Cross-cultural study of idioms of distress among Spanish nationals and Hispanic American migrants: susto, nervios and ataque de nervios

Susto (fright), nervios (nerves) and ataque de nervios (attack of nerves) are idioms of distress widely experienced amongst Hispanic Americans, often associated with psychiatric
disorders. This study explores understanding of these idioms of distress and attitudes to help seeking amongst indigenous
Spanish and Hispanic American residents in Spain.

A population survey was undertaken in four adult education centres in Spain. Hypothetical case vignettes of individuals suffering
from the idioms of distress were used to investigate understanding and help seeking by a Spanish sample compared with Hispanic
American migrants to Spain. 350 questionnaires were obtained (94.6% response rate).

The idioms ataque de nervios and nervios were recognised by the majority of the Spanish group but by significantly more of the Hispanic American migrants. However,
susto was infrequently recognised by the Spanish group but it was recognised by half of the Hispanic Americans. Hispanic Americans
were also more likely to recommend consultation with a psychiatrist/psychologist than Spanish respondents for ataque de nervios and nervios. The Spanish group were more likely to recommend non-medical sources of support such as relatives and priest than Hispanic
Americans. Hispanic Americans, more recently arrived, did not show greater recognition of the three idioms than those who
have been in Spain longer. Regression analysis showed that being Hispanic American and having lower educational attainment
was associated with greater use of susto.

The study suggests that people hold multiple models of distress and disorder. This may influence clinical presentations and
help seeking behaviour in Spanish as well as Hispanic American populations.