--and hear voices, this can be a culturally accepted form of expressing distress, and unrelated to psychosis, experts say. Studies and interviews with his own patients, says Lewis-Fernandez, indicate that experiencing celajes and voices is “extremely widespread” in Puerto Rico.

“There is a cultural explanation for this,” said Lewis-Fernandez. “It is related to a host of religious and spiritual ideas.

“But . . . it is not just language, but a recognition of the importance of culture that is critical here.”

Other presentations during the conference spotlighted the problems of depression among recent immigrants to the United States, and the links between childhood trauma and what researchers call the Latino culture-bound syndrome ataque de nervios.

Olarte pointed out the nexus between the increasing rate of depression in immigrant women and the stressors common to becoming a minority in a new culture. For example, she said that family dynamics in the United States--where American wives and children often have stronger roles--can blur the traditional roles that men may have had in their homeland. Many men may compensate by exercising more control over women and children.

As a result, Olarte says, immigrant women often find themselves dealing with both a new minority status in a host culture as well as perplexing changes in their status within the family.

Compounding the situation, Olarte adds, is a reluctance among many first-generation Latinos to seek out medical advice. “Even those with medical insurance often don’t think they have the right to use the medical system unless they are in crisis,” she says.

Adding to the stress of relocation, many Latino immigrants arrive in cities such as Los Angeles and Miami after fleeing war or political oppression. Miami psychiatrist Ana Campo-Bowen urged her colleagues to be mindful of the added burden hundreds of thousands of Salvadorans, Nicaraguans and Cubans carried as refugees from troubled countries.

“Immigration is stressful enough,” she said. “When you add the effects of war, then you are often dealing with post-traumatic stress disorder, avoidance, shortened view of the future, anxiety and depression.”

In a study headed by Dr. Daniel S. Schechter of the New York State Psychiatric Institute, Latino patients seeking treatment at an anxiety disorder clinic were questioned about ataque de nervios and any history of childhood trauma, including physical or sexual abuse.

Among many Spanish-speaking cultures, ataques are a relatively common complaint, comparable to the “nervous breakdown” in this country.

In a study of 50 subjects, mostly female, 70% rated positive for ataque de nervios, Schechter reports. Of those who said they suffered from ataques, 71% had a history of childhood trauma, compared to 33% of those who did not report such episodes.