Commentary
The manuscript compares the adjusted rates of psychiatric disorders among three population based representative samples of island and mainland Puerto Ricans, as well as the US population. Results showed similar rates of overall psychiatric disorder between island Puerto Ricans and the US population, but higher rates of substance use disorders (SUD) in Puerto Rico (PR). A prior comparison between island and mainland rates carried almost 30 years ago had shown similar overall rates of psychiatric disorders between the US and the island [1]. What was surprising to us was that substance use disorders now were higher in the island, particularly because in our first comparison, the opposite was found [2]. It may be that these higher rates of SUD observed in PR versus the US, may be related to the difference in the time that the two surveys were conducted. The National Comorbidity Survey Replication (NCS-R) US survey was carried out more than 10 years before the most recent PR survey compared in this manuscript [3,4]. Substance use disorders, as compared to other disorders, are more likely to change with time due to a number of contextual factors including availability of the drugs [5,6]. The trend in several more recent surveys carried in the US has shown a significant increase in the rates of SUD [7].
We also compared the rates of psychiatric disorders in PR with US Puerto Ricans as part of the National Latino and Asian American Study (NLAAS) survey [8]. Given previous findings from this survey and the fact that US Puerto Ricans are subjected to discrimination and prejudice, which have been associated with higher rates of disorder; we expected higher rates of disorder and SUD among US Puerto Ricans as compared to the island population. Furthermore, recent findings from another study that compared young adult Puerto Ricans from the South Bronx in New York, to those living in the San Juan Metropolitan area of the island, showed higher rates of disorder among those living in New York, with the exception of alcohol use disorders and mania [9]. However, in this manuscript [4], when comparing the overall rates of disorder of the entire US Puerto Rican population with that of the island, the rates were similar among both groups, with the exception of anxiety and depression. We were surprised by these findings and decided to analyze the role of social support as a possible protective factor for both the island and US Puerto Rican population. We found that island Puerto Ricans had significantly higher rates of social support than US Puerto Ricans. When adjusting for social support in the US Puerto Rican sample, the observed higher risk of anxiety and depression disappeared. These results are consistent with prior research that has found that social support may serve to buffer stress and discrimination commonly experienced by US Puerto Ricans and previously associated with the development of internalizing symptoms [10-12].
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