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Cumulative Trauma Among Adult Mayas Living in Southeast

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Cumulative Trauma Among Adult Mayas Living in Southeast CUMULATIVE TRAUMA AMONG ADULT MAYAS LIVING IN SOUTHEAST FLORIDA by Eugenia I. Millender A Dissertation Submitted to the Faculty of The Christine E. Lynn College of Nursing in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Florida Atlantic University Boca Raton, FL August 2013 Copyright by Eugenia I. Millender 2013 ii CUMULATIVE TRAUMA AMONG ADULT MAYAS LIVING IN SOUTHEAST FLORIDA by Eugenia I. Millender This dissertation was prepared under the direction of the candidate's dissertation advisor, Dr. John Lowe, the Christine E. Lynn College of Nursing, and has been approved by the members of her supervisory committee. It was submitted to the faculty of the Christine E. Lynn College of Nursing and was accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy. SUPERVISORY COMMITTEE: John Lowe, Ph.D., RN, F AAN orr~nAd~ ~/VIu..<-- I~ Patricia Liehr, Ph.D., RN David Newman, Ph.D. ~~ Marlaine S ith, Ph.D., RN Dean, The Christine E. Lynn College ofNursing. :5~/1t ~/3 Barry '¥.Rosson, Ph.D. Date Dean, Graduate College 111 ACKNOWLEDGEMENTS I would like to thank the members of my dissertation committee: Dr. John Lowe, Dr. Patricia Liehr, Dr. David Newman, and Dr. John Linstroth for their constant encouragement and direction. A special thanks to Ms. Janet Jackson and Dr. Hossein Yarandi for their unconditional support and motivation. A heartwarming and sincere thanks to Dr. Faye Gary, who has inspired me to reach for the stars, you are the wind beneath my wings. A special thank you to the participants of my research and community partners, we are absolutely better together. Thank you for sharing your culture, ideas, and history of resilience. Thank you to my friends, SAMHSA fellows, colleagues, family and new friend, Mary Neva Kupferschmidt, for making this difficult journey bearable and enjoyable. This dissertation was supported in part by the Substance Abuse and Mental Health Service Administration (SAMHSA) Minority Fellowship Program of the American Nurses Association. iv ABSTRACT Author Eugenia I. Millender Title Cumulative Trauma among Adult Mayas Living in Southeast Florida Institution Florida Atlantic University Dissertation Advisor Dr. John Lowe Degree Doctor of Philosophy Year 2013 The toxic combination of social, psychological, environmental, cultural, and physiological trauma Mayas living in Southeast Florida face daily places them at higher risk for mental and physical disorders (Marmot & Wilkinson, 2006; WHO, 2010, September). The burden of disease is not limited to mental disorder comorbidities; psychological stress can also induce or exacerbate chronic medical diseases such as obesity, diabetes, and hypertension (Brunner & Marmot, 2006; Sridhar, 2007). This translates to high levels of morbidity, mortality, and disability among ethnically diverse populations (U.S. Department of Health and Human Services, 2001). The continuation of this disregard will add to the health disparity of this nation by delaying assessment, treatment, and development of interventions. The purpose of this study was to explore cumulative trauma as it related to social determinants of health and pathophysiological, psychological, and health behaviors of 102 adult Mayas living in Southeast Florida. The trauma profile for the Mayan population sample obtained through this study reflected v high exposure to different types of trauma; collective identity trauma was most frequently reported, followed by survival trauma, achievement trauma, secondary trauma, and personal identity trauma, with high rates of repetition of the same traumas. Cumulative trauma emerged as the most significant type of trauma, in that it addresses the combination of all similar and dissimilar traumas in the lifespan of a person. Data also revealed that language combined with literacy level may play a role on how populations such as the Mayas report symptoms, as Spanish is a second language for Mayas, with few being able to read it fluently. The findings in this study confirmed that high levels of cumulative trauma dose and the social determinants of health are embedded throughout the cultural experience of the Mayan people, which in the present day manifests as mild forms of depression symptoms for women and moderate alcohol use risk for men. Key words: Maya; alcohol; ASSIST; cumulative trauma; Beck Depression Inventory-II; genocide; Guatemala; Hispanic; social determinants of health vi DEDICATION This manuscript is dedicated to my husband, Don, sons, Don, AJ, and Mehki, and my mother, Carolina. To my husband, thank you for being my biggest fan and keeping all stress tucked away in order for me to complete the task at hand. Your perseverance, encouragement, support, and unconditional love set me up for nothing but success. This dissertation would not have been possible without each one of you. CUMULATIVE TRAUMA AMONG ADULT MAYAS LIVING IN SOUTHEAST FLORIDA List of Tables .................................................................................................................... xii List of Figures .................................................................................................................. xiii Chapter 1. Cumulative Trauma among Adult Mayas Living in Southeast Florida ............ 1 What’s in a Name? .......................................................................................................... 1 Mayas in Central America .............................................................................................. 3 Mayan Exodus to the United States ................................................................................ 3 Mayas in Florida ......................................................................................................... 4 Significance of the Problem ............................................................................................ 5 Mental Health and Substance Abuse Worldwide ....................................................... 5 Mental Illness and Alcohol Use in the United States.................................................. 7 Costs of Mental Health Disorders and Alcohol Use in the United States. ............. 9 Disparities in Mental Illness and Alcohol Use Disorders. .................................... 11 Social Determinants of Health .................................................................................. 13 Stressors. ............................................................................................................... 15 Cumulative Trauma. ......................................................................................... 15 Statement of the Problem .............................................................................................. 17 Conceptual Framework ................................................................................................. 18 Social Determinants of Health Model ....................................................................... 20 vii Conceptual Model for the Study. .......................................................................... 23 Research Questions ....................................................................................................... 25 Research Question 1: ............................................................................................ 25 Research Question 2: ............................................................................................ 25 Research Question 3: ............................................................................................ 25 Research Question 4: ............................................................................................ 25 Research Question 5: ............................................................................................ 25 Research Question 6: ............................................................................................ 25 Definitions of Terms ..................................................................................................... 26 Significance of the Study .............................................................................................. 29 Chapter 2. Literature Review ............................................................................................ 31 Early Life of the Mayas ................................................................................................ 31 Culture/Ethnicity ........................................................................................................... 34 Social Determinants of Health of Adult Mayas ............................................................ 36 Social Structure ......................................................................................................... 36 Social Environment ................................................................................................... 39 Trauma .......................................................................................................................... 41 Historical Trauma ..................................................................................................... 42 Complex and Cumulative Trauma ............................................................................ 44 Psychological Characteristics ................................................................................... 47 Psychological Characteristics and Ethnicity/Culture. ........................................... 48 Psychological Characteristics and Trauma. .........................................................
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