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Cases and controls were matched to form pairs of people who differed in whether they reported susto but were similar in other respects: age, gender, community, and complaints of being sick. Rubel and colleagues then tested cases and controls for differences in social stress, psychiatric symptoms, and physical health problems. There were no significant associations between psychiatric symptoms and susto, but people suffering from susto did experience more social stress, including perceived difficulty in performing important social roles – a pattern Rubel et al. expected from ethnography. And this difference really made a difference: Seven years later, 17% of people who complained of susto had died, but all the controls were still alive.

Rubel and colleagues’ study also teaches a valuable lesson about research design in general. It is a model of good design, but it wasn’t perfect – things happen in the field. Rubel et al. are honest about this fact and acknowledge their uncertainty. They realized, for example, that the gendered stigma of susto may have resulted in fewer Chinantec being willing to label themselves with the illness. This pattern would have biased the researchers’ conclusions about gender differences in the experience of susto. One of hallmarks of well-designed research design is that it makes such problems public.