An Exploration of the Relationships

AN EXPLORATION OF THE RELATIONSHIPS

AMONG CULTURAL IDENTITY AND PERCEPTION

OF DANGEROUSNESS OF THOSE

WITH MENTAL ILLNESS

Final Project for PSY589: Thesis Presented to Dr. Gayle Morse Department of Psychology Sage Graduate School

In Partial Fulfillment of the Requirements for the Degree of Master of Arts in Counseling and Community Psychology

Erin M. Applegarth

May, 2008

TABLE OF CONTENTS

Page Abstract……………………………………………………………………… 4

Chapter

1. Introduction and Review of the Literature………………………………... 5 Philippine Culture…………………………………………...... 6 Cultural Identification………………………………………………... 12 Mental Health and Filipino Perceptions……………………………… 15

2. Methods…………………………………………………………………… 20 Materials and Methodology………………………………………….. 20 Design and Data Analysis…………………………………...... 23

3. Results…………………………………………………………………….. 25 Demographics………………………………………………………… 25 Characteristics of Measures…………………………………………... 26 Descriptive Statistics………………………………………...... 26 Analysis and Test of Hypotheses…………………………………….. 27 Multiple Regression Analysis………………………………………… 30 Tests of Hypotheses…………………………………………………... 32

4. Discussion…………………………………………………………………. 34 Implications for Past Theory and Research………………...... 34 Limitations…………………………………………………………… 35 Implications for Future Research…………………………...... 36

5. References…………………………………………………………………. 37

6. Appendix: Pilot Study Questionnaire……………………………………… 41

Cultural Identity and Perception of Dangerousness 4

ABSRACT

The purpose of this study is to investigate the relationship between cultural identity and perceptions of dangerousness of persons diagnosed with mental illness. Twelve Philippine born

Filipino Americans and ten non-Filipino Americans participate (N=22). Using individually administered questionnaires which were translated and discussed with community consultants for their cultural sensitivity and utility for the Filipino community, results of this research suggest that culture is significantly related to perceptions of dangerousness. Identification with White

American or Anglo cultural identity (WAC) accounts for 37% of the variance when predicting perceptions of dangerousness of individuals with mental illness. The goal of this research is to facilitate understanding regarding cultural perceptions of mental health diagnoses.

Suggested Keywords: culture, cultural identity, ethnicity, Philippines, Filipino American, perceptions of dangerousness, mental illness.

Cultural Identity and Perception of Dangerousness 5

Chapter One

Introduction and Review of the Literature

Comprising 3.6 percent of the total U.S. population, Asian Americans are the fastest growing minority group in the United States (Speller, 2005; Chung, Teresi, Guarnaccia, Meyers,

Holmes, Bobrowitz, Eimicke, & Ferran, 2003; Chandras, Eddy, & Spaulding, 1999; Chen,

Kramer, Chen, & Chung, 2005; Bjorck, Cuthbertson, Thurman, & Lee, 2001). Only second to the Chinese, Filipino Americans are the largest growing Asian group with nearly three million

Filipinos currently residing in the U.S. (Sanchez & Gaw, 2007; Tompar-Tiu & Sustento-

Seneriches, 1995). Of those living in the United States, foreign born Filipinos out number U.S. born Filipinos at a ratio of two-to-one (Sanchez & Gaw, 2007; Tuason, Taylor, Rollings, Harris,

& Martin, 2007). It is estimated that by the year 2030, the Filipino American population in the

U.S. will grow to four million (Sanchez & Gaw, 2007). Despite these statistics, little is known about the mental health concerns within this Asian population (Tompar-Tiu & Sustento-

Seneriches, 1995; Sanchez & Gaw, 2007; Speller, 2005).

Research compiled over the last few decades indicates a well-documented disparity in mental health research, service utilization, and treatment availability for all Asian American groups (Chandras et al., 1999; Chen et al, 2005; Sanchez & Gaw, 2007; Speller, 2005; David &

Okazaki, 2006). The literature suggests there are a number of practical and cultural barriers to delivering effective and culturally competent mental health care to this population (Speller,

2005; Chen et al., 2005; Chandras et al., 1999). While a number of studies have attempted to investigate Asian and Pacific Islander populations in the United States, there is a deficit in the

Cultural Identity and Perception of Dangerousness 6

amount of knowledge published on the topic of Philippine mental health, as well as current attitudes toward mental illness and treatment (Tompar-Tiu & Sustento-Seneriches, 1995).

Due to the void of information concerning the mental health profile of the Filipino

American, as well as the substantial influx of foreign born Filipinos immigrating to the United

States, the current study is an attempt to help bring recognition and understanding about the

perceptions of mental health in an immigrant Filipino population. Assessing the cultural identification of Philippine born Filipinos and U.S. born non-Filipinos, this study investigates how cultural identity may be related to perceptions of dangerousness of individuals with mental health diagnoses. For the purpose of this investigation, the term ‘Filipino American’ refers to

Filipinos who are either U.S. born or Philippine-born and are currently residing in the United

States.

Philippine Culture

In order to assess perceptions of Filipino Americans, it is important to understand the rich

cultural context native to the Philippine Islands. Positioned between the China Sea to the west,

the Pacific Ocean to the east, and the Celebes Sea to the south, the Republic of the Philippines is

an archipelago consisting of some 7,107 islands in Southeast Asia (Conde, 2004; Sanchez &

Gaw, 2007; Tompar-Tiu & Sustento-Senriches, 1995; de Torres, 2002). This is one of the world’s most populous countries with a population approximating 76.5 million people (Conde,

2004; National Statistic Office [NSO], Republic of the Philippines, 2003). According to the 2000

Census of Population and Housing National Report, 48% of the Philippine population resides in urban areas with approximately 10 million people concentrated in the twelve cities and five municipalities that constitute the greater metropolitan area of the capital city of Metro Manila, Cultural Identity and Perception of Dangerousness 7 also known as the National Capital Region (NCR) (“Index of Demographic Statistics”, 2007).

Throughout this small and populous archipelago in which provinces are divided by water and the larger islands are scattered with mountain ranges, thus separating land areas and creating

physical isolation, language and ethnicity diversify the native population (de Torres, 2002). As a

result, more than 100 different ethnic languages currently exist (Sanchez & Gaw, 2007; de

Torres, 2002). In addition, while more than sixty cultural minority groups comprise the

Philippines eight main ethnic groups, each with their own distinct language have been identified

(Tompar-Tiu & Sustento-Senriches, 1995; deTorres, 2002). The eight principle ethic groups recognized in the Philippines include the Tagalogs, the Cebuano, the Ilocano, the Bikolano, the

Ilonggo, the Waray, the Kapampangan, and the Pangasinenses (Tompar-Tiu & Sustento-

Senriches, 1995; de Torres, 2002). Each ethnic sub-group is perceived as possessing stereotypic characteristics unique to their group affiliation. Despite the apparent ethnic diversity among native Filipinos, Pilipino (Tagalog) is the National language spoken by one third of the population, and English is the second official language of the Philippines with a hybrid of both

Tagalog and English spoken by many Filipinos (Sanchez & Gaw, 2007; Tompar-Tiu & Sustento-

Seneriches, 1995; de Torres, 2002; Conde, 2004).

The culture of the Philippine Islands has historically been marked by neighboring

Malayan, Chinese, Indonesian, and Asian Indian custom and traditions (Tompar-Tiu & Sustento-

Senriches, 1995). The culture of the present day Philippines is a blend of foreign influences from the Spanish era of rule, American regime, and Japanese occupation (Sanchez & Gaw, 2007).

These influences continue to merge with indigenous Philippine philosophy and culture (2007).

Cultural Identity and Perception of Dangerousness 8

Regionalism

It has been theorized that the strong regionalism demonstrated by Filipinos is an effect

created by the archipelago setting of the Philippines Islands (Sanchez & Gaw, 2007; Tompar-Tiu

& Sustento-Seneriches, 1995). By nature of the archipelago, conditions of geographic isolation,

poor means of transportation, and a scarce economy have historically fostered interdependence

and reliance on extended-family systems (Conde, 2004; Sanchez & Gaw, 2007; Tompar-Tiu &

Sustento-Seneriches, 1995). Rural-to-urban relocation to areas such as Metro Manila has been

encouraged in pursuit of educational opportunities and employment (Conde, 2004; Sanchez &

Gaw, 2007). Regional differences become more apparent in urban areas where Filipinos tend to group themselves by regional homogeneity and commingle with peers who are native to the

same region (de Torres, 2002). In spite of the regionalism that appears to distinguish and

diversify Filipinos in their native country, as immigrants, Filipinos tend to perceive themselves

as one people with the common bond of being of Filipino ethnicity (Tompar-Tiu & Sustento-

Seneriches, 1995).

The Role of Family

Considered the fundamental basis of society, the significance of family is a prominent aspect of Philippine culture. While it is common for extended and multigenerational family

members to reside in one household, traditionally, the Filipino family is a nuclear one (Conde,

2004; Tompar-Tiu & Sustento-Seneriches, 1995). Predominately the father is viewed as the head

of the family unit and provides financial support while the mother governs the household,

budgets the family income, maintains most child rearing responsibilities, and may also earn

additional income for the family (1995). However, major family decisions are only decided upon Cultural Identity and Perception of Dangerousness 9

after speaking with nuclear, as well as extended family members (1995). Essentially, Filipinos are viewed as collectivists where the family offers strength to its members and the needs and welfare of the family come before individual or community needs (Shakman, 1969; deTorres,

2002; Tompar-Tiu & Sustento-Seneriches, 1995; Sanchez & Gaw, 2007).

The prominent role of the family system continues to be an influential factor after immigration. When Filipinos immigrate to the United States, they often live with relatives during the first few months or years until they have a job in which to support themselves successfully or until they can afford to buy a home (Tompar-Tiu & Sustento-Seneriches, 1995). It is uncommon for Filipinos to reside in a location where they do not have relatives (1995). Additionally,

Filipinos living abroad are expected to provide ongoing familial financial support to aging parents, Godchildren, as well as the educational expenses of siblings (1995).

Religion

Spanish rule brought Christianity to the Philippines. Currently 83-85 percent of the

population identify themselves as practicing the Roman Catholic tradition (Conde, 2004; Tuason

et al., 2007; Sanchez & Gaw, 2007).

Religious spirituality is a primary component of Filipino life and is relevant to indigenous beliefs about the mental, emotional, and physical facets of health and well being. The strong faith in religion that is demonstrated by the Filipino people is believed to be a source of strength and comfort for individuals, especially in times of adversity and hardship (Conde, 2004; Tompar-Tiu

& Sustento-Seneriches, 1995).

Cultural Identity and Perception of Dangerousness 10

American Governance

Historically, Filipinos have a distinct and unmatched relationship with the United States.

Being the earliest Asian immigrants to arrive in the U.S., Filipinos first settled in Louisiana as

early as the 1700’s (David & Okazaki, 2006; Tompar-Tiu & Sustento-Senriches, 1995; Sanchez

& Gaw, 2007).

Under Spanish rule for three hundred thirty three years, Spain ceded the Philippines to

the United States in 1898 after defeat in the Spanish-American War (deTorres, 2002; Tompar-

Tiu & Sustento-Senriches, 1995). The Republic of the Philippines remained a U.S. protectorate

and the only U.S. colony in Asia for the next forty-eight years, until 1946 (David & Okazaki,

2006; deTorres, 2002). Despite Philippine independence from the U.S. following 1946, the

United States military bases located in the Philippines were maintained until 1992 (David &

Okazaki, 2006).

Under U.S. authority, many changes took place in the Republic of the Philippines. One of

the most influential projects implemented by the U.S. was the establishment of a public education system making education available for members of all social classes (Tompar-Tiu &

Sustento-Seneriches, 1995). As a result of American governance or colonialism, which exposed and influenced the culture of the Philippines to the English language and American lifestyle,

Filipinos remain familiar with current American language and culture (deTorres, 2002; David &

Okazaki, 2006).

Cultural Identity and Perception of Dangerousness 11

Filipino Immigration

Throughout history, there have been four major periods of Filipino immigration to the

United States. In regard to their relevance on current Filipino American culture, the latter two

immigration periods are most significant. The third major immigration period occurred when the

Philippines gained their independence from the United States. Between 1945 and 1965, Filipinos

entering the U.S. consisted mainly of war veterans who fought along side U.S. soldiers during

World War II, military personnel and their families, students, and professionals (Tompar-Tiu &

Sustento-Seneriches, 1995; deTorres, 2002). This wave of immigration brought a significant

number of doctors, nurses, engineers, technicians, accountants, and other educated professionals

to the States.

The fourth significant period of immigration occurred from 1965 and after (Tompar-Tiu

& Sustento-Seneriches, 1995). The Immigration and Naturalization Act (PL 89-236) passed in

1965, ended the national origin quota established by the Tydings McDuffie Law, thus allowing

entry of foreigners into the United Sates based on family reunification and occupational

characteristics (Sanchez & Gaw, 2007; Chandras et al., 1999; Tompar-Tiu & Sustento-

Seneriches, 1995). Since the passage of the Immigration Act into the present, there has been an influx of Filipino immigrants who are characteristically, college educated, English-speaking,

professionals trained as physicians, nurses, and other health care occupations (Sanchez & Gaw,

2007; Tompar-Tiu & Sustento-Seneriches, 1995). The trend of mostly educated, English

speaking Filipino professionals continues to be the majority of persons arriving from the

Philippines today.

Cultural Identity and Perception of Dangerousness 12

Filipinos in America

The residual influence of American culture in the Philippines has allowed emigrating

Filipinos to adapt easily to the American lifestyle without the obstacle of overcoming traditional

language and cultural barriers markedly experienced by other ethnic immigrant populations

(deTorres, 2002). With a reputation for being industrious and attaining upward mobility,

currently in the U.S., Filipino Americans have the highest rate of labor participation among all

Asian groups (Sanchez & Gaw, 2007). However, despite high employment rates, Filipino

Americans typically earn a median income in comparison to other Asian ethnic groups (2007).

While it appears that Filipino Americans may acculturate to the American way of life with noted ease, it has been implicated that second generation (U.S. born) Filipinos have a decreased sense of Filipino ethnic identity, attend college less frequently and exhibit a greater degree of mental health concerns versus first generation immigrants (Tuason et al., 2007).

Cultural Identification

Oetting and Beauvais (1990-1991) define cultural identity as an outcome of continuous interaction between the individual and his or her environment. While cultural identity is generally related to early familial experiences, it is has the ability to change throughout an individual’s life in accordance with the individuals’ experiences (1990-1991). Given the ethnic and cultural diversity among the Filipino population it is necessary to recognize that cultural content within a single ethnic group can vary considerably (Oetting & Beauvais, 1990-91). In addition, a person may identify with two separate cultural groups despite incongruities between the cultures.

Cultural Identity and Perception of Dangerousness 13

Cultural Identification becomes even more complex when considering the experience of immigration. Bhugra, Bhui, Mallett, Desai, Singh, and Leff (1999) suggest the issue of acculturation in the form of assimilation to a new or different culture, deculturation, or adaptation, is an important element when measuring cultural identity. Recognizing that cultural identification is a multi-dimensional concept, Bhugra et al., (1999) suggest the relationship between the dominant cultural group and the non-dominate group is crucial to the dynamic acculturation process, in that, when two cultures merge it is likely that the cultural change will affect both groups; however the non-dominate group will be affected the most by demonstrating the most change.

A Qualitative Study in Review

In a qualitative study comparing the ethnic identities of Filipino Americans born in the

United States with Philippine-born Filipino Americans, Tuason, Taylor, Rollings, Harris, and

Martin (2007) identify several factors pertinent to distinguishing an individual’s identity.

According to their findings, both groups respectively consider themselves Filipino American.

However, it appears that Philippine-born Filipino Americans identify themselves as being

Filipino foremost while defining themselves as being American only by matter of circumstance

(e.g. emigrating as an adult or being married to an American). Identification of oneself as predominately Filipino is directly related to having lived in the Philippines longer than one has resided in the U.S., emigrating at an older age, typically as an adult, or having parents who emigrated. In contrast with Philippine-born immigrants, U.S-born Filipinos place a greater emphasis on identification with the American lifestyle (2007). While Philippine born individuals identify more strongly with Filipino ethnic identity than their U.S. born counterpart, despite Cultural Identity and Perception of Dangerousness 14 place of birth, both groups ultimately consider the Filipino American ethnic identity as being a combination of both cultures (2007).

While the individuals who participated in the qualitative study had either emigrated to the U.S. or were born in the U.S., all respondents stated that they participate in the American way of life, as well as retain Filipino cultural identity to some degree. However, it is unclear to what extent if any, that the cultural content of the Filipino American changed as a result of cultural transition. According to Bhugra et al’s., (1999) research on acculturation, it would be important to consider how this process may effect or alter individual or group perceptions.

Ethnic Invisibility

The concept of cultural identification becomes evermore important when considering the

Filipino American identity. Despite the vast number of Filipinos currently immigrating to and residing in the United States, they are often perceived as an “invisible” ethnic group (Sanchez &

Gaw, 2007, p.811; deTorres, 2002). Research indicates that Filipinos are often misidentified as

Latinos because of their Spanish sounding sir names (Sanchez & Gaw, 2007; deTorres, 2002). In addition, due to their Asian features, Filipinos are sometimes mistaken as being Chinese or mistaken for being African American due to their sometimes dark skin tone (Sanchez & Gaw,

2007; deTorres, 2002). Among Asian minorities, Filipino Americans also have the highest rate of interracial marriages which may influence acculturation, ethnic identification, and self- perception (Sanchez & Gaw, 2007; Tuason et al., 2007).

Recognizing the ethnic diversity of Filipino Americans and the need to assess cultural identification in order to fully understand the Filipino experience and perspective, the current

Cultural Identity and Perception of Dangerousness 15 study considers the concept of cultural content, or the specific behaviors, attitudes, or beliefs adorned by Filipino culture and acknowledges that cultural content may be altered in the process of cultural transition; transition from one culture to another (Oetting & Beauvais, 1990-91).

Therefore, findings from identification with one sub-group may not generalize to all people of

Filipino ethnicity (Sanchez & Gaw, 2007).

Mental Health and Filipino Perceptions

Individuals, as well as ethnic groups cannot be fully understood outside of the context of

their culture. While research clearly suggests Asian populations in the U.S. underutilize mental

health services, yet appear to have significant instances of mental health concerns, it is necessary

to consider the notion of mental illness from both the native Filipino perspective, as well as the

Filipino American perspective (Speller, 2005; Tuason et al., 2007; Sanchez & Gaw, 2007).

Native Historical Perspective

Unlike the Western illness model which lends organic and physiological causation to

illness, early ethnographic studies conducted in the Philippines suggest that Filipinos’ conceptualize illness differently. Traditionally Filipinos have held strong beliefs that spirits can produce both physical and mental illness (Conde, 2004). In addition, the notion of pasma, an interaction between hot and cold, wherein health is measured by the balance between these two extremities, is a common explanation for the onset of illness, particularly in the Christian

Filipino population (Tompar-Tiu & Sustento-Senriches, 1995; Edman & Johnson, 1999).

In Robert Shakman’s (1969) research on Philippine indigenous healing practices used to treat mental illness, he concludes that traditional folk medicine utilized in the Philippines is

Cultural Identity and Perception of Dangerousness 16 embedded in native theories of disease causation including beliefs pertaining to the loss of a

person’s soul, evil spirits, magic, and violation of taboo. In accordance with Shakman’s (1969) early research, similar ethnographic studies conclude that spiritual and social elements are important causal factors in the Filipino conceptualization of illness (Edman & Kameoka, 1997).

Indigenous treatments for metal illness include the use of herbs, liniments, prayer, healers, and priests (Tompar-Tiu & Sustento-Seneriches, 1995; Sanchez & Gaw, 2007; deTorres, 2002)

Current Filipino Culture Perspective

Unlike many other Asian countries located in the Western Pacific region, over the past few decades, the Philippines has experienced significant transformation including an increased access to modern Western treatment facilities for health care, increased availability of formal education, as well as an economical growth of the middle class (Edman & Kameoka, 1997;

Conde, 2004). While some regions of the Philippine Islands are becoming urbanized, traditional folk beliefs and practices remain prevalent in many rural communities (Conde, 2004). The importance of prayer and spiritual or religious consultation in regards to mental health can not be emphasized enough (Sanchez & Gaw, 2007).

Schizophrenic disorders are cited as a significant mental health problem in the

Philippines (Tompar-Tiu & Sustento-Seneriches, 1995; Conde, 2004). While there is limited access to psychotropic medications, outpatient mental health clinics, and inpatient mental health facilities remain largely over crowded, mental illness is generally dealt with through the help of the family system, friends, and religious faith (Conde, 2004; Sanchez & Gaw, 2007; deTorres,

2002). Being collectivists with an emphasis on the significance of the family unit, there is an expectation within Philippine culture for the family to take care of those members, who are Cultural Identity and Perception of Dangerousness 17 young, elderly, weak, or sick (Tompar-Tiu & Sustento-Seneriches, 1995). However, it is imperative to note that the indigenous concept of ‘hiya’ or shame is often felt by family members of an individual who is inflicted with such illness (Tompar-Tiu & Sustento-Seneriches, 1995;

Sanchez & Gaw, 2007, p. 812). Often, the mental illness of a family member is associated as being an illness of the family system and can be a source of social embarrassment for family members.

Although literature suggests that Filipinos are apt to willingly interact with persons diagnosed with mental illness, there is generally a rejection based on the belief that persons with mental illnesses are dangerous and unpredictable (deTorres, 2002; Sanchez & Gaw; 2007).

Rejection of these individuals is demonstrated through the non acceptance of persons with mental illness as employees or cohabitants.

Interestingly, several studies indicate that persons with a higher degree of education are less likely to view individuals with mental illness as being dangerous (Corrigan & Watson, 2007;

Edman & Kameoka, 1997; Edman & Johnson, 1999). In their study on stigma, Corrigan and

Watson (2007) found that women were less likely to endorse stigma of psychiatric disorders versus men. In addition, they also found that participants with higher degrees of education were also less likely to endorse stigma than less educated participants.

Similarly, in their study examining the role of cultural group membership and education in explaining illness schemas, Edman and Kameoka (1997) compared Filipina women’s perceptions with Caucasian Americans perspectives. Results from their study supported the hypothesis that belief in Spiritual-Social components of illness causation is more predictive for both the educated and less educated Filipina women versus the Caucasian American women. Cultural Identity and Perception of Dangerousness 18

However, among the Filipina participants, the Spiritual-Social component of illness causation was more salient for the less educated Filipina women than the educated Filipina women.

These results suggest that cultural group membership and education may have an impact on beliefs about illness causation. As demonstrated by the data, Edman and Kameoka (1997) suggest that formal education and higher socioeconomic status within ethnic groups may alter indigenous beliefs to some extent, however it is not likely that the cultural component of spiritual attribution toward illness schema would be eliminated. Furthermore, these authors indicate that the notion of modernization is important to consider when assessing the extent to which indigenous beliefs may be modified by Western influences.

Ultimately, the rationale and explanation of an illness concept is inseparable from an individuals’ cultural and social frame of reference and should therefore, always be taken into account when interpreting the illness (Edman & Kameoka, 1997). Based on the few existing studies on Filipino ethnicity and perceptions of persons with mental illness, an exploratory analysis was conducted through a pilot study.

After reviewing the research on Filipino Americans and assessing the possible influence of several factors including the effects of modernization, familiarity with American culture, current immigration trends indicating a continuous influx of educated professional Filipino immigrants, many who work as health care professionals, as well as potential transitions in cultural content post immigration, it is hypothesized that:

H1: Perceptions of dangerousness will be negatively associated with Filipino or Filipino

American cultural identification.

Cultural Identity and Perception of Dangerousness 19

H2: Perceptions of dangerousness will be positively associated with White American or Anglo cultural identification.

Thus, if identification with Filipino or Filipino American cultural identity increases then perceptions of dangerousness should decrease and as White American or Anglo cultural identity increases, perception of dangerousness should also increase. Further, since this is an orthogonal model there are no hypotheses examined with respect to Filipino cultural identity and White cultural identity.

White-American or Anglo Cultural + Identification Perception of Dangerousness

Filipino or Filipino American Cultural _ Identification

Figure 1

Cultural Identity and Perception of Dangerousness 20

Chapter Two

Methods

This study involved the second phase of a two-phase process and can best be described as

a retrospective, post hoc design since no manipulation of an experimental condition was

conducted. The primary research design was based on ascertaining the extent to which cultural

identification can be utilized to understand perceptions of dangerousness of persons diagnosed with mental illness.

Participants

This research involved conducting a pilot study (Phase II). A convenience sample of twelve Filipino immigrants living in the Albany, New York area and ten U.S. born non-Filipino

Americans living in the Albany, New York area, participated. All participants were between

eighteen and sixty-seven years of age (M = 40, SD = 39.7). Filipino participants did not immigrate to the United States prior the age of twelve. No female participants were pregnant.

Materials

The relationship among cultural identity and perceptions of dangerousness were assessed using an individually administered questionnaire. Questionnaires were translated and discussed with community consultants (Phase I) for their cultural sensitivity and utility for the Filipino community. Each survey instrument consisted of a demographics questionnaire, a Cultural

Identity Scale (CIS), two questions related to mental illness, one question related to recovery, and a Dangerousness Scale (DS) measuring perceptions of dangerousness in regard to individuals with mental illness.

Cultural Identity and Perception of Dangerousness 21

Demographics Questionnaire

The demographics questionnaire contained fourteen items pertaining to each participant’s

gender, date of birth, location where the participant was born, location where participant

currently lives, marital status, highest level of education completed, weather or not she/he is a

student and if so what is the field of study, employment status, and religious or spiritual

affiliation.

Cultural Identity Scale (CIS)

The Cultural Identification instrument used was designed to measure an individual’s perception of their cultural affiliation. It is an orthogonal model that allows an individual to identify with more than one culture simultaneously and at different levels, therefore increased identification with one culture does not require decreased identification with another (Oetting &

Beauvais, 1990-1991). Essentially, cultural identification with one ethnic group can be measured independently from one’s identification with another group. The Orthogonal Identification

Model was designed to capture all possible combinations of cultural identity and acknowledges that change in one’s cultural identity is possible. This measure specifically includes a category for measuring the identity of Asian or Asian American individuals and has been used to measure the cultural identity in several studies conducted by Oetting and Beauvais (1990). The orthogonal model has been used by researchers in New York State as well (Santiago-Rivera, A., Morse, G.

S., Hunt, A., & Lickers, H., 1997; DeCaprio, A. P., Johnson, G. W., Tarbell, A. M., Carpenter,

D. O., Chiarenzelli, J. R., Morse, G. S., Santiago-Rivera, A. L., Schymura, M. J., and Akwesasne

Task Force on the Environment, 2005). Typical internal consistency of this measure has reliability with a Chronbach’s alpha measure in the high .80s. Cultural Identity and Perception of Dangerousness 22

Dangerousness Scale (DS)

The Dangerousness Scale (DS) is an eight-statement survey designed to measure attitudes and stigma toward persons with mental illness. This scale was adopted from Penn (1994) and

Link (1986) and modified by Mas and Hatim (2002). The original scale measured attitudes and stigma toward persons with mental illness in a population of undergraduate students attending college at the University of Nebraska-Lincoln (Penn, 1994). This scale had an internal consistency of 0.78. The dangerousness scale was amended from its original form in order to accommodate Malaysian and Pacific Islander (Asian) populations. Conducted with first year pre- clinical and final year clinical students attending the University of Malaya, Kuala Lumpur,

Malaysia; the dangerousness scale was used to assess the attitudes of medical students toward mental illness (Mass & Hatim, 2002). The proposed study utilized the dangerousness scale adapted by Mass and Hatim (2002) to accommodate the Filipino population.

Procedure

Both measures were translated into Tagalog in order to clarify any differences or unfamiliarity with American terminology. Additionally, ten Filipino cultural identities were added to the Cultural Identity Scale (CIS) to capture the main cultural sub-groups identified in the literature. Participants were individually asked by the researcher to participate in this study.

Upon consent to participate in this study, subjects were instructed to complete the survey by circling or checking all answers that applied to them directly. Participants were asked to answer all questions to the best of their ability.

Cultural Identity and Perception of Dangerousness 23

Upon completion, subjects were instructed to place their own, individually completed survey in a manila envelope. All completed forms remained in the envelope unseen by the researcher until all necessary data had been collected. All participants were thanked individually for his or her participation. No compensation was given.

Design and Data Analysis

The methods of data analysis that were employed include (1) descriptive statistics of the

sample, and the classified sub-groups on all of the study variables, (2) histograms, box plots, and

correlation matrices for variables in question, (3) bivariate correlation analysis of the study variables, and (4) logistic regression for the multiple predictor models aimed at predicting

differences among the variables.

An ex post facto research design was employed in this study. The dependent variable

(DV) is the measured levels of perception of dangerousness using the Dangerousness Scale (DS).

The independent variables (IV) were identification with White American or Anglo culture

(WAC) and identification with Filipino or Filipino American culture (FAM). Additional cultural

variables were included in a modified version of the Cultural Identity Scale (CIS) revised to

encompass the ten main Filipino ethnic sub-groups identified in the literature along with the original six cultural identifications. Both measures are self-reports, therefore while they may adequately indicate an individual’s subjective sense of their cultural affiliation, as well as perceptions of dangerousness, they may also present limitations and other problems with measurement.

Cultural Identity and Perception of Dangerousness 24

Power Analysis

A power analysis was conducted prior to commencement of this pilot study which indicates that a sample size of N=22 was enough to identify variability. The statistical power of the overall model described in previous paragraphs was greater than 90% on the equivalent of the whole model R2’s.

Cultural Identity and Perception of Dangerousness 25

Chapter Three

Results

Demographics

The majority of respondents in this study were female (72.7%). The respondents were between 18 and 67 years of age. The mean age of subjects was 40 (M=39.7, SD=14.7). All

participants had a least some high school education and most had some degree of college

education (81.8%). Additionally, 63.6% of this sample identified themselves as being married.

The Catholic tradition was the predominate religious affiliation for this sample.

Table 1

Descriptive Statistics for Pilot Study Sample (N=22)

Variable Name N % of sample

Gender______Males 6 27.3% Females 16 72.7%

Educational Attainment______Some High School 1 4.5% High School Diploma/ 3 13.6% GED Certificate Some College 5 22.7% Bachelor’s Degree 8 36.4% Some Graduate School 2 9.1% Master’s Degree 3 13.6%

Religious Affiliation______Catholic 13 59.1% Protestant 6 27.3% Other 1 4.5% No Religious Affiliation 2 9.1%

Cultural Identity and Perception of Dangerousness 26

Variable Name N % of sample

Marital Status______Never Married 6 27.3% Married 14 63.6% Divorced 1 4.5% Separated 1 4.5%

Age______18-67 yrs. N=22 M=39.7, SD=14.7

Characteristics of Measures

Participants in this study varied greatly in their cultural identification, even within the ten

Filipino sub-groups. Due to the large number of possible cultural sub-group affiliations and small sample size a Factor Analysis was conducted to coalesce the data. Upon conducting a principle component factor analysis with varimax rotation, five categories emerged. These were organized in a logical fashion and can be best described as (1) identification with White American or Anglo culture (WAC), (2) identification with Mexican American or Spanish culture (MSC), (3) predominate identification with Filipino cultures (PFC), (4) predominate identification with

Asian or Asian American culture (PAC) and (5) predominate identification with Black and

American Indian cultures (PBAIC). These will be used in the analysis.

Descriptive Statistics

The means, standard deviations and ranges for the independent and dependent variables

of the study are summarized in Table 2 (N=22). The Dangerousness Scale (DS), a measure used to assess participant’s perceptions regarding individuals diagnosed with mental illness revealed

appropriate variability across subjects with a standard deviation of 5.16, a minimum score of

22.00 and a maximum score of 41.00. The Cultural Identification Scale (CIS), which is a

Cultural Identity and Perception of Dangerousness 27

subjective measure of an individual’s perception of their cultural affiliation, also demonstrated

acceptable variability across subjects.

______Table 2

Descriptive Statistics of the Dependent and Independent Variables of the Study (N=22)

Variable Mean SD Range DS 32.22 5.16 22.00-41.00 WAC 1.371 1.08 .00-3.00 MSC .38 .598 .00-2.17 PFC .31 .558 0-2 PAC .71 .868 0-3 PBAIC .28 .516 0-2

Analysis and Tests of Hypotheses

Data were analyzed using regression analysis to evaluate the hypothesized relationships between cultural identification and perceptions of dangerousness. The principle analysis is based on the evaluation of a univariate, five predictor multiple regression model using the operational variables perception of dangerousness (DS), identification with White American culture (WAC), identification with Mexican American or Spanish culture (MSC), predominate identification with

Filipino culture (FAM), predominate identification with Asian or Asian American culture (PAC), and predominate identification with Black and American Indian cultures (PBAIC). Cultural Identity and Perception of Dangerousness 28

______Table 3

Regression Equation

DS= a+b1*WAC+b2*MSC+b3*PFC+b4*PAC+b5*PBAIC

Where: a is a constant DS represents Perceptions of Dangerousness, WAC represents Identification with White American or Anglo Culture MSC represents Identification with Mexican American or Spanish Culture PFC represents Predominate Identification with Filipino Cultures PAC represents Predominate Identification with Asian or Asian American Culture PBAIC represents Predominate Identification with Black and American Indian Cultures

Table four illustrates the specific statistical tests and research criteria used to evaluate the

overall statistical significance and congruousness of the regression model, as well as to test the

two research hypotheses.

Table 4

Statistical Tests and Research Criteria

Tests Acceptance Criteria

The F-Test was used to evaluate the overall P(F)<.05 congruousness of the Regression Model.

The Coefficient of Multiple Determination (R2) P(F)<.05 was used to estimate the proportion of the variation in DS accounted for by the variation in WAC, MSC, PFC, PAC, and PBAIC.

H1 was evaluated based on the significance of t for P(tb1)<.05 the coefficient b1.

H2 was evaluated based on the significance of t for P(tb1)<.05 the coefficient b2.

Cultural Identity and Perception of Dangerousness 29

The dependent variable (DS), the independent variables (IV) related to the five cultural

identity categories, and the variables age, gender, and education were used in the Correlation

Matrix illustrated in Table five.

Table 5

Correlations of Log Transformed DS and the Independent Variables (N=22)

Table # DS WAC MSC PFC PAC PBAIC Age Gender Education

DS 1.00

WAC -.584** 1.00

MSC .185 -.074 1.00

PFC .261 -.128 .213 1.00

PAC .423 -.177 .432* .671** 1.00

PBAIC -.010 -.126 .017 -.142 -.023 1.00

Age -.075 .219 -.323 -.383 -.447* .049 1.00

Gender -.021 -.139 .106 .185 .094 .083 -.097 1.00

Education -.073 .072 -.053 -.176 -.231 -.069 -.146 .183 1.00

**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

NOTE: DS = Perception of Dangerousness WAC = White American or Anglo Cultural Identity MSC = Mexican American or Spanish Cultural Identity PFC = Predominate Filipino Cultural Identity PAC = Predominate Asian or Asian American Cultural Identity PBAIC = Predominate Black and American Indian Cultural Identity

Cultural Identity and Perception of Dangerousness 30

Upon conducting a correlation matrix assessing perceptions of dangerousness (DS) among the variables of age, gender, education and the five independent variables (IV), identification with White American or Anglo culture (WAC), identification with Mexican

American or Spanish culture (MSC), predominate identification with Filipino culture (PFC), predominate identification with Asian or Asian American culture (PAC), and predominate identification with Black and American Indian cultures (PBAIC), the demographic characteristics of gender and education, as well as identification with Black and American Indian cultures did not convey any evidence of a correlation with any of the variables. Therefore,

gender, education, and PBAIC were removed.

Multiple Regression Analysis

Two regression analyses were conducted. One analysis contained the remaining four cultural variables (IV), age, and the dependent variable (DV) dangerousness which was not statistically significant. The second analysis was conducted with only the hypothesized variables.

The results of the first regression analysis (Table 6) demonstrate the effects of DS, WAC,

MSC, PFC, PAC, and age (F (5, 17)=3.02, p<.044, R2=.50). Of the five independent variables estimated in the model, Mexican American or Spanish cultural identification (MSC),

predominate Filipino cultural identification (PFC), predominate Asian or Asian American

cultural identification (PAC), and age were not statistically significant. However, the relationship between affiliation with White American or Anglo cultural (WAC) and perception of dangerousness (DS) was statistically significant (r = .708, p = .008). Identification with White

American or Anglo culture (WAC) was negatively associated with perception of dangerousness

(DS). Cultural Identity and Perception of Dangerousness 31

Since there was no evidence of statistically significant correlations between any other variables, MSC, PAC, and age were removed from the analysis. Therefore, the second

regression, as demonstrated in Table seven was conducted using only the two hypothesized

variables.

Table 6

Multiple Regression of log on DS*, WAC, MSC, PFC, PAC, and Age

R2 = .50, F(5, 17) = 3.02, p< .044

Variable B SE b Beta t p(t)

WAC -2.918 .955 -.602 -3.054 .008 MSC .374 1.742 .044 .215 .833 PFC .097 2.260 .011 .043 .966 PAC 2.279 1.595 .386 1.428 .174 Age .118 .078 .324 1.505 .153

The second regression (Table 7) was conducted using only the variables WAC and PFC.

Results of this analysis indicate a statistically significant relationship between WAC and DS (r =

.606, p = .009). The relationship between affiliation with White American or Anglo cultural was found to be negatively associated with perception of dangerousness. Therefore, the more an individual identified with White American or Anglo Culture the less they perceived persons with a diagnosis of mental illness as being dangerous. Cultural Identity and Perception of Dangerousness 32

______Table 7

Multiple Regression of log on DS*, WAC, PFC

R2 = .37, F(2, 20) = 5.24, p< .016

Variable B SE b Beta t p(t)

WAC -2.693 .922 -.556 -2.921 .009 PFC 1.504 1.730 .165 .869 .396

Tests of Hypotheses

The two hypotheses set forth and the results of the hypotheses tested are reviewed below

Hypothesis #1: It was hypothesized that perceptions of dangerousness is negatively associated

with Filipino American cultural identification.

Hypothesis #1 was not supported by the analysis. Perceptions of dangerousness were not

associated with Filipino American participants.

Hypothesis #2: It was hypothesized that perceptions of dangerousness would be positively associated with White American or Anglo cultural identification.

Hypothesis #2 was not supported by the analysis; rather perceptions of dangerousness were negatively associated with White American or Anglo cultural identification.

The results of this study suggest that culture was significantly related to perceptions of dangerousness. Identification with White American or Anglo (WAC) cultural identity accounted for 37% of the variance when predicting perceptions of dangerousness of individuals with mental illness.

Cultural Identity and Perception of Dangerousness 33

White-American -.556 Cultural Identification

Perception of ns Dangerousness __

Predominate ns Filipino Cultural Identification

Figure 2

Cultural Identity and Perception of Dangerousness 34

Chapter Four

Discussion

This study examined the relationship between cultural identity and perceptions of

dangerousness of persons diagnosed with mental illness. It was hypothesized that perceptions of dangerousness would be negatively associated with Filipino or Filipino American (FAM)

cultural affiliation and that perceptions of dangerousness would be positively associated with

White American or Anglo (WAC) cultural identification. However, the results of this study did

not support these hypotheses.

Contrary to the proposed hypotheses there was no statistically significant relationship between predominate identity with Filipino culture (PFC) and perceptions of dangerousness

(DS). However, findings conclude there was a negative association between WAC and DS suggesting the more an individual identifies with White American or Anglo culture (WAC), the less likely they are to view persons with mental illness as being dangerous. Overall, the model indicates there is a relationship between cultural identity and perception of dangerousness.

Implications for Past Theory and Research

Results from the current study support the outcomes reported in similar research on

stigma associated with mental health diagnoses. In Corrigan and Watson’s (2007) study on

stigma of psychiatric disorders, nonwhite participants were more likely to than whites to endorse

stigma.

In contrast with studies assessing the effects of gender and education on perceptions of

mental illness, the current study did not support such research. While several studies conclude

that higher education decreases the likelihood of stigmatizing mental illness, there was no Cultural Identity and Perception of Dangerousness 35 significant relationship between education and perception of dangerousness in the current study.

In addition, gender was not a significant variable in relation to perception of dangerousness.

Limitations

While the current data suggests there is a relationship between cultural identification and perceptions of dangerousness, there are several limitations to this study. The sample size (N=22) used in this study was small, and is under representative of Filipino American and American culture as a whole. In addition, the selected participants constitute a convenience sample.

Therefore, one can not discount the possibility that the outcome of this study was due to unidentified participant characteristics. Replication of this study using random sampling with a larger subject population would be beneficial.

Additionally, when assessing cultural identification, the cultural identity of Pacific

Islander was not included. Literature pertaining to Filipino American identity indicates that some

Filipinos self identify as Pacific Islanders (Tuason et al., 2007; Chandras et al, 1999). As an ethnic affiliation, Pacific Islanders differentiate themselves from other Asian American groups based on several characteristics including having knowledge of the English language (the second official language of the Philippines) and predominate affiliation with the Catholic religion, unlike other Asian sub-groups who mainly practice Buddhism or Confucianism (Tuason et al.,

2007). Therefore it would be worthwhile to include the ethnic affiliation of Pacific Islander in future research assessing the cultural identity of Filipino Americans.

Furthermore, cultural identification was measured using an orthogonal model. This study did not examine the specific degree to which each individual participant identified with White

American or Anglo cultural (WAC). In consideration of potential acculturation effects on Cultural Identity and Perception of Dangerousness 36 cultural content post immigration, it may be beneficial to investigate perceptions of dangerousness in regard to the extent participants individually affiliate with WAC.

Implications for Future Research

Current research on Asian American ethnic groups documents a void of information

regarding the Filipino American mental health profile in the United States. It has been well established that a lack of culturally appropriate mental health services for all Asian ethnic groups

exists in the U.S. In addition, research indicates that cultural conceptions of mental illness influences help seeking behaviors. Therefore, additional research is necessary to examine and understand potential relationships between culture and the conceptualization of illness, perceptions of mental health, and cultural differences in symptom expression, patterns of service utilization, and diagnosis and treatment of mental disorders (Link, Phelan, Bresnahan, Stueve, &

Pescosolido, 1999; Edman & Kameoka, 1997; Speller, 2005).

Given the unique culture of the Philippines, the influx of Filipinos immigrating to the

United States, and the cultural variability within Filipino sub-groups, there is a considerable need to conduct research that distinguishes Filipino Americans from other Asian American ethnicities.

In addition, as the ethnic diversity within the United States continues to expand, the need for research about these ethnic groups in relation to their immigration experiences, as well as culturally indigenous belief systems, will be an important factor for establishing effective cultural centered mental health services for Asian Americans and other ethnic groups.

Cultural Identity and Perception of Dangerousness 37

References

Bhugra, D., Bhui, K., Mallett, R., Desai, M., Singh, J. & Leff, J. (1999). Cultural identity and its

measurement: A questionnaire for Asians. International Review of Psychiatry, 11, 244-249.

Bjorck, J. P., Cuthbertson, W., Thurman, J. W. & Lee, Y. S. (2001). Ethnicity, coping, and

distress among Korean Americans, Filipino Americans, and Caucasian Americans. The

Journal of Social Psychology, 141(4), 421-442.

Chandras, K. V., Eddy, J. P. & Spaulding, D. J. (1999). Counseling Asian Americans:

Implications for training. Education, 120(2), 239-246.

Chen, H., Kramer, E. J., Chen, T. & Chung, H. (2005). Engaging Asian Americans for mental

health research: Challenges and solutions. Journal of Immigrant Health, 7(2), 109-116.

Chung, H., Teresi, J., Guarnaccia, P., Meyers, B. S., Holmes, D., Bobrowitz, T., et al. (2003).

Depressive symptoms and psychiatric distress in low income Asian and Latino primary care

patients: Prevalence and recognition. Community Mental Health Journal, 39(1), 33-46.

Conde, B. (2004). Philippines mental health country profile. International Review of Psychiatry,

16(1-2), 159-166.

Corrigan, P. W. & Watson, A. C. (2007). The stigma of psychiatric disorders and the gender,

ethnicity, and education of the perceiver. Community Mental Health Journal, 43(5), 439-458.

David, E. R. & Okazaki, S. (2006). The colonial mentality scale (CMS) for Filipino Americans:

Scale construction and psychological implications. Journal of Counseling Psychology, 53(2),

241-252.

DeCaprio, A. P., Johnson, G. W., Tarbell, A. M., Carpenter, D. O., Chiarenzelli, J. R., Morse, G.

S., et al. (2005). Polychlorinated biphenyl (PCB) exposure assessment by multivariate Cultural Identity and Perception of Dangerousness 38

statistical analysis of serum congener profiles in an adult Native American population.

Environmental Research, 98(3), 284-302. deTorres, S. Understanding persons of Philippine origin: A primer for rehabilitation service

providers In (Stone, J., Ed.). State University of New York, University at Buffalo: Center for

International Rehabilitation Research Information and Exchange, 2002. i-22. 28 p. Retrieved

November 28, 2007, REHABDATA database.

Edman, J. L. & Johnson, R. C. (1999). Filipino American and Caucasian American beliefs about

the causes and treatment of mental problems. Cultural Diversity and Ethnic Minority

Psychology, 5(4), 380-386.

Edman, J. L. & Kameoka, V. A. (1997). Cultural differences in illness schemas: An analysis of

Filipino and American illness attributions. Journal of Cross-Cultural Psychology, 28(3), 252-

265.

(2007). Index of Demographic Statistics. Retrieved April 07, 2008, from National Statistics

Office, Republic of the Philippines Web site:

http://www.census.gov.ph/data/sectordata/datapop.html

Link, B. G. & Cullen, F. T. (1986). Contact with the mentally ill and perceptions of how

dangerous they are. Journal of Health and Social Behavior, 27(4), 289-302.

Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public

conceptions of mental illness: Labels, causes, dangerousness, and social distance. The

American Journal of Public Health, 89(9), 1328-1333.

Mas, A. S. & Hatim, A. (December 2002). Stigma in mental illness: Attitudes of medical

students towards mental illness. The Medical Journal of Malaysia, 57(4), 433-444. Cultural Identity and Perception of Dangerousness 39

(2003, January 14). National Capital Region. Retrieved April 07, 2008, from National Statistics

Office, Republic of the Philippines Web site:

http://www.census.gov.ph/data/pressrelease/2003/pr0312tx.html

Oetting, E. R. & Beauvais, F. (1991). Orthogonal cultural identification theory: The cultural

identification of minority adolescents. The International Journal of the Addictions, 25(5A &

6A), 655-685.

Penn, D. L., Guynan, K., Daily, T., Spaulding, W. D., et al. (1994). Dispelling the stigma of

schizophrenia: What sort of information is best? Schizophrenia Bulletin, 20(3), 567-578.

Sanchez, F. & Gaw, A. (2007). Mental health care of Filipino Americans. Psychiatric Services,

58(6), 810-815.

Shakman, R. (1969). Indigenous healing of mental illness in the Philippines. The international

Journal of Social Psychiatry, 15(4), 279-287.

Simons, R. C. & Hughes, C. C. (Eds.). (1985). Schizophrenia, Acute Psychoses, Culture-Bound

Syndromes and Other Mental Disorders. The Culture-Bound Syndromes Folk Illness of

Psychiatric and Anthropological Interest (pp. 64-88). Dordrecht/Boston/Lancaster/Tokyo: D.

Reidel Publishing Company.

Simons, R. C. & Hughes, C. C. (Eds.). (1985). Glossary of 'Culture-Bound' or Psychiatric

Syndromes. The Culture-Bound Syndromes Folk Illnesses of Psychiatric and Anthropological

Interest (pp. 475-497). Dordrecht/Boston/Lancaster/Tokyo: D. Reidel Publishing Company.

Santiago-Rivera, A. L., Morse, G. S., Hunt, A. & Lickers, H. (March 1998). Building a

community-based research partnership: Lessons from the Mohawk Nation of Akwesasne.

Journal of Community Psychology, 26(2), 163-174. Cultural Identity and Perception of Dangerousness 40

Speller, H. (2005). Asian Americans and mental health: Cultural barriers to effective treatment.

Elements, Spring, 69-79.

Tompar-Tiu, A. & Sustento-Seneriches, J. (1995). Depression and Other Mental Health Issues:

The Filipino American Experience. San Francisco: Jossey-Bass.

Tuason, T. G., Taylor, A. R., Rollings, L., Harris, T. & Martin, C. (2007). On both sides of the

hyphen: Exploring Filipino-American identity. Journal of Counseling Psychology, 54(4),

362-372.

Cultural Identity and Perception of Dangerousness 41

Appendix

Pilot Study Questionnaire

Part I. Unang Parte

Today’s Date Ang Petsa Ngayon ______/______/______Mo. Day Yr. (Buan) (Araw) (Taon)

1. Gender: 1=Male 2=Female Kasarian Lalake Babae

2. On what date were you born? Anong petsa ka pinanganok? ______/______/______Mo. Day Yr. (Buan) (Araw) (Taon)

3. Where were you born? Saan ka pinanganak? [GEOGRAPHIC LOCATION Tiyak na kinalalagyan, i.e. TOWN Bayan, PROVINCE Probinsiya, CITY Lunsod, STATE]

______

4. Where do you live now? Saan ka ngayan nakatira? [GEOGRAPHIC LOCATION Tiyak na kinalalagyan, i.e. TOWN Bayan, PROVINCE Probinsiya, CITY Lunsod, STATE]

______

5. What is your current Marital Status? 1 = Never Married 2 = Married Ano ang iyong estado sa buhay? (Binata o Dalaga) (Kasal) 3 = Widowed 4 = Divorced (Biyudo o Biyuda) (Diborsyado o Diboryada) 5 = Separated 6 = Live-in-partner (Hiwalay) (Kinakasama sa bahay) 8 = Other Iba pa ______

Cultural Identity and Perception of Dangerousness 42

6. What is your highest level of education completed? Bago ngayon, ano ang pinaka-mataas na grado ng pag-aaral ang iyong nakumpleto?

0 = No school Hindi nakapag-aral 1 = Grade school Elementarya 2 = Some high school Konting high school 3 = High school diploma/GED certificate High School Diploma o ano mang Katumbas 4 = Some college Konting kolehiyo 5 = Bachelor’s degree 6 = Some graduate school Konting graduate school 7 = Master’s degree 8 = Professional degree (i.e. Ph.D., RN, M.D., etc.) 9 = Other Iba pa ______

7a. Are you going to school now? Ikaw ba ay nag-aaral sa eskuwelahan ngayon? ______1 = Yes 2 = No [If no, skip to question 7]

7b. What is your field of study? Anong kurso ang iyong pinag-aaralan?

______

8. Are you currently employed? Nagtatrabaho ka ba ngayon?

1 = Yes, full-time Oo pultaym 2 = Yes, part-time Oo pultaym 3 = Seasonally 4 = No, I choose not to work at this time Hinde, pinili kong hinde magtrabaho 5 = No, I am laid-off from work Hinde, natanggal ako sa trabaho 6 = No, I cannot find suitable employment Hinde, walang angkop na trabaho 7 = No, I am retired Hinde, reterido 8 = No, other Hinde, ibang dahilan ______

9. Do you have a religious or spiritual affiliation? ______Mayroong ka bang kinasasa-lihang relihiyion o paniniwala?

1 = Yes Oo [If yes, go to question 10] [Kung oo, sagutan ang ika- 10] 2 = NO Wala

Cultural Identity and Perception of Dangerousness 43

10. What is your religious or spiritual affiliation? Ano ang iyong relihiyon o paniniwala?

Select [write] all that apply: ______Piliin [isulat] ang tumutungkol sa’yo ______

1 = Catholic Katoliko 2 = Protestant (Methodist, Baptist, Presbyterian, etc.) Protestante (Methodist, Baptist,Presbyterian, atbp.) 3 = Mormon (Church of Latter Day Saints) Mormon (Church of Latter Day Saints) 4 = Jehovah’s Witness Saksi ni Hoba 5 = Jewish Hudyo 6 = Buddhist 7 = Muslim 8 = Hinduism 9 = Other Iba pa ______

11. [If more than one type selected above] Which one is most important to you right now? [Kung mahigit sa isa ang napili] Alin ang pinaka-importante sa iyo ngayon? [write the number listed above] ______[isulat ang numero na nakalista sa itaas] ______

12. What is the extent to which you practice this religious or spiritual affiliation? Gaano kadalas mo sinasanay ang iyong pananampalataya sa iyong relihiyon o paniniwala?

1 = a little Kaunti 2 = somewhat Hindi gaanong madalas 3 = a lot Madalas

Cultural Identity and Perception of Dangerousness 44

Part II. Pangalawang Parte

The following questions ask how close you are to different cultures. When answering the questions about “family”, think about the family that is most important to you now. How would you define that family? You can include your current family, your family of origin, or both. Answer the questions keeping that definition in mind. You may identify with more than one culture, so please mark all responses that apply to you. Ang sumusunod na mga katanungan ay tumutukoy kung gaano kayo kalapit sa iba't-ibang kultura. Kapag sumasagot ng tanong tunkol sa 'pamilya', isaisip ang pamilya na mahalaga sa iyo ngayon. Paano mo bibigyang kahulugan ang pamilyang ito? Pwede mong isama ang pamilya mo ngayon, ang iyong mga magulang at kanilang magulang o pareho. Sagutan ang mga tanong na nasa isip ito. Maari kang makaugnay sa mahigit isang kultura, markahan ang lahat ng naangkop sa iyo.

Cultural Identity and Perception of Dangerousness 45

1. Some families have special activities or traditions that take place every year at particular time (such as holiday parties, special meals, religious activities, trips, or visits). How many of these special activities or traditions does your family have that are based on… 1. May ilang pamilya na mayroong selebrasyon o tradisyon na ipagdiriwang taun-taon sa ibat'-ibang panahon (katulad ng piyesta opisyal, piyesta ng mga patron, pasyal, bisita o bakasyon). Ilan sa mga okasyon na ito na mayroon ang iyong pamilya na batay sa ....

A lot Some A few None at Marami Kaunti Mas all Kaunti Wala White American or Anglo Culture Amerikano (puti) kultura Asian or Asian American culture Asiano o Asianong Amerikanong kultura Mexican American or Spanish culture Mexicano Amerikano o Espanyol/Kastila na kultura Black or African American culture

American-Indian culture

Filipino or Filipino American culture Filipino o Fil-Am kultura Tagalog or Filipino culture Tagalog o Pilipinong kultura Cebuano or Filipino Cuture Cebuano o Pilipinong kultura Ilocano or Filipino culture Ilocano o Pilipinong kultura Bikolano or Filipino culture Bikolano o Pilipinong kultura Ilonggo or Filipino culture Ilonggo o Pilipinong kultura Waray or Filipino culture Waray o Pilipinong kultura Kapampangan or Filipino culture Kapampangan o Pilipinong kultura Pangasinenses or Filipino culture Pangasinenses o Pilipinong kultura Chinese-Filipino culture Intsik-Pilipino kultura Other culture Ibang kultura

Cultural Identity and Perception of Dangerousness 46

2. In the future, with your own family, will you do special things together or have special traditions, which are based on… 2. Sa hinaharap, sa iyong pamilya, may balak ka bang magkaroon ng selebrasyon o tradisyon na batay sa...

A lot Some A few None at Marami Kaunti Mas all Kaunti Wala Asian or Asian American culture Asiano o Asianong Amerikanong kultura Mexican American or Spanish culture Mexicano Amerikano o Espanyol/Kastila na kultura Black or African American culture

American-Indian culture

Cultural Identity and Perception of Dangerousness 47

3. Does your family live by or follow the… 3. Ang pamilya mo ba ay namumuhay o sumusunod sa....

A lot Some A few None at Marami Kaunti Mas all Kaunti Wala Mexican American or Spanish culture Mexicano Amerikano o Espanyol/Kastila na kultura Black or African American culture

American-Indian culture

Cultural Identity and Perception of Dangerousness 48

4. Do you live by or follow the… 4. Ikaw ba namumuhay o sumusunod sa...

A lot Some A few None at Marami Kaunti Mas all Kaunti Wala Black or African American culture

American-Indian culture

Cultural Identity and Perception of Dangerousness 49

5. Is your family a success in the… 5. Ang pamilya mo ba ay matagumpay sa....

A lot Some A few None at Marami Kaunti Mas all Kaunti Wala Filipino or Filipino American culture Filipino o Fil-Am kultura Tagalog or Filipino culture Tagalog o Pilipinong kultura Cebuano or Filipino Cuture Cebuano o Pilipinong kultura Ilocano or Filipino culture Ilocano o Pilipinong kultura Bikolano or Filipino culture Bikolano o Pilipinong kultura Ilonggo or Filipino culture Ilonggo o Pilipinong kultura Waray or Filipino culture Waray o Pilipinong kultura Kapampangan or Filipino culture Kapampangan o Pilipinong kultura Pangasinenses or Filipino culture Pangasinenses o Pilipinong kultura Chinese-Filipino culture Intsik-Pilipino kultura White American or Anglo Culture Amerikano (puti) kultura Asian or Asian American culture Asiano o Asianong Amerikanong kultura Mexican American or Spanish culture Mexicano Amerikano o Espanyol/Kastila na kultura Black or African American culture

American-Indian culture

Other culture Ibang kultura

Cultural Identity and Perception of Dangerousness 50

6. Are you a success in the… 6. Ikaw ba ay matagumpay sa...

A lot Some A few None at Marami Kaunti Mas all Kaunti Wala Tagalog or Filipino culture Tagalog o Pilipinong kultura Cebuano or Filipino Cuture Cebuano o Pilipinong kultura Ilocano or Filipino culture Ilocano o Pilipinong kultura Bikolano or Filipino culture Bikolano o Pilipinong kultura Ilonggo or Filipino culture Ilonggo o Pilipinong kultura Waray or Filipino culture Waray o Pilipinong kultura Kapampangan or Filipino culture Kapampangan o Pilipinong kultura Pangasinenses or Filipino culture Pangasinenses o Pilipinong kultura Chinese-Filipino culture Intsik-Pilipino kultura White American or Anglo Culture Amerikano (puti) kultura Asian or Asian American culture Asiano o Asianong Amerikanong kultura Mexican American or Spanish culture Mexicano Amerikano o Espanyol/Kastila na kultura Black or African American culture

American-Indian culture

Filipino or Filipino American culture Filipino o Fil-Am kultura Other culture Ibang kultura

Cultural Identity and Perception of Dangerousness 51

Part III. Ikatlong Parte

Based on your own knowledge and personal beliefs, please check any of the following answers that apply. Batay sa iyong pagkakaalam at personal na paniniwala, tsekan kung alin sa sumusunod ang nararapat na sagot. Which of the following is/are mental illness? Alin sa sumusunod ang pagkukulang sa isip?

Yes No Don’t Oo Hinde Know Hinde ko alam Phobia

Anxiety disorder

Neurasthenia/Shinkeisuijaku

Mania

Depression (Depresyon)

Schizophrenia

Mental Retardation

Suicide

Somatazation disorder

Speech and language disorders

Substance abuse/dependence

Amok

Koro/ fuk-yeoung

Mali-mali/ Latah

Silok

Psychosis

Cultural Identity and Perception of Dangerousness 52

Signs and/or symptoms of mental illness include? Tanda at/o sintomas ng pagkukulang ng isip?

Yes No Don’t Know Oo Hinde Hinde ko alam Worrying (Nag-aalala)

Nervousness (Pagkakaba)

Sadness/loneliness (Kalungkutan)

Hopelessness (Nawalan ng pag-asa)

Unkempt (Pagpabaya sa sarili)

Hallucinations (seeing or hearing things that are not there) (Naka-kita o nakaka-rinig ng mga bagay na sa guni-guni lang totoo.)

Violent Aggression (Bayolenteng Pagka-agresibo)

Delusions (false beliefs) (Maling paniniwala)

Having trouble with sleeping or eating (too much or too little) (Hirap sa pag-tulog o pag-kain [kaontian o karamihan])

Feeling guilty (Makaramdam ng pagsisisi)

Poor concentration (Hindi lubos ang konsentrasyon)

Anxiety (Pagkabalisa)

Irrational fear (Walang kahulugang pangamba)

Moodiness or brooding (Sumpong)

Addiction to drugs/alcohol (Adiksyon sa bawal na gamot o alcohol)

Cultural Identity and Perception of Dangerousness 53

Which of the following is/are possible treatment for mental illness? Alin sa mga sumusunod ang (mga) posibleng lunas para sa pagkukulang sa isip?

Yes No Don’t Know Oo Hinde Hinde ko alam Prayer (Dasal)

Family care giving (Pag-aalaga ng pamilya)

Indigenous healer (Albolaryo)

Psychiatric medications (Gamot na nireseta ng doctor)

Herbs (Gamot na halaman)

Psychotherapy

Psychiatric hospitalization (Ipasok sa ospital)

Community support (Suporta ng komunidad)

Long-term institutionalization (confinement to a mental hospital) (Pang-mahabaang pamamalagi sa ospital) Spirituality (Espiritualidad)

Psychosocial rehabilitation (Rehabilitasyon)

Massage (Hilot)

Meditation (Magnilay-nilay/Magbulay-bulay)

Job training (Pag-sasanay sa trabaho)

Electro-convulsive therapy (ECT)

Outpatient clinical treatment

Home treatment care (Alaga sa bahay na binibigay ng nars)

Family education (Edukasyon para sa pamilya)

Cultural Identity and Perception of Dangerousness 54

Part IV. Ikaapat na Parte /≥¨®∫¨π®ª¨ªØ¨∫ª®ª¨¥¨µª∫©¨≥∂æ∂µªØ¨≠∂≥≥∂æ∞µÆ∫™®≥¨ ,®π≤®Ø®µ®µÆ¥Æ®∑®Ø®¿®Æ∫®∞©®©®®¿∂µ∫®¥Æ®∫º¥º∫∂µ∂´∫®®µª®∫ 2ªπ∂µÆ≥¿ Æπ¨¨ - ∂. ∑∞µ∞∂µ 2ªπ∂µÆ≥¿# ∞∫®Æπ¨¨

6 ®≥®µÆ 2º¥ ®∫®µÆ®¿∂µ ' ∞µ´∞2º¥ ®∫®µÆ®¿∂µ . ∑∞µ¿∂µ

* ºµÆ®µÆ∞∫®µÆÆπº∑∂µÆ´®ª∞µÆ∑®∫¿¨µª¨µÆ ¥ ®¿∑®Æ)≤º≤º≥®µÆ∫®∞∫∞∑®¿¥ ®≥®∑∞ª≥®µÆ µ®µ∞µ∞π®Ø®µØ∞µ´∞≤∂∑®∑®¿®Æ®µÆ " # $ % & ' ¥ ®Æ∑º¥ ºµª®®µÆ®≤∞µÆ®µ®≤∫®∫Ø∂∑∑∞µÆ¥ ®≥≥ µ®æ ®≥®µÆ≤®∫®¥ ®

' (≠®≠∂π¥ ¨π¥ ¨µª®≥∑®ª∞¨µª®∑∑≥∞¨´≠∂π®±∂© ª¨®™Ø∞µÆ®ª®∫™Ø∂∂≥®µ´∏º®≥∞≠∞¨´≠∂πªØ¨±∂©( ' & % $ # " æ ∂º≥´π¨™∂¥ ¥ ¨µ´Ø∞π∞µÆØ∞¥ -Ø¨π * ºµÆ®µÆ∞∫®µÆ´®ª∞µÆ∑®∫¿¨µª¨µ®¥ ®¿ ∑®Æ≤º≤º)≥®µÆ∫®∞∫∞∑®¿µ®≤®Ø®µ®∑µÆªπ®©®Ø∂ ∫®∞∫®µÆ¨∫≤ºæ ¨≥®Ø®µ®ª¥ ®¿π∂∂µ∫∞¿®µ ' & % $ # " ≤®ª®µÆ∞®µÆ≤∞µ®≤®∞≥®µÆ®µ∞)π¨π¨≤∂¥ ¨µ´¨≤∂ ∫∞¿®µÆ¥ ®ª®µÆ®∑∫®ªπ®©®Ø∂

& . µ¨∞¥ ∑∂πª®µªªØ∞µÆ®©∂ºª¥ ¨µª®≥∑®ª∞¨µª∫∞∫ ªØ®ª¿∂º™®µµ∂ªª¨≥≥æ Ø®ªªØ¨¿æ ∞≥≥´∂≠π∂¥ ∂µ¨ " # $ % & ' ¥ ∞µºª¨ª∂ªØ¨µ¨øª (∫®µÆ∞¥ ∑∂πª®µª¨µÆ≤®ª®µÆ∞®µµÆ∑®∫¿¨µª¨µ® ¥ ®¿∑®Æ≤º≤º≥®µÆ∫®∞∫∞∑®¿Ø∞µ´∞¥ ∂®≥®¥ " # $ % & ' ≤ºµÆ®µ∂®µÆ∑∂∫∫∞©≥¨µ∞≥®µÆÆ®æ ∞µ®µ∂¥ ®µÆ ∂π®∫

% (≠(≤µ∂æ ®∑¨π∫∂µØ®∫©¨¨µ®¥ ¨µª®≥∑®ª∞¨µª( ' & % $ # " æ ∞≥≥©¨≥¨∫∫≥∞≤¨≥¿ª∂ªπº∫ªØ∞¥ * ºµÆ®≥®¥ ≤∂µ®®µÆ∞∫®µÆª®∂®¿µ®Æ∞µÆ ∑®∫¿¨µª¨µ®¥ ®¿∑®Æ≤º≤º≥®µÆ∫®∞∫∞∑¥ ®≥®≤∞ ' & % $ # " ®µÆ∑∂∫®©∞≥∞´®´µ®Ø∞µ´∞≤∂∫∞¿® ∑®Æ≤®≤®ª∞æ ®≥®®µ

Cultural Identity and Perception of Dangerousness 55

µÆ∑®µÆºµ®Ø∞µÆªºµÆ≤º≥∞µµÆ∂∫∑∞ª®≥∑®π® ∫®¥ Æ®¥ ®¿∑®Æ≤º≤º≥®µÆ∫®∞∫∞∑®¿®µÆ " # $ % & ' ∑π∂ª¨≤∫¿∂µµÆ∑º©≥∞≤∂∫®≤®µ∞≥®µÆ¥ Æ® ∑®∫¿¨µª¨

# (≠®≠∂π¥ ¨π¥ ¨µª®≥∑®ª∞¨µª≥∞Ω¨´µ¨®π©¿( æ ∂º≥´µ∂ªØ¨∫∞ª®ª¨ª∂®≥≥∂æ ¿∂ºµÆ™Ø∞≥´π¨µ ' & % $ # " ºµ´¨π¥ ¿™®π¨ª∂Æ∂ª∂ªØ¨∑≥®¿Æπ∂ºµ´ ®≥∂µ¨ * ºµÆ®µÆ∞∫®µÆ´®ª∞µÆ∑®∫¿¨µª¨µ®¥ ®¿ ∑®Æ≤º≤º≥®µÆ∫®∞∫∞∑®¿¥ ®≥®∑∞ª ' & % $ # " µ®µ∞µ∞π®Ø®µØ∞µ´∞®≤∂¥ ®Æ´®´®≥®æ ®µÆ∞∫∞∑ µ®∑®∑ºµª®Ø∞µ∫®∑®≥®πº®µµ®¥ ®Æ)∞∫®

" ≥ªØ∂ºÆØ∫∂¥ ¨¥ ¨µª®≥∑®ª∞¨µª∫¥ ®¿∫¨¨¥ ®≥≥π∞ÆØª∞ª∞∫´®µÆ¨π∂º∫ª∂≠∂πÆ¨ª≠∂π® " # $ % & ' ¥ ∂¥ ¨µªªØ®ªªØ¨¿®π¨¥ ¨µª®≥≥¿∞≥≥ * ®Ø∞ª¥ º≤Ø®µÆµ∂π¥ ®≥®µÆ¥ Æ®∑®∫¿¨µª¨ µ®¥ ®¿∑®Æ≤º≤º≥®µÆ∫®∞∫∞∑¥ ®∑®µÆ®µ∞© " # $ % & ' µ®≤®≥∞¥ ºª®µ®µÆ≤®µ∞≥®µÆ≤®≥®Æ®¿®µ

# ®∑®ªµ®¥ ®¿π∂∂µÆ©®ª®∫µ®¥ ®Æ©®©®æ ®≥ µ®¥ ®≤®≤ºØ®µÆ≥∞∫¨µ∫∞¿®µÆ∑®µÆ)®π¥ ®∫ ' & % $ # " ®µÆ¥ Æ®´®ª∞µÆ∑®∫¿¨µª¨µ®¥ ®¿ ∑®Æ≤º≤º≥®µÆ∫®∞∫∞∑

Cultural Identity and Perception of Dangerousness 56

Have you ever known someone with mental illness? Mayroon ka na bang nakilalang tao na may pagkukulang sa isip?

Yes Oo No Hindi

If you have known someone with mental illness, who are they? Kung mayroon ka ngang nakilala, sino sila?

Self Aking sarili Family member Miyembro ng pamilya Friend Kaibigan Unspecified contact Hindi kakilala Patient in the hospital Pasyente ng ospital Neighbor Kapitbahay Unsure Hindi sigurado