Background
Psychiatric disorders have a high prevalence in children and adolescents, and often persistent into adulthood. Their importance has made them a growing subject of research in recent years [
1]. Among the psychiatric disorders, anxiety and depression are the most common reasons for seeking mental health services [
2‐
5]. Worlwide statistics reported rates of anxiety in children and adolescents range from 5.6% to 21%, depending on the criteria and the type of anxiety disorder [
2,
6‐
9], with higher rates observed in older children [
10]. The prevalence of depressive disorders also varies depending on the population and evaluation method [
11]. Rates of depressive disorders between 0.5% and 2.0% have been reported for children in the general population aged 9 to 11 years [
8].
In Chile, anxiety and depressive disorders are the most prevalent mental health diagnoses in children, with reported rates of 8.3% and 5.1%, respectively [
12].
There has been very little research on anxiety and depression among different ethnic groups, with no research in Chile, despite its numerous indigenous groups.
Stressors that can impact mental health, such as racism, family disconnectedness, community dysfunction, and social disadvantage, are more prevalent among ethnic minorities [
13,
14]. Indigenous peoples have identified certain stressors as causes of poor health, such as loss of native lands, culture, and identity; covert and overt racism; marginalization; and powerlessness [
14‐
17].
Culture can also affect the way in which symptoms of mental illness manifest. Culture can determine or frame causative, precipitating, or maintenance factors that influence the onset, symptom profile, impact, course, and outcome of mental illness [
17,
18].
The prevalence of anxiety symptoms in children and adolescents also varies between ethnic minorities [
19]. For instance, adolescent immigrants in Belgium reported more traumatic experiences, more problems with their peers, and greater avoidance than non-immigrants [
20]. Similar findings were observed in a study of immigrant children in the Netherlands, who demonstrated a greater level of externalized and internalized problems than their peers [
21‐
24].
Migration to a new country or sociocultural context can cause stress due to cultural acclimatization. Such stress tends to increase levels of anxiety and depression, loneliness, psychosomatic symptoms, and contribute to a confused sense of identity [
25].
Research on stress due to cultural acclimatization has focused on how conflicts with the host language and the perception of discrimination can affect psychological well-being [
26,
27]. However, stress due to cultural acclimatization can take various paths. Thus, acclimatization is driven by transcultural or intercultural dynamics [
28,
29].
While there are numerous studies on the mental health of indigenous adults and adolescents in North America, studies of indigenous children are rare, and even more rare among indigenous children of Latin America [
30‐
34].
The lack of such studies on Chilean indigenous children is worrisome. Mental health problems in childhood have important repercussions in adulthood, including declines in academic achievement and interpersonal relations, as well as ongoing behavioural problems and drug abuse [
11,
35,
36]. Factors pertaining to the risks to and protection of mental health in children and adolescents vary in different contexts, especially between developed and developing countries [
37].
This study’s objective is to analyze the differences in the presence of anxiety and depressive symptoms between Aymara and non-Aymara children and to evaluate the relation between mental disorders and cultural involvement.
Aymara is a centuries-old culture centred in the Andes mountains. In 2012, the Aymara community had a population of about 2 million living in g central and western Bolivia, southern Peru, northern Chile, and north western Argentina [
38,
39]. The Aymara have an agricultural economy based on cultivation of potatoes, corn, and quinoa and domestication of llamas, alpacas, and vicuñas [
38,
40,
41], two activities that are complementary, both ecologically and economically [
42,
43]. The Aymara is a geographically broad and heterogeneous group, although certain common characteristics undoubtedly prevail [
44]. The culture is characterized by its intergenerational communication, where elders provide advice to the young. In addition, it is a culture in which the mother focuses on household tasks and education, the father makes the family and monetary decisions and is the breadwinner, and family members work together to complete various tasks, with young children helping out with simple household tasks.
The Aymara community in Chile has a population of approximately 48,000 [
45], only 2,300 of which still live in their original mountain territories. The rest have emigrated towards the nearby port cities and mining regions, where they have intermingled with the working classes from other areas of the country [
38,
46‐
48]. Chile’s large-scale migration towards the coast, its policy of Chilenization – where indigenous people are encouraged to accept Chilean culture and abandon their own particularly during the Pinochet dictatorship – this last forged an identity for the Aymara people, shaped by the difficulty and complexity of the process in different areas [
49].
This mass migration and rapid abandonment of rural settlements in the Andean foothills have been among the most difficult experiences for the Aymara. Migration has been a complex phenomenon that has not necessarily involved a departure without return, as evidenced by the number of simultaneous residencies and linkages that are maintained with the native communities [
50].
In adapting to a hegemonic culture, Aymara families have abandoned, to some extent, traditional cultural patterns and are slowly adopting new and increasingly intercultural lifestyles [
51,
52]. These intercultural dynamics have led to an identity crisis, not only at the level of the Aymara population, but at the level of the country, in which the issue of interculturalism has not yet been constructively addressed. Given this context, a large number of people who could be identified as Aymara by heritage or because they still practice certain Aymara customs, are no longer considered such, at least until recently [
53].
Various government organizations around the world have expressed concern for the rights of indigenous people, especially their autonomy to raise, educate, and ensure the well-being of their children, in line with children’s rights [
54]. Such recognition, however, is insufficient to eliminate the discrimination and other problems Aymara descendants face, leading to reduced access to economic, educational, and social opportunities.
Given these inequalities and the stress due to cultural acclimatization experienced by Aymara youth, we expect higher levels of anxiety and depressive symptoms among Aymara children compared to non-Aymara children.
Discussion
The study’s objective was to measure potential differences in the mental health of Aymara and non-Aymara children in northern Chile. We found no difference in levels of anxiety or depression symptoms between Aymara children and their non-Aymara peers. This finding is contrary to the stress due to cultural acclimatization hypothesis [
25]. This suggests that Aymara children possess adequate adaptive mechanisms for integrating into an urban context. These results are consistent with those of Zwirs et al. [
63] in Europe and Costello et al. [
64] in the United States.
While there may be no difference in anxiety and depression symptoms between Aymara children and their non-Aymara peers, differences could still arise as they grow into adulthood and encounter greater discrimination [
63].
Another possibility is that although these particular children are Aymara, they may have been away from the high Andean plateau long enough to have learned to live between two cultures: that of their ancestors and their current urban environment. It is possible that stress from cultural acclimatization may not have developed in these children and consequently there is no reduction in their mental health. In fact, various aspects of their lives may have improved [
65]. Some authors describe the ‘cultural advantages’ of younger groups ‘forced’ into historic processes of cultural acclimatization [
66]. This notion is consistent with a study of immigrant children in Barcelona, who developed strategies for dealing with the adaptation process and actively searched for solutions to conflicts [
67].
In anthropological terms, the dynamics of cultural acclimatization can result on difficult but constructive processes of ‘creolization’. This means that ‘contact zones’ – interfaces between different practices or cultural environments [
68] – are being generated in these indigenous children [
66]. Outside these zones, coping strategies can arise that allow individuals to combine different living strategies, enabling adequate mental health.
Within the Aymara children, those with high involvement in Aymara traditions exhibited lower levels of anxiety and fewer feelings of hopelessness. These results indicate that Aymara children with high cultural involvement may cope better with anxiety and feelings of hopelessness. Traditional celebrations, for example, have two characteristics that protect against the development of mental disorders: social and community participation and religious events. The high involvement children’s regular contact with other children of the community involves them more with the cultural perception of more positive events that happen in one’s life, with fewer feelings of hopelessness. Research during the past two decades has shown that social support is significantly linked to psychological well-being [
69]. Studies demonstrate that children with social support who are exposed to adverse experiences exhibit less psychological illness compared to children without social support [
69].
Religious beliefs have also been associated with healthy adjustment in adolescence. This may function through personal beliefs regarding behaviour, constraints on behaviour, or support for healthy behaviour by religious institutions [
70,
71]. In our study, participation in activities linked to religious beliefs or ritual practices specific to the Aymara culture could be a protective factor.
The study has a number of limitations. First, selection of the subjects was not random. Second, only Aymara children in Chile were evaluated, and these results may not apply to Aymara in other countries. Future studies should also examine children of other ethnicities in Chile, such as Mapuches, Rapa Nuis, and Quechuas, as well as indigenous children in other countries. Third, neither the SiC nor the CDI-S were validated in Chile, and only the SiC was adapted to the country. There is a likelihood of difficulties arising when psychological concepts and measurement techniques developed for one culture are used in another [
20,
72]. This issue can also be related to social expectancy. Fourth, this study contains no information from parents or teachers, which would have been important to consider to properly understanding the children’s problems. Finally, this was a cross-sectional study. It is important to carry out longitudinal studies to evaluate the consistency of findings over time [
73].
Competing interests
The authors have declared that there are no conflicts of interest in relation to the subject of this study.
Authors’ contributions
ACU contributed to the design and coordination of the study. AU was responsible for the primary study design, consulted on the methodology, and assisted with the data analysis and interpretation. KDM participated in the data collection and manuscript editing. All authors read and approved the final manuscript.