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. Author manuscript; available in PMC: 2025 Feb 26.
Published in final edited form as: J Racial Ethn Health Disparities. 2015 Nov 12;3(4):646–657. doi: 10.1007/s40615-015-0183-y

Interactive Effect of Negative Affectivity and Rumination in Terms of Mental Health Among Latinos in Primary Care

Michael J Zvolensky 1,2,9, Daniel J Paulus 1, Jafar Bakhshaie 1, Monica Garza 3, Melissa Ochoa-Perez 3, Chad Lemaire 3, Daniel Bogiaizian 4, Zuzuky Robles 1, Amelia Aldao 5, Anahi Collado 6, Carl W Lejuez 7, Norman B Schmidt 8
PMCID: PMC11862904  NIHMSID: NIHMS2053927  PMID: 27294754

Abstract

The present investigation examined the interactive effects of rumination and negative affectivity in relation to anxiety and depressive symptoms and psychopathology among 245 Latino adults (Mage = 39.7, SD = 11.4; 86.9 % female; 97.6 % reported Spanish as their first language) attending a community-based primary healthcare clinic. As expected, there was a significant interaction between rumination and negative affectivity for depressive, suicidal, social anxiety, anxious arousal symptoms, number of mood and anxiety disorders, and disability among the primary care Latino sample. Inspection of the interaction forms indicated a high degree of conceptual similarity. Specifically, rumination was related to greater levels of suicidal symptoms, social anxiety, anxious arousal, number of mood and anxiety disorders, and disability among individuals with higher, but not lower, levels of negative affectivity. The form of the interaction for depressive symptoms was in line with this pattern, but more extreme; rumination was related to greater levels of depressive symptoms among individuals with both higher and lower levels of negative affectivity. Together, these data provide novel empirical evidence suggesting that there is clinically relevant interplay between rumination and negative affectivity in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.

Keywords: Negative affect, Rumination, Latinos, Primary care, Mental health

Introduction

Latinos are the largest and most rapidly growing racial/ethnic group in the USA [1]. Yet, Latinos in the USA are subject to a number of health disparities [2], particularly in regard to mental health issues. For example, when compared with non-Latino Whites, Latinos utilize fewer mental health services [3, 4] despite experiencing greater mental health problems [5], perhaps most notably anxiety/depressive symptoms and psychopathology [6–10].

From a public health perspective, primary care medical settings arguably represent the most important strategic location to address mental health disparity among Latinos in the USA. Indeed, primary care medical settings are the main “health portal” wherein treatment for health problems in general, and mental health specifically, is sought [11, 12]. In fact, research has established the feasibility and efficacy of a number of psychosocial interventions for Latinos in primary care for depression (e.g., [13, 14–16]) and anxiety disorders (e.g., [17]). However, there is a dearth of empirical information about risk factors for anxiety/depressive symptoms and psychopathology among Latinos in general, and primary care settings, specifically [18]. The identification of malleable risk factors in the onset/progression of anxiety/depression among Latinos in primary care will be central to future efforts to develop targeted screening protocols and interventions for high-risk segments of this underserved population [19].

There are numerous temperamental factors have been theorized to play a key role in the etiology of anxiety and depressive psychopathology. One of the most notable temperamental factors is negative affectivity [20]. Negative affectivity reflects a largely stable and inherited disposition to experience non-specific distress or unpleasant emotions [20, 21]. A large corpus of work links negative affectivity to increased anxiety and depressive symptoms as well as health complaints more generally [21–25]. Additionally, there is strong evidence of cross-cultural validity of the role of negative affectivity to anxiety/depressive symptoms (e.g., [26, 27]), including Spanish-speaking samples [28]. Yet, integrative models of anxiety/depressive vulnerability posit that negative affectivity by itself is not solely apt to lead to clinical disorders. Rather, this disposition may interact with various more specific psychological factors (e.g., cognitive styles, genetic history) or socioenvironmental experiences (e.g., trauma, discrimination) to confer risk for specific types of anxiety/depressive conditions [29, 30]. Despite the theoretical and clinical appeal of this type of interactive account, research testing interactive models of negative affectivity in relation to anxiety/depressive disorders in Latinos are highly limited.

One of the most influential cognitive factors related to anxiety/depressive vulnerability is rumination, reflecting a cognitive-based response style characterized by repetitive and focused attention on the causes and consequences of one’s negative feelings [31]. A large body of empirical work has found that increased levels of ruminative thinking are associated with increased risk of psychopathology, including depression, anxiety, borderline personality disorder, eating disorders, and substance abuse disorders [32, 33]. Although the mechanisms are not fully clear, there is some evidence that ruminative thinking may serve to promote the activation of memories associated with negative emotional states [31]. It is posited that due to such activation, negative mood states tend to become more pronounced, and perhaps, chronic in course [32, 34]. Rumination is also thought to increase negative mood by impacting the interpretation of life events, and as a result, may adversely affect cognitive capacity (e.g., attention). Furthermore, rumination has been found to interfere with instrumental problem solving (see review by [35]) and to drive away social support (see review by [34]). Therefore, persons higher in ruminative thinking may have more difficulty in proactively coping, problem solving life challenges, and even experience less reinforcement for pleasurable life events [36]. The vast majority of research on rumination and mental health has focused on non-Latino samples. Yet, there is some limited empirical work suggesting that rumination may influence suicidal ideation among Latino college students in the USA and Chile [37–40] and adolescents from Chile [39, 40].

From an integrative perspective, negative affectivity and rumination may operate with one another to confer greater anxiety/depressive vulnerability among Latinos. To offer one such illustration, an individual with a higher propensity to experience negative affect states may be at an increased risk of experiencing more severe and disabling anxiety and depressive symptoms when they also have greater tendencies to ruminate about such aversive mood states. That is, greater ruminative thinking may be more impacted by negative mood states. This viewpoint posits the interaction between negative affectivity and rumination may increase the likelihood of anxiety/depressive symptom expression and corresponding impairment above and beyond the singular contributions. Past work suggests that negative affectivity and rumination may interact to confer greater risk for emotional problems (e.g., [41, 42]). Indeed, rumination and negative affectivity may exacerbate and prolong each other [43]. Further, laboratory work suggests that negative affectivity moderates the association between rumination and aversiveness of emotional responding [44]. However, work has not thus far examined such associations among Latinos, or in real world medical settings (e.g., primary care).

With this background, the present investigation sought to test an interactive model of negative affectivity and rumination in relation to an array of mental health indices among a Latino sample in primary care. It was predicted that higher levels of negative affectivity in conjunction with higher levels of rumination would be associated with greater psychopathology across a relatively wide range of anxiety/depression symptoms. More specifically, it was hypothesized that the effect of rumination on the dependent variables would be moderated by negative affectivity, such that the association between rumination and the dependent variables would be stronger for those with greater negative affectivity. Primary dependent measures included depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood and anxiety disorders, and disability.

Method

Interested individuals (n = 377) for this study contacted research staff for potential participation. They were recruited from a primary care health facility located in an urban south-western area where study fliers were posted. The facility is a full-service federally qualified community health center that provides low cost health care. Potential participants were excluded if there was a history of psychosis (n = 10). Cases with missing or incomplete data on study measures or covariates (n = 120) were not included in the current analyses. Further, two multivariate outliers with high leverage were discovered and excluded from analyses, resulting in a total of 245 adults (Mage = 39.7, SD = 11.4; 86.9 % female; 97.6 % reported Spanish as first their language) available for the current study. The majority (62.0 %) of the sample indicated Mexico as their nation of origin with 27.8 % from Central America, 2.9 % South America, 3.7 % the USA, 1.2 % Cuba, and 2.4 % not indicating a nation of origin. In terms of education, 7.5 % of participants reported less than 6 years of education, 46.8 % 6–11 years, 27.9 % 12 years (completion of high school), and 17.8 % reported more than 12 years. Half of the sample (50.0 %) was married, 16.8 % were living with partner, 25.5 % were single, 6.0 % were divorced, and 1.7 % were widowed. As for employment, 22.2 % were employed full time (40 h a week), 12.6 % were employed part time (20 h a week), 9.8 % were employed less than 20 h a week, 43.9 % were unemployed, and 11.5 % were looking for employment.

The reasons for attendance to clinic were as follows: family medicine (12.9 %), dental (32.5 %), psychiatric/psychological (4.9 %), and lab test, physical exam, or other reasons (e.g., accompanying someone; 49.7 %). As determined by the Mini International Neuropsychiatric Interview 6.0 [45], 26.1 % of the sample met criteria for current (past year) axis I psychopathology. Among participants with current psychopathology, the average number of diagnoses per participant was 2.2 (SD = 1.6). The most common diagnoses were major depressive disorder (26.9 %), post-traumatic stress disorder (6.1 %), agoraphobia (5.3 %), and generalized anxiety disorder (5.3 %) (see Table 1 for full diagnostic breakdown).

Table 1.

Psychopathology among sample (n = 245)

Diagnosis Number Percentage
Major depressive disorder 66 26.9
Post-traumatic stress disorder 15 6.1
Generalized anxiety disorder 13 5.3
Agoraphobia 13 5.3
Dysthymia 7 2.8
Substance abuse/dependence 6 2.4
Alcohol abuse/dependence 6 2.4
Social anxiety disorder 5 2.0
Obsessive-compulsive disorder 9 3.6
Panic disorder 7 2.8
Bulimia nervosa 3 1.2
Bipolar I or II disorders 3 1.2
Anorexia nervosa 0 0.0
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Measures

All measures used in the current investigation have previously been translated and tested for their psychometric performance using procedures consistent with accepted guidelines [46, 47].

Demographics Questionnaire

Demographic information collected included sex, age, race, educational level, marital status, and employment status.

M.I.N.I. International Neuropsychiatric Interview 6.0

Trained, Spanish-speaking staff administered the M.I.N.I. International Neuropsychiatric Interview 6.0 (MINI) [45], a time-efficient diagnostic assessment, under the supervision of an independent doctoral-level rater. The MINI has demonstrated satisfactory inter-rater reliability, test-retest reliability and validity [48] and has been deemed applicable for use in research settings [45]. A random selection of interviews (approximately 12 %) was checked for accuracy with no cases of diagnostic disagreement noted.

Ruminative Response Scale

The Ruminative Response Scale (RRS) [36] is a subscale of the Response Styles Questionnaire [49]. Participants indicate how often they think or do each of the 22 statements (e.g., “think about all your shortcomings, failings, faults, mistakes”) when feeling down, sad, or depressed on a Likert scale from 1 “almost never” to 4 “almost always” and summed to a total score. The RRS has been previously used and validated among Spanish-speakers (e.g., [50]). In the current sample, internal consistency was excellent (Cronbach’s α = 0.97).

Positive and Negative Affect Schedule

The Positive and Negative Affect Schedule (PANAS) [51] is a 20-item self-report measure, which yields two separate factors of positive (PANAS-PA) and negative (PANAS-NA) affectivity, which have demonstrated strong psychometric properties [52]. Each item (e.g., “interested”, “nervous”) is rated on a Likert scale ranging from 1 “very slightly or not at all” to 5 “extremely” and summed for each subscale. The PANAS has been employed successfully among Spanish-speaking populations in past work [53]. In the present study, the PANAS-NA displayed good internal consistency (Cronbach’s α = 0.81).

Inventory of Depression and Anxiety Symptoms

The Inventory of Depression and Anxiety Symptoms (IDAS) [54] is a self-report measure, tapping into several domains of affect. Specifically, the IDAS contains 10 specific symptom subscales (suicidality, social anxiety, anxious arousal, lassitude, ill temper, well-being, insomnia, appetite loss, appetite gain, and traumatic intrusions) as well as two broad subscales for general depression and dysphoria. Participants indicate on a 5-point Likert scale ranging from 1 “not at all” to 5 “extremely” the degree to which they have experienced each item within the previous 2-week period. Subscales of the IDAS demonstrated excellent psychometric properties among samples of both community and psychiatric patients, respectively [55, 56]. In the current study, the general depression (20 items; e.g., “I had little interest in my usual hobbies or activities”), suicidality (6 items; e.g., “I had thoughts of suicide”), social anxiety (5 items; e.g., “I was worried about embarrassing myself socially”), and anxious arousal (8 items; e.g., “I felt a pain in my chest”) subscales were used as criterion variables. In the current sample, these subscales demonstrated adequate to excellent levels of internal consistency (Cronbach’s α’s = 0.91, 0.76, 0.73, 0.81 for the depressive, suicide, social anxiety, and anxious arousal symptom subscales, respectively), consistent with past work among Spanish-speakers [57].

The Sheehan Disability Scale

The Sheehan Disability Scale (SDS) [58] is a 3-item self-report measure that assesses a patient’s overall functioning and has been extensively validated in past work [59]. For the SDS, participants rate on a Likert-type scale from 0 “not at all” to 10 “extremely” how much their emotional symptoms have disrupted their lives in the past month with regard to three domains: work/school, social life, and family/home life. These items are averaged to form a total disability score, which was used as a criterion variable in the current study. As in past work among Spanish-speakers [60], internal consistency of SDS total scores in the present sample was excellent (Cronbach’s α = 0.93).

Procedure

Participants for the study attended a community-based primary care healthcare clinic. All individuals provided informed written consent (in Spanish) prior to engaging in study procedures. Following consent, they completed a diagnostic interview and completed self-report questionnaires. Participants were compensated with $20. The study protocol was approved by the Institutional Review Board.

Analytic Strategy

First, bivariate correlations between study variables were evaluated to examine associations. Then, main and interactive effects of rumination (RRS) and negative affectivity (PANAS-NA) were examined among the dependent variables: depressive symptoms, suicidal symptoms, social anxiety, and anxious arousal symptoms (via IDAS subscales), number of mood and anxiety disorders (obtained from the MINI), and disability (SDS). A series of hierarchical regression analyses were conducted with predictors centered at their respective means. Covariates included sex, age, number of years in the USA, educational attainment, marital status, and employment status; these were entered in the first step. Rumination and negative affectivity were entered together in the second step. Finally, the interaction of rumination and negative affectivity was entered in the final step. Planned post-hoc analyses consisted of both simple slope analyses for significant interaction terms using values of ±1 SD (high/low) from the mean of the moderator variable, negative affectivity as well as the Johnson–Neyman technique [61], which identifies specific regions of significance for the association between rumination and outcome variables.

Results

Bivariate Relations

Pair-wise deletion was used resulting in 242–245 cases for analysis. Bivariate correlations are presented in Table 2. Rumination had a statistically significant and positive association with negative affectivity (r = 0.55; p < 0.001) and all six dependent variables (r’s from 0.44–0.72; all p’s < 0.001). Likewise, negative affectivity was significantly and positively associated with all dependent variables (r’s ranged from 0.41–0.66; all p’s < 0.001). There was no indication of collinearity among predictors/covariates (all variance inflation factor (VIF) < 1.5).

Table 2.

Means, standard deviations, and bivariate correlations among variables

Variable Mean/n (SD/%) 1 2 3 4 5 6 7 8 9 10 11 12 13
1. Sex (% female) 213 (86.9) –
2. Age 39.7 (11.4) 0.01 –
3. Years in the USA 19.1 (12.8) −0.03 0.46** –
4. Education (% with 12 years plus) 113 (46.1) −0.04 −0.08 0.01 –
5. Marital status (% with partner) 162 (66.1) 0.03 0.02 −0.08 −0.05 –
6. Employment (% employed) 107 (43.7) −0.27** 0.04 0.03 0.12 −0.08 –
7. PANAS-NA 17.5 (5.7) 0.01 0.02 −0.02 0.01 −0.08 0.06 –
8. RRS 38.3 (15.7) 0.02 0.02 −0.06 −0.09 −0.15* 0.04 0.55** –
9. IDAS-DEP 34.9 (12.3) −0.01 0.03 0.02 −0.08 −0.17** 0.03 0.66** 0.72** –
10. IDAS-SUI 6.5 (1.9) −0.13* 0.05 0.09 −0.03 −0.17** 0.05 0.41** 0.44** 0.54** –
11. IDAS-SOC 7.0 (3.1) 0.01 0.01 0.03 −0.09 −0.14* 0.04 0.51** 0.54** 0.70** 0.57** –
12. IDAS-ANX 11.4 (5.3) −0.01 0.01 0.02 −0.16* −0.13 0.08 0.55** 0.57** 0.73** 0.48** 0.68** –
13. Number of Dx 0.6 (1.2) 0.02 0.03 0.03 −0.04 −0.09 0.04 0.48** 0.45** 0.61** 0.40** 0.52** 0.47** –
14. SDS 3.5 (6.4) −0.03 0.03 0.05 −0.11 −0.08 0.06 0.53** 0.51** 0.64** 0.46** 0.55** 0.55** 0.50**
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Sex, age, years in the USA, education, marital status, and employment status were covariates. Numbers across the header correspond with variables numbered 1–14

PANAS-NA Positive and Negative Affect Schedule, Negative Affectivity Subscale, RRS Ruminative Response Scale, IDAS Inventory for Depression and Anxiety Symptoms, DEP depressive, SUI suicidal, SOC social anxiety, ANX anxious arousal, Number of Dx number of mood/anxiety disorders as per the Mini International Neuropsychiatric Inventory, SDS Sheehan Disability Scale.

*

p < 0.05

**

p < 0.01

Interactive Analyses

Depressive and Suicidal Symptoms

In predicting depressive symptoms (n = 242), covariates entered in the first step did not account for a significant amount of variance, although marital status was a significant covariate (β = −0.17, t = −2.63, p = 0.009). There were significant main effects for both negative affectivity (β = 0.38, t = 7.79, p < 0.001) and rumination (β = 0.50, t = 10.16, p < 0.001). As expected, there was also a significant interaction between negative affectivity and rumination (β = 0.69, t = 3.15, p = 0.002). Simple slope analyses revealed that rumination was positively associated with depressive symptoms at both lower (β = 0.35, t = 0.06, p = <0.001) and higher (β = 0.60, t = 10.3, p < 0.001) scores of negative affectivity (see Fig. 1). Specifically, Johnson–Neyman results identified no regions of transition; rumination was associated with depressive symptoms at all values of negative affectivity.

Fig. 1.

Fig. 1

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Plotting the conditional effect of RRS on depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood/anxiety disorders, and disability. Plots represent the association between rumination and depressive symptoms (top left) suicide symptoms (top right), social anxiety symptoms (middle left), anxious arousal symptoms (middle right), number of mood/anxiety disorders (bottom left) and disability (bottom right), at high and low values of PANAS-NA. RRS Ruminative Response Scale, PANAS-NA Positive and Negative Affect Schedule, IDAS Inventory for Depression and Anxiety Symptoms, SDS Sheehan Disability Scale; Number of Mood/Anxiety Disorders based on the MINI (Mini International Neuropsychiatric Interview)

As for suicidal symptoms (n = 242), covariates, again, did not account for a significant amount of variance in the first step; however, marital status was a significant predictor (β = −0.16, t = −2.55, p = 0.011). There were significant main effects for both negative affectivity (β = 0.24, t = 3.51, p < 0.001) and rumination (β = 0.30, t = 4.35, p < 0.001). As expected, there was also a significant interaction of rumination and negative affectivity (β = 1.18, t = 3.89, p < 0.001). Simple slope analyses revealed that rumination was positively associated with suicidal symptoms at higher (β = 0.47, t = 5.89, p < 0.001), but not lower (β = 0.06, t = 0.62, p = 0.53), scores of negative affectivity (see Fig. 1). Further, the Johnson–Neyman technique indicated that rumination was significantly and positively associated with suicidal symptoms (β = 0.19–0.98, p < 0.05) for PANAS-NA scores of 14.3 or higher (62.8 % of the sample; see Fig. 2).

Fig. 2.

Fig. 2

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Location of change in significance for the conditional effect of rumination on suicide, social anxiety, anxious arousal, number of mood/anxiety diagnoses, and disability. The solid black lines illustrate the conditional effect of RRS on IDAS-suicide (top left), IDAS-social (top right), IDAS-anxious arousal (middle left), number of mood/anxiety disorders (middle right) and SDS (bottom center) at values of the moderator (PANAS-NA). Dotted lines represent the 95% confidence interval for the effect. The grey area represents the regions of PANAS-NA scores where the respective associations are significant

Social Anxiety and Anxious Arousal Symptoms

Regarding social anxiety symptoms (n = 242), the covariates in the first step were not significant as a set. However, marital status was a significant covariate (β = −0.14, t = −2.11, p = 0.036). There were main effects of negative affectivity (β = 0.31, t = 4.98, p < 0.001) and rumination (β = 0.36, t = 5.69, p < 0.001). As expected, there was a significant interaction of rumination and negative affectivity (β = 0.88, t = 3.10, p = 0.002). Simple slope analyses revealed that rumination was positively associated with social anxiety symptoms at both lower (β = 0.17, t = 2.14, p = 0.036) and higher (β = 0.49, t = 6.54, p < 0.001) scores of negative affectivity (see Fig. 1). Johnson–Neyman results indicated that rumination was significantly and positively associated with social anxiety symptoms (β = 0.20–0.87, p < 0.05) for PANAS-NA scores of 11.5 or higher (90.9 % of the sample; Fig. 2).

In predicting anxious arousal symptoms (n = 242), covariates as a set did not account for a significant amount of variance, although education (β = −0.17. t = −2.70, p = 0.008) was a significant predictor. There were main effects of negative affectivity (β = 0.35, t = 5.90, p < 0.001) and rumination (β = 0.36, t = 5.87, p < 0.001). As expected, there was a significant interaction of rumination and negative affectivity (β = 0.77, t = 2.81, p = 0.005). Simple slope analyses revealed that rumination was positively associated with anxious arousal symptoms at lower (β = 0.19, t = 2.41, p = 0.016) and higher (β = 0.46, t = 6.50, p < 0.001) scores of negative affectivity (see Fig. 1). Rumination was significantly associated with anxious arousal symptoms (β = 0.19–0.79, p < 0.05) for PANAS-NA scores of 10.8 or higher (95.9 % of the sample; Fig. 2) according to the Johnson–Neyman procedure.

Depressive and Anxiety Disorders

For the number of mood and anxiety disorders (n = 245), the covariates did not account for significant variance, and there were no significant univariate predictors. As expected, there were two significant main effects (negative affectivity β = 0.34, t = 5.06, p < 0.001; and rumination β = 0.26, t = 3.81, p < 0.001) and a significant interaction (β = 0.78, t = 2.57, p = 0.011). Simple slope analyses revealed that rumination was positively associated with the number of mood and anxiety disorders at higher (β = 0.37, t = 4.63, p = <0.001), but not lower, (β = 0.09, t = 1.6, p = 0.28) scores of negative affectivity (Fig. 1). Rumination was significantly associated with the number of mood/anxiety disorders (β = 0.19–0.71, p < 0.05) for PANAS-NA scores of 14.1 or higher (62.9 % of the sample; Fig. 2).

Disability

For disability (n = 242), the set of covariates in the first step were not statistically significant. There were main effects for both negative affectivity (β = 0.37, t = 5.85, p < 0.001) and rumination (β = 0.30, t = 4.76, p < 0.001) and the interaction was also significant (β = 1.28, t = 4.58, p < 0.001). Simple slope analyses revealed that rumination was positively associated with disability at higher (β = 0.48, t = 6.67, p = <0.001), but not lower (β = 0.04, t = 0.49, p = 0.62), scores of negative affectivity (Fig. 1). Rumination was significantly associated with disability (β = 0.18–1.04, p < 0.05) for PANAS-NA scores of 14.2 or higher (62.8 % of the sample; Fig. 2).

Discussion

The present investigation tested an interactive model of negative affectivity and rumination in relation to an array of mental health indices among a Latino sample in primary care. There was consistent empirical evidence of an interaction between rumination and negative affectivity for depressive, suicidal, social anxiety, anxious arousal symptoms, number of mood and anxiety disorders, and disability among the primary care Latino sample. The effect size of the observed interaction across the models was small in absolute effect size, but given the magnitude of variance accounted for by the main effects (ranging from 22 to 58 % of variance), these effects are clinically noteworthy. Indeed, inspection of the forms of the significant interactions indicated a high degree of conceptual similarity. Specifically, rumination was related to greater levels of suicidal symptoms, social anxiety, anxious arousal, number of mood and anxiety disorders, and disability among individuals with higher, but not lower, levels of negative affectivity. The form of the interaction for depressive symptoms was the same pattern but more extreme, as rumination was related to greater levels of depressive symptoms among individuals with higher and lower levels of negative affectivity (see Fig. 1). That is, the rumination-depressive symptom relation is evident at higher levels of negative affectivity, but at a lower threshold. Together, these data provide novel empirical evidence suggesting that there is indeed clinically relevant interplay between rumination and negative affectivity in regard to anxiety and depressive symptom expression among a Latino primary care sample.

Although not a primary aim, it is noteworthy that there was evidence that negative affectivity and rumination each independently explained unique variance in each of the dependent measures. These findings are consistent with past work on negative affectivity [20] and rumination [32]. Negative affectivity and rumination shared only 31 % of variance, suggesting they represent interconnected, but distinct, constructs. Additionally, although the sample was not primarily seeking treatment for mental health problems, it is striking that over one-quarter of the sample met criteria for a past year axis I disorder. These data make clear the high prevalence of mental health disorders in Latino primary care settings.

Clinically, the present findings suggest intervention programs for anxiety/depressive symptoms and disorders among Latinos in primary care might benefit from screening for rumination and negative affectivity for early intervention. Specifically, targeting Latinos with higher levels of rumination and higher levels of negative affectivity in primary care may help isolate a high-risk segment of the Latino population for anxiety/depressive problems in need of targeted interventions that address their interplay through intervention. This approach could build upon past work that has utilized behavioral and cognitive-behavioral tactics for improving mental health, and perhaps, further refine them to target transdiagnostic processes, such as rumination, in a targeted and theoretically-driven fashion (e.g., [13, 14, 15]). For example, given past evidence that negative affectivity and rumination may exacerbate one another [44] and the current findings demonstrating the interactive effects of these two risk factors in a real world setting, primary care health workers may benefit from screening for these risk processes and engaging patients in targeted mental health intervention.

Several study limitations should also be noted. First, due to the observational nature of this design, it is not possible to draw causal conclusions from our findings. One next step in this line of inquiry would be to employ prospective methodologies to evaluate the consistency of the present findings over time. Second, the present Latino sample was largely female and seeking medical services for a wide range of issues (the reasons for visiting the clinic were limited to fixed categories such as family medicine, dental, psychiatric/psychological, and lab test, physical exam, or other). Future work could evaluate the generalizability of the present model to other sectors of the Latino community, including samples with a larger percentage of males and persons not seeking medical services as well as whether there is an influence based on the type of care being sought. Third, Latinos often employ an extreme and acquiescent response style relative to other groups [62]. Accordingly, there is the possibility that a response bias may have influenced the present observations, although this issue should be minimized in the current study because the tests conducted were within group (rather between-group) in nature. Fourth, we collapsed across anxiety and depressive disorders to index the number of diagnoses due to the sample size (cf. analyzing data by disorder). Future work may benefit by testing whether the interactive model is particularly applicable to certain types of anxiety/depressive psychopathology. Additionally, we focused our investigation on general manifestations of anxiety/depressive phenomenology. However, it is possible that the same type of interactive model between rumination and negative affectivity is applicable to other more culturally-specific forms of distress or stress. Future work may benefit by exploring the interactive model in relation to such processes, including acculturation anxiety/stress, subjective social status, and even culturally variant types of anxiety among specific Latino subpopulations (e.g., ataque de nervios among Spanish-speaking people from the Caribbean). Finally, it is possible that there may be differences based on nativity, as non-U.S.-born Latinos may be protected against mental health vulnerabilities, relative to U.S.-born Latinos (i.e., the immigrant/Latino Paradox [63]). However, in the current study, years spent in the USA was used as a covariate and was not significantly predictive of any of the dependent variables (see Tables 3 and 4) and was not significantly directly associated with rumination or negative affectivity (see Table 2). Although not a direct measure of nativity, years in the USA may serve as a proxy for this construct. Future work could usefully directly examine the current findings among native and non-native Latinos to more comprehensively address this question.

Table 3.

Main and interactive effects of negative affectivity and rumination

Depressive symptoms (IDAS; n = 242)
β t p R2 change
Step 1
 Gender 0.01 0.03 0.978
 Age 0.02 0.33 0.745
 Years in the USA 0.01 −0.06 0.954
 Marital status −0.17** −2.63 0.009
 Education −0.09 −1.36 0.177
 Employment status 0.03 0.40 0.692 0.04
Step 2
 Negative affectivity (PANAS-NA) 0.38*** 7.79 <0.001
 Rumination (RRS) 0.50*** 10.16 <0.001 0.58***
Step 3
 Negative affectivity*rumination (PANAS-NA*RRS) 0.69** 3.15 0.002 0.02**
Suicidal symptoms (IDAS; n = 242)
β t p R2 change
Step 1
 Gender −0.12 −1.83 0.068
 Age 0.02 0.34 0.732
 Years in the USA 0.06 0.79 0.432
 Marital status −0.16* −2.55 0.011
 Education −0.04 −0.63 0.526
 Employment status 0.01 0.04 0.971 0.05
Step 2
 Negative affectivity (PANAS-NA) 0.24*** 3.51 <0.001
 Rumination (RRS) 0.30*** 4.35 <0.001 0.22***
Step 3
 Negative affectivity*rumination (PANAS-NA*RRS) 1.18*** 3.89 . <0.001 0.05***
Social anxiety symptoms (IDAS; n = 242)
β t p R2 change
Step 1
 Gender 0.02 0.28 0.781
 Age −0.01 −0.15 0.877
 Years in the USA 0.03 0.38 0.705
 Marital status −0.14* −2.11 0.036
 Education −0.11 −1.62 0.106
 Employment status 0.05 0.70 0.487 0.03
Step 2
 Negative affectivity (PANAS-NA) 0.31*** 4.98 <0.001
 Rumination (RRS) 0.36*** 5.69 <0.001 0.34***
Step 3
 Negative affectivity*rumination (PANAS-NA*RRS) 0.88** 3.10 0.002 0.03**
Open in a new tab

IDAS Inventory for Depression and Anxiety Symptoms, PANAS-NA Positive and Negative Affect Schedule, Negative Affectivity, RRS Ruminative Response Scale

*

p < 0.05

**

p < 0.01

***

p < 0.001

Table 4.

Main and interactive effects of negative affectivity and rumination

Anxious arousal symptoms (IDAS; n = 242)
β t p R2 change
Step 1
 Gender 0.01 0.13 0.900
 Age −0.01 −0.12 0.901
 Years in the USA 0.01 0.13 0.893
 Marital status −0.13 −1.95 0.053
 Education −0.17** −2.70 0.008
 Employment status 0.09 1.34 0.181 0.05
Step 2
 Negative affectivity (PANAS-NA) 0.35*** 5.90 <0.001
 Rumination (RRS) 0.36*** 5.87 <0.001 0.38***
Step 3
 Negative affectivity*rumination (PANAS-NA*RRS) 0.77** 2.81 0.005 0.02**
Number of mood/anxiety disorders (MINI; n = 245)
β t p R2 change
Step 1
 Gender 0.04 0.55 0.584
 Age 0.02 0.34 0.734
 Years in the USA 0.01 0.11 0.912
 Marital status −0.09 −1.44 0.150
 Education −0.04 −0.68 0.499
 Employment status 0.04 0.63 0.527 0.01
Step 2
 Negative affectivity (PANAS-NA) 0.34*** 5.06 <0.001
 Rumination (RRS) 0.26*** 3.81 <0.001 0.27***
Step 3
 Negative affectivity*rumination (PANAS-NA*RRS) 0.78* 2.57 0.011 0.02*
Disability (SDS; n = 242)
β t p R2 change
Step 1
 Gender −0.01 −0.18 0.856
 Age −0.01 −0.08 0.938
 Years in the USA 0.04 0.61 0.545
 Marital status −0.07 −1.15 0.253
 Education −0.12 −1.85 0.066
 Employment status 0.07 0.98 0.328 0.03
Step 2
 Negative affectivity (PANAS-NA) 0.37*** 5.85 <0.001
 Rumination (RRS) 0.30*** 4.76 <0.001 0.34***
Step 3
 Negative affectivity*rumination (PANAS-NA*RRS) 1.28*** 4.58 <0.001 0.05***
Open in a new tab

IDAS Inventory for Depression and Anxiety Symptoms, PANAS-NA Positive and Negative Affect Schedule, Negative Affectivity, RRS Ruminative Response Scale, MINI Mini International Neuropsychiatric Interview, SDS Sheehan Disability Scale

*

p < 0.05

**

p < 0.01

***

p < 0.001.

In sum, although primary care medical settings represent a strategic location to address mental health disparity among Latinos in the USA, there has been strikingly little empirical work about risk processes for mental health among this population. The current study found novel empirical evidence for an interaction between negative affectivity and rumination in terms of the likelihood of anxiety/depressive symptom expression and corresponding impairment above and beyond the singular contributions. The findings generally suggest rumination was related to greater levels of mental health symptoms and psychopathology as well as impairment among individuals with higher, but not lower levels of negative affectivity.

Acknowledgments

Funding for the study was from an endowment awarded to Dr. Zvolensky. This work has not been presented previously in any form. No authors have any conflicts of interests or financial disclosures to report. The study was approved by Institutional Review Board at the University of Houston. Informed written consent was obtained prior to initiating study procedures. No animals have been employed in this research.

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