Perceived Discrimination, Experiential Avoidance, and Mental Health among Hispanic Adults in Primary Care

“Specifically, the predictor and mediator were reversed, such that perceived discrimination was tested as a mediator of the associations between experiential avoidance and each criterion variable (Judd & Kenny, 2010; Kraemer et al., 2008; Preacher & Hayes, 2008).”

“…To further strengthen the interpretation of results, alternative models were tested by reversing the proposed mediator for each of the three models (Preacher & Hayes, 2004); specifically, experiential avoidance was the predictor, perceived discrimination was the indirect variable, and all three…”

“Consistent with a fear-avoidance model of emotional processing (Hayes et al., 1996; Vlaeyen & Linton, 2000), Hispanic individuals who experience such personal discomfort may be more likely to be motivated to escape or avoid the immediate situation (e.g. avoiding broader social and economic…”

“In terms of mental health, higher rates of racial discrimination or perceived discrimination among Hispanic individuals are consistently related to globally higher rates of psychiatric symptoms (Araújo & Borrell, 2006; Finch et al., 2000; Moradi & Risco, 2006; Williams et al., 1997).”

“Acceptance and Action Questionnaire (AAQ; Bond et al., 2011).”

“Experiential avoidance reflects the tendency to be consistently (i.e., inflexibly) unwilling to remain in contact with aversive internal experiences, including thoughts, emotions, and physical sensations (Hayes et al., 1996).”

“This semi-structured interview provides reliable DSM-IV diagnoses within a short time frame, which is applicable to primary care settings (Lecrubier et al., 1997).”

“Effect sizes of .01, .09, and.25 refer to small, medium, and large effects, respectively (Preacher & Kelley, 2011).”

“…in line with the theoretical perspective that experiential avoidance may represent a transdiagnostic mechanism underlying the relation between perceived racial discrimination (Chawla & Ostafin, 2007; Kashdan & Rottenberg, 2010) and anxiety/depressive symptoms and disorders among Hispanic persons.”

“For instance, perceived racial discrimination is associated with poorer physical health and greater health complaints among Hispanic persons (Kessler et al., 1999; Pérez et al., 2008; Williams et al., 2003).”

“For instance, perceived racial discrimination is associated with poorer physical health and greater health complaints among Hispanic persons (Kessler et al., 1999; Pérez et al., 2008; Williams et al., 2003).”

“The MINI has demonstrated sound inter-rater and test-retest reliability and validity (Sheehan et al., 1997).”

“Further, some efforts to escape or avoid threatening stimuli may actually promote the intensity and severity of the emotions and thoughts being avoided (Wegner & Zanakos, 1994).”

“Importantly, experiential avoidance is distinct from other transdiagnostic factors, including emotion regulation (Kashdan et al., 2006) and the tendency to experience negative affect (Gámez et al., 2011).”

“Indeed, perceived racial discrimination is consistently linked to heightened levels of negative affect (Gee & Payne-Sturges, 2004; Geronimus et al., 2015; LaVeist et al., 2003; Williams et al., 2003).”

“Perceived racial discrimination is a highly common risk factor for anxiety and depression and poorer mental health in general among Hispanic individuals (Berg et al., 2011; Finch et al., 2000; Flores et al., 2008).”

“Theoretically, it is possible that recurrent racial discrimination may increase experiential avoidance as a coping strategy for dealing with such toxic personal experiences (Chawla & Ostafin, 2007).”

“Subscales of the IDAS have shown strong internal consistency, convergent and discriminant validity with psychiatric diagnoses and self-report measures as well as short-term retest reliability among samples of both community, and psychiatric participants, respectively (Watson et al., 2007).”

“Specifically, the predictor and mediator were reversed, such that perceived discrimination was tested as a mediator of the associations between experiential avoidance and each criterion variable (Judd & Kenny, 2010; Kraemer et al., 2008; Preacher & Hayes, 2008).”

“Social, Attitudinal, Familial, and Environmental Acculturation Stress Scale (SAFE; Mena et al., 1987).”

“For instance, perceived racial discrimination is associated with poorer physical health and greater health complaints among Hispanic persons (Kessler et al., 1999; Pérez et al., 2008; Williams et al., 2003).”

“Importantly, experiential avoidance is distinct from other transdiagnostic factors, including emotion regulation (Kashdan et al., 2006) and the tendency to experience negative affect (Gámez et al., 2011).”

“Although females compared to males are more apt to seek medical care in the Hispanic population (Burgess et al., 2008; Flores & Vega, 1998; Hofstede, 2001), there is a needed to have more sexbalanced samples in future research.”

“5%) report any physician office visit within a given year (Manuel, 2018).”

“Within the Hispanic community, this measure has shown to be valid and reliable (Hovey & Magaña, 2000).”

“For instance, work has found that experiential avoidance is associated with anxiety broadly (Kashdan et al., 2008), as well as social anxiety and depression symptoms (Kashdan et al., 2010), and generalized anxiety disorder (Roemer et al., 2005).”

“Yet, there is highly limited empirical data on the processes by which perceived racial discrimination is related to anxiety and depression among Hispanic adults (Alvidrez, 1999; Bledsoe, 2008).”

“In terms of mental health, higher rates of racial discrimination or perceived discrimination among Hispanic individuals are consistently related to globally higher rates of psychiatric symptoms (Araújo & Borrell, 2006; Finch et al., 2000; Moradi & Risco, 2006; Williams et al., 1997).”

“There is consistent empirical evidence that Hispanic in the United States are exposed to frequent and clinically significant types of racial discrimination (Stuber et al., 2003; Trivedi & Ayanian, 2006).”

“Perceived racial discrimination is a highly common risk factor for anxiety and depression and poorer mental health in general among Hispanic individuals (Berg et al., 2011; Finch et al., 2000; Flores et al., 2008).”

“Indeed, perceived racial discrimination is consistently linked to heightened levels of negative affect (Gee & Payne-Sturges, 2004; Geronimus et al., 2015; LaVeist et al., 2003; Williams et al., 2003).”

“More recent longitudinal work suggests that experiential avoidance is a relatively stable trait-like construct, with state-like fluctuations related to the presence of emotional and fear-related disorders (Spinhoven et al., 2014).”

“The most common psychiatric symptoms among Hispanic individuals are anxiety and depression (Martín-Santos et al., 2008; Meeske et al., 2013; Pina & Silverman, 2004; Pole et al., 2005).”

“…individuals tend to present with somatic complaints in relation to psychological distress (e.g., Varela et al., 2007) and evidence suggests that Hispanic persons frequently seek mental health services from primary care settings compared to other resources (Bridges et al., 2012; Vega & Lopez, 2001).”

“Other work has documented that racial discrimination among Hispanic adults is linked to less treatment-seeking behavior (Hausmann et al., 2008; Lauderdale et al., 2006; Ryan et al., 2008).”

“For example, some work has shown that gender differences in terms of type of health service used exist with women being more likely to use primary care services (Koopmans & Lamers, 2007).”

“In terms of mental health, higher rates of racial discrimination or perceived discrimination among Hispanic individuals are consistently related to globally higher rates of psychiatric symptoms (Araújo & Borrell, 2006; Finch et al., 2000; Moradi & Risco, 2006; Williams et al., 1997).”

“Yet, in a nonmutually exclusive manner, it also may be that greater experiential avoidance may increase the probability of threat processing (Forsyth et al., 2003), thereby heightening perceptions of racial discrimination.”

“The most common psychiatric symptoms among Hispanic individuals are anxiety and depression (Martín-Santos et al., 2008; Meeske et al., 2013; Pina & Silverman, 2004; Pole et al., 2005).”

“…utility in drawing from past work on Acceptance and Commitment Therapy (ACT) that has shown to decrease experiential avoidance and improve mental health (Lillis & Hayes, 2007; Luoma et al., 2007; Villatte et al., 2016; Woidneck et al., 2012), including among Hispanic groups (Hinton et al., 2011).”

“There is consistent empirical evidence that Hispanic in the United States are exposed to frequent and clinically significant types of racial discrimination (Stuber et al., 2003; Trivedi & Ayanian, 2006).”

“, 2012), including among Hispanic groups (Hinton et al., 2011).”

“Specifically, the predictor and mediator were reversed, such that perceived discrimination was tested as a mediator of the associations between experiential avoidance and each criterion variable (Judd & Kenny, 2010; Kraemer et al., 2008; Preacher & Hayes, 2008).”

“Although not always consistent (Huang et al., 2006; Ortega & Rosenheck, 2000), research has indicated that anxiety and depression are correlated with higher 1Department of Psychology, University of Houston, Houston, TX, USA 2Department of Behavioral Science, The University of Texas MD Anderson…”

“For instance, work has found that experiential avoidance is associated with anxiety broadly (Kashdan et al., 2008), as well as social anxiety and depression symptoms (Kashdan et al., 2010), and generalized anxiety disorder (Roemer et al., 2005).”

“Other work has documented that racial discrimination among Hispanic adults is linked to less treatment-seeking behavior (Hausmann et al., 2008; Lauderdale et al., 2006; Ryan et al., 2008).”

“…utility in drawing from past work on Acceptance and Commitment Therapy (ACT) that has shown to decrease experiential avoidance and improve mental health (Lillis & Hayes, 2007; Luoma et al., 2007; Villatte et al., 2016; Woidneck et al., 2012), including among Hispanic groups (Hinton et al., 2011).”

“When such experiential avoidance tactics are employed consistently and across all situations, they are highly associated with greater psychological distress (Lynch et al., 2001).”

“Indeed, perceived racial discrimination is consistently linked to heightened levels of negative affect (Gee & Payne-Sturges, 2004; Geronimus et al., 2015; LaVeist et al., 2003; Williams et al., 2003).”

“…individuals tend to present with somatic complaints in relation to psychological distress (e.g., Varela et al., 2007) and evidence suggests that Hispanic persons frequently seek mental health services from primary care settings compared to other resources (Bridges et al., 2012; Vega & Lopez, 2001).”

“We adjusted for age, sex, relationship status and years in the US, as past work has found these variables to be related to mental health among Hispanic groups (Noonan et al., 2016; Winkleby et al., 1995; Zvolensky et al., 2014).”

“Additionally, the impact of anxiety and depression may be underestimated among Hispanic individuals, as some research has found that this group may be more apt to somaticize emotional experiences (Escobar et al., 1983; Mezzich & Raab, 1980; Varela et al., 2007).”

“Perceived racial discrimination is a highly common risk factor for anxiety and depression and poorer mental health in general among Hispanic individuals (Berg et al., 2011; Finch et al., 2000; Flores et al., 2008).”

“The validity of the Spanish version of the MINI has been established (Bobes, 1998) and successfully employed among Spanish-speaking samples (e.g., Zvolensky et al., 2017).”

“The most common psychiatric symptoms among Hispanic individuals are anxiety and depression (Martín-Santos et al., 2008; Meeske et al., 2013; Pina & Silverman, 2004; Pole et al., 2005).”

“Other work has documented that racial discrimination among Hispanic adults is linked to less treatment-seeking behavior (Hausmann et al., 2008; Lauderdale et al., 2006; Ryan et al., 2008).”

“For instance, experiential avoidance is related to greater anxiety and depression among racialized and ethnic minorities in general (Zvolensky et al., 2016) as well as among Hispanic individuals specifically (Bakhshaie et al.”

“For instance, work has found that experiential avoidance is associated with anxiety broadly (Kashdan et al., 2008), as well as social anxiety and depression symptoms (Kashdan et al., 2010), and generalized anxiety disorder (Roemer et al., 2005).”

“Experiential avoidance also appears to be related to the emergence and trajectory of anxiety/depression symptoms in late adolescence (Mellick et al., 2019).”

“Here, there may be clinical utility in drawing from past work on Acceptance and Commitment Therapy (ACT) that has shown to decrease experiential avoidance and improve mental health (Lillis & Hayes, 2007; Luoma et al., 2007; Villatte et al., 2016; Woidneck et al., 2012), including among Hispanic groups (Hinton et al.”

“We adjusted for age, sex, relationship status and years in the US, as past work has found these variables to be related to mental health among Hispanic groups (Noonan et al., 2016; Winkleby et al., 1995; Zvolensky et al., 2014).”

“, 2013), which has been successfully employed among Spanish-speaking samples in past work (Bakhshaie et al., 2017; Zvolensky et al., 2015).”

“The most common psychiatric symptoms among Hispanic individuals are anxiety and depression (Martín-Santos et al., 2008; Meeske et al., 2013; Pina & Silverman, 2004; Pole et al., 2005).”

“Accordingly, future work may seek to understand the impact of gender and role expectations (Hawkins et al., 2017) and other culturally-relevant factors which may serve as deterrents or barriers for Hispanic males in terms of seeking care, including machismo, denial, and fatalism (Hunter et al.”

“It may be useful to integrate ACT with psychoeducation about perceived racial discrimination in one integrated protocol that is focused on the Hispanic population (Hayes et al., 2011).”

“…may seek to understand the impact of gender and role expectations (Hawkins et al., 2017) and other culturally-relevant factors which may serve as deterrents or barriers for Hispanic males in terms of seeking care, including machismo, denial, and fatalism (Hunter et al., 2007; Macnaughton, 2008).”

“Email: mjzvolen@central.uh.edu personal impairment among Hispanic relative to non-Hispanic Whites (Moitra et al., 2014; Polo et al., 2011).”

“Yet, there is highly limited empirical data on the processes by which perceived racial discrimination is related to anxiety and depression among Hispanic adults (Alvidrez, 1999; Bledsoe, 2008).”

“Email: mjzvolen@central.uh.edu personal impairment among Hispanic relative to non-Hispanic Whites (Moitra et al., 2014; Polo et al., 2011).”

“…may seek to understand the impact of gender and role expectations (Hawkins et al., 2017) and other culturally-relevant factors which may serve as deterrents or barriers for Hispanic males in terms of seeking care, including machismo, denial, and fatalism (Hunter et al., 2007; Macnaughton, 2008).”

“The validity of the Spanish version of the MINI has been established (Bobes, 1998) and successfully employed among Spanish-speaking samples (e.g., Zvolensky et al., 2017).”

“For instance, experiential avoidance is related to greater anxiety and depression among racialized and ethnic minorities in general (Zvolensky et al., 2016) as well as among Hispanic individuals specifically (Bakhshaie et al., 2017; Raines et al., 2018).”

“The current study utilized the Spanish-language version of this questionnaire (Ruiz et al., 2013), which has been successfully employed among Spanish-speaking samples in past work (Bakhshaie et al., 2017; Zvolensky et al., 2015).”

“Findings from a primary-care sample of Latine adults suggest that discrimination has an indirect effect on depression, social-anxiety, and anxious-arousal symptoms through experiential avoidance (Zvolensky et al., 2022).”

“When such escape/avoidance behavior is engaged and chronic, there can be a greater probability of more severe longer-term emotional distress and functional impairment (Zvolensky et al., 2022).”

“For instance, psychological flexibility measured broadly, or as specific processes such as experiential avoidance, is associated with mental health outcomes after experiencing racism and discrimination, such that more avoidance and inflexible coping leads to worsened mental health and avoidance, and more mindful aware…”

“…such as gender-based discrimination, racial bias, and socioeconomic disparities, and fostering inclusive, culturally sensitive environments that respect and celebrate the diverse experiences and viewpoints of Latina immigrants (Calzada et al., 2020; Romero et al., 2007; Zvolensky et al., 2022).”

“Indeed, higher levels of perceived ethnic discrimination have been linked to a greater risk for more severe depression and anxiety, anxious arousal, fatigue, chronic illness, and substance use [16–23].”

“…minority status and mediates the relationship between perceived racial discrimination and various psychopathology outcomes, including mood and anxiety disorders, suicidality, and PTSD in racial and ethnic minority populations (Cole et al., 2023; Martinez et al., 2022; Zvolensky et al., 2016, 2022).”