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Book Review   |    
Immigrant Women's Health: Problems and Solutions
F. M. Baker, M.D., M.P.H.
Psychiatric Services 2000; doi: 10.1176/appi.ps.51.11.1461
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edited by Elizabeth J. Kramer, Ph.D., Susan L. Ivey, M.D., and Yu-Wen Ying, Ph.D.; San Francisco, Jossey-Bass, 1999, 440 pages, $49.95

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Patterns of immigration to the United States have changed over time. In the 19th century immigrants came primarily from the four corners of Europe. Today immigrants are predominantly from Asia, Central and South America, and the Caribbean. Immigrant women constituted 54 percent of all immigrants admitted to the United States in 1996. Immigrant Women's Health addresses the unique "health and mental health concerns of women coming to the United States and the provision of culturally competent services to them."

The book is arranged in four parts. Part 1 provides background data about the numbers of immigrant women and their countries of origin, a useful clarification of the categories of immigrants, an overview of the barriers to care (cultural, linguistic, systemic, and legal), specific issues in migration, and health status before and after migration.

The second part addresses the health problems and concerns of immigrant women. Their role as the gatekeeper of their family's health is emphasized, along with the problems that they may bring with them as immigrants, when the move was planned, or as refugees, when the move was unplanned or not made by choice. Sections on screening, infectious disease, and nutritional concerns address the assessment of immigrants' current health status at their first health clinic visit.

Next in this section is a review of prenatal and reproductive health care concerns, followed by coverage of chronic diseases, cardiovascular disease, hypertension, diabetes mellitus, breast and cervical cancer, and osteoporosis. This overview can aid in assessing current clinical practices as well as providing a checklist for the types of health assessments needed and the culturally competent ways in which they are being done.

Mental health topics are covered in part 3, with chapters on domestic and sexual violence, depression and anxiety disorders, posttraumatic stress disorders, and somatization, neurasthenia, and culture-bound syndromes. Specific intercultural conflicts, DSM-IV criteria for specific disorders, and specific techniques for clarifying symptoms are discussed by diagnostic category. Sensitivity to the refugee experience is illustrated by a case of a Middle Eastern woman who has posttraumatic stress disorder, with a description of her effective evaluation and treatment. The role of somatic symptoms as communications about stress and as flags for underlying anxiety or depressive disorders is illustrated for different Asian and Hispanic cultural groups.

Part 4 addresses meeting the health care needs of immigrant women through model programs and interventions. Linguistic strategies for health care settings and a cultural competence curriculum are described.

Immigrant Women's Health has particular value for clinical settings where large immigrant populations are treated. The chapters are written by clinicians from various cultures who are providing effective services to these populations. The book can serve as a resource for clinicians seeking further consultation on clinical interventions and for administrators trying to develop culturally sensitive service delivery systems for diverse immigrant populations.

Dr. Baker is professor of psychiatry and coordinator of research in the department of psychiatry at the John A. Burns School of Medicine at the University of Hawaii at Manoa in Honolulu.




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