Mental health service utilization for psychiatric disorders among Latinos living in the United States: the role of ethnic subgroup, ethnic identity, and language/social preferences

Determining the role of acculturative stress in predicting mental health service use among Latinx immigrants

OBJECTIVES

Acculturative stress is an important factor that affects health for Latinx immigrants in the US, with multiple studies identifying a link between depression and acculturative stress in this population. However, far fewer studies have examined the specific role and relationship of acculturative stress on mental health service use in this population. Through the lens of Yang's 2016 Model of Immigrant Health Service Use, this study aimed to examine the role of acculturative stress in predicting mental health service use in a sample of Latinx immigrants in the Southeast US.

DESIGN

We conducted a secondary data analysis from a longitudinal study of Latinx immigrant health (n = 391).

RESULTS

Our study found that while total acculturative stress was not significantly associated with mental health service use in this sample, parenting stress was a significant predictor of mental health service use in the past six months when controlling for covariates (OR: 1.043, 95% CI [1.009, 1.078]). Additionally, important Predisposing and Need for Healthcare factors were significantly associated with mental health service use, specifically: males were less likely to utilize mental health services than females (OR: 0.401, 95% CI [0.166-0.968]), English language acculturation was positively associated with mental health service use (OR: 1.953, 95% CI [1.130, 3.377]), and depression was positively associated with mental health service use (OR: 1.107, 95% CI [1.027, 1.194]).

CONCLUSION

These findings support the need for more culturally sensitive mental health services, and the need to develop strategies to engage males and less acculturated individuals in mental health services to promote health equity among Latinx immigrants.

Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study

BACKGROUND

Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health.

OBJECTIVE

This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults.

METHODS

Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest.

RESULTS

Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000.

CONCLUSIONS

Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity.

Family Language Preference, Not Provider-Family Language Concordance, Predicts Integrated Psychology Treatment Engagement in a Spanish-English Bilingual Clinic

OBJECTIVE

Monolingual Spanish speakers-many of whom identify as Hispanic/Latine-often experience barriers to accessing psychology services, including language access. Integrated primary care (IPC) clinics, where individuals receive psychological services within primary care, aim to improve service accessibility. However, minoritized populations are less likely to engage with these services than non-Hispanic/Latine White individuals. Few studies examine psychology treatment engagement within pediatric integrated clinics for Spanish-speaking families. This study investigated differences in psychology treatment engagement for Spanish-speaking families and the role of patient-provider language concordance within pediatric IPC.

METHODS

A retrospective chart review examined data from a multiethnic sample of 887 patients (M age = 8.97 yrs, 55.69% male, 64.83% Hispanic/Latine, 6.99% non-Hispanic/Latine White, 41.71% Spanish-preferring) from an urban pediatric IPC clinic serving a high proportion of Hispanic/Latine, Spanish-speaking families. We examined the association between language preference and patient-provider language concordance on service engagement using hierarchical linear regression.

RESULTS

Spanish-preferring families were more likely than English-preferring families to engage in psychology services. Working with a Spanish-speaking provider during an initial psychology visit was unrelated to psychology treatment engagement for Spanish-preferring families.

CONCLUSION

Higher engagement for Spanish-preferring families seems to reflect the clinic's reputation as a center for linguistically accessible services. While linguistic accessibility remains important, our study did not detect an effect of language concordance during the initial psychology visit and subsequent treatment engagement. The findings highlight the importance of providing culturally responsive and linguistically accessible mental health services for Spanish-speaking families.

Racial, Ethnic, and Sex Disparities in Mental Health Among US Service Members and Veterans: Findings From the Millennium Cohort Study

Although disparities in mental health occur within racially, ethnically, and sex-diverse civilian populations, it is unclear whether these disparities persist within US military populations. Using cross-sectional data from the Millennium Cohort Study (2014-2016; n = 103,184; 70.3% male; 75.7% non-Hispanic White), a series of logistic regression analyses were conducted to examine whether racial, ethnic, and/or sex disparities were found in mental health outcomes (posttraumatic stress disorder (PTSD), depression, anxiety, and problematic anger), hierarchically adjusting for sociodemographic, military, health-related, and social support factors. Compared with non-Hispanic White individuals, those who identified as American Indian/Alaska Native, non-Hispanic Black, Hispanic/Latino, or multiracial showed greater risk of PTSD, depression, anxiety, and problematic anger in unadjusted models. Racial and ethnic disparities in mental health were partially explained by health-related and social support factors. Women showed greater risk of depression and anxiety and lower risk of PTSD than men. Evidence of intersectionality emerged for problematic anger among Hispanic/Latino and Asian or Pacific Islander women. Overall, racial, ethnic, and sex disparities in mental health persisted among service members and veterans. Future research and interventions are recommended to reduce these disparities and improve the health and well-being of diverse service members and veterans.

Language adaptations of mental health interventions: User interaction comparisons with an AI-enabled conversational agent (Wysa) in English and Spanish

Background

In recent times, digital mental health interventions (DMHIs) have been proven to be efficacious; however, most are available only for English speakers, leaving limited options for non-English languages like Spanish. Research shows that mental health services in one's dominant language show better outcomes. Conversational agents (CAs) offer promise in supporting mental health in non-English populations. This study compared a culturally adapted version of an artificial intelligence (AI)-led mental health app, called Wysa, in Spanish and English.

Objectives

To compare user engagement patterns on Wysa-Spanish and Wysa-English and to understand expressions of distress and preferred language in both versions of Wysa.

Methods

We adopted a cross-sectional retrospective exploratory design with mixed methods, analyzing users from 10 Spanish-speaking countries between 1 February and 1 August 2022. A quantitative sample A (n = 2767) was used for descriptive statistics, including user engagement metrics with a Wilcoxon test. A subset qualitative sample B (n = 338) was examined for word count differences based on valence, and a content analysis was conducted to examine idioms of distress.

Results

Compared to Wysa-English, Wysa-Spanish had more sessions (P < .001, d = 0.18) and a greater volume of disclosure of distress. In Wysa-Spanish, the average length of a conversation was significantly longer than in Wysa-English (P < .001, d = 0.44). Users preferred interventions with free text responses ("Thought recording") in Spanish (P < .01, d = 0.41), and Spanish messages were significantly longer (P < .01, d = 0.24). Wysa-Spanish saw more frequent expressions of negative emotions and feelings of self-harm and suicide.

Conclusion

Given the high engagement within the Spanish version of Wysa, the findings demonstrate the need for culturally adapted DMHIs among non-English populations, emphasizing the importance of considering linguistic and cultural differences in the development of DMHIs to improve accessibility for diverse populations.

Ethnic Identity and Mechanisms of Mental Health Service Engagement Among Young Adults with Serious Mental Illnesses

PURPOSE

Young adults from minoritized racial and ethnic groups have lower rates of engagement in treatment for serious mental illnesses (SMI). Previous research suggests a relationship between ethnic identity development and engagement in mental health services, but it remains unclear how a sense of belonging and attachment to one's racial and ethnic group influences participation in treatment among young adults with SMI.

METHODS

Bivariate analyses and structural equation modeling (SEM) were used to examine whether ethnic identity was associated with treatment engagement (attendance and investment in treatment) and how ethnic identity might influence engagement through theoretical proximal mediators. Eighty-three young adults with SMI (95% from minoritized racial and ethnic groups) were recruited from four outpatient psychiatric rehabilitation programs and assessed at least 3 months after initiating services.

RESULTS

Stronger ethnic identity was associated with greater investment in treatment but not with treatment attendance. The SEM analysis indicated that stronger ethnic identity may improve investment in treatment by enhancing hope (0.53, p < .05) and beliefs that mental health providers are credible (0.32, p < .05), and by increasing self-efficacy (-0.09, p < .05). Proximal mediators of engagement were associated with investment in treatment (hope and credibility, p < .05, and self-efficacy p = 0.055).

CONCLUSIONS

Findings provide preliminary evidence of an empirical and theoretical relationship between ethnic identity development and engagement in treatment among young adults with SMI. Assessment and strengthening of a young person's ethnic identity may be a promising approach for improving their engagement in services and reducing inequities in their care.

The relative contribution of ethnic identity and ethnic discrimination on alcohol, tobacco, and other drug use disorders among Hispanic/Latin American individuals

INTRODUCTION

Racial/ethnic discrimination and ethnic identity, the affiliation and connection to one's ethnic group, are important for understanding alcohol, tobacco, and drug use disorders (AUD, TUD, DUD, respectively) among Hispanic/Latin American individuals. Although discrimination is a well-recognized risk factor, the role of ethnic identity is less understood. Moreover, no study has examined which of these factors is more important for informing AUD, TUD, and DUD. This information is necessary for creating effective prevention and treatment programs tailored for Hispanic/Latin American people. Herein we examined the role and relative importance of racial/ethnic discrimination and Hispanic ethnic identity on past year AUD, TUD, and DUD.

METHODS

Hispanic/Latin American participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III constituted the sample for this cross-sectional secondary data analysis. Participants (N = 7037) were 39.93 years old on average (SD = 15.32). More than half were female (56.1 %) and had family incomes below the median household income in the United States (58.7 %). Most had national origins in North America (79.3 %), including US dependent territories and Mexico. Confirmatory factor analysis (CFA) verified the psychometric properties of the discrimination and Hispanic ethnic identity measures. Logistic regressions, supplemented with dominance analysis, estimated the role and relative contribution of discrimination and Hispanic ethnic identity on the probability of past year AUD, TUD, and DUD.

RESULTS

The CFAs yielded adequate convergent validity and reliability for each construct. More racial/ethnic discrimination and a higher Hispanic ethnic identity related to a higher and lower probability of AUD, TUD, and DUD, respectively. The magnitude of the association between Hispanic ethnic identity and the probability of TUD exceeded that of racial/ethnic discrimination, but the converse was the case for AUD and DUD.

CONCLUSIONS

Prevention and treatment programs for TUD that highlight the value of having a strong sense of self as a member of a Hispanic ethnic group, and that encourage the individual to explore their Hispanic ancestry may prove effective among Hispanic/Latin American individuals, particularly those who have experienced racial/ethnic discrimination. Programs for AUD and DUD tailored for Hispanic Latin/American adults should also incorporate coping strategies to address experiences with racial/ethnic discrimination.

Acculturation and Psychopathology

Acculturation and psychopathology are linked in integrated, interactional, intersectional, and dynamic ways that span different types of intercultural contact, levels of analysis, timescales, and contexts. A developmental psychopathology approach can be useful to explain why, how, and what about psychological acculturation results in later adaptation or maladaptation for acculturating youth and adults. This review applies a conceptual model of acculturation and developmental psychopathology to a widely used framework of acculturation variables producing an Integrated Process Framework of Acculturation Variables (IP-FAV). This new comprehensive framework depicts major predisposing acculturation conditions (why) as well as acculturation orientations and processes (how) that result in adaptation and maladaptation across the life span (what). The IP-FAV is unique in that it integrates both proximal and remote acculturation variables and explicates key acculturation processes to inform research, practice, and policy.

The Measurement of Acculturation in Neuropsychological Evaluations of Hispanic/Latino Individuals across the Lifespan: A Scoping Review of the Literature

OBJECTIVE

Acculturation has been linked to health outcomes in Hispanics/Latinos (H/Ls). However, there is equivocal evidence of a relationship between acculturation and neuropsychological outcomes. Various factors limit the ability to subject the evidence to systematic/meta-analytic review. We sought to examine the current state of the literature in the context of H/Ls and neuropsychology and describe the various limitations of measuring acculturation across the lifespan.

METHOD

Applying a scoping review approach, we identified unique stand-alone (e.g., questionnaires) measures of acculturation. We focused on psychometric (e.g., internal consistency) and other characteristics (e.g., language, structure/format) and description of the validation samples (e.g., cultural background/country of origin).

RESULTS

A total of 40 unique acculturation measures were identified. Measures spanned various domains (e.g., language proficiency, food preference, music choice), and relied heavily on linguistic behavioral characteristics. Internal consistency varied from unacceptable to clinically acceptable ranges. Variable approaches to development and validation were reported. Validation samples varied from 22 to 2,048 respondents (median = 380), most of which represented a general adult population. Only eight measures were validated for use in pediatric populations; none were developed specifically for use with older adults.

CONCLUSIONS

Published measures are outdated, evidence highly variable psychometric and methodological weaknesses, and lack a lifespan perspective. Several themes in the types of items considered elemental to the acculturative process are revealed and findings are summarized via an "ABC" framework, categorizing items as antecedents, behaviors, and consequent acculturative changes, that lends itself to clinical and research settings.

Strategies for Naming and Addressing Structural Racism in Immigrant Mental Health

Immigrants account for 13.7% of the US population, and the great majority of these individuals originate from Latin America or Asia. Immigrant communities experience striking inequities in mental health care, particularly lower rates of mental health service use despite significant stressors. Structural barriers are a significant deterrent to obtaining needed care and are often rooted in racist policies and assumptions. Here we review and summarize key pathways by which underlying structural racism contributes to disparities in immigrant mental health, including anti-immigration policies, labor and financial exploitation, and culturally insensitive mental health services. Significant accumulated research evidence regarding these barriers has failed to translate into structural reform and financial investment required to address them, resulting in pronounced costs to both immigrant populations and society at large. We propose specific strategies for addressing relevant structural inequities, including reforming economic and financial policies, community education initiatives, and task-sharing and strengths-based interventions developed in partnership with immigrant communities to promote access to mental health care for populations in dire need of culturally appropriate services. (Am J Public Health. 2023;113(S1): S72-S79. https://doi.org/10.2105/AJPH.2022.307165).

Espiritismo and Santeria: a gateway to child mental health services among Puerto Rican families?

BACKGROUND

Barriers to mental health care access among Latinx children contribute to mental health disparities. It is unclear whether traditional spiritual guides in Latinx communities may function more as gateway providers or in some instances as deterrents to mental health treatment. This study assesses whether family involvement in Espiritismo and/or Santeria, two forefront non-Christian spiritual traditions among Latinx families, is associated with mental health care utilization among Puerto Rican children in two contexts.

METHODS

Data are from Waves 1-3 (2000-2004) of the Boricua Youth Study, a population-based longitudinal cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico (PR), and the South Bronx, New York (SBx), 5 to 17 years of age (N = 2491).

RESULTS

At baseline, 5.02% (n = 58) of the families reported involvement with Espiritismo and/or Santeria in the SBx and 3.64% (n = 52) in PR. Logistic regression models predicting mental health service use found, after adjusting for multiple risk and protective factors, that families involved with Espiritismo and/or Santeria were 2.41 times more likely (p = 0.0034) to use mental health services over the course of 3 years than children with no family involvement in these practices in the SBx. The same association was not found in PR.

CONCLUSIONS

The findings among PR families in the SBx lend support to the gateway provider model in which spiritual guides open doors to mental health treatment. Forming community connections between mental health providers and traditional spiritual groups may be a culturally considerate, fruitful approach to reducing barriers to mental health treatment among Latinx families.

Digital conversations about depression among Hispanics and non-Hispanics in the US: a big-data, machine learning analysis identifies specific characteristics of depression narratives in Hispanics

BACKGROUND

Digital conversations can offer unique information into the attitudes of Hispanics with depression outside of formal clinical settings and help generate useful information for medical treatment planning. Our study aimed to explore the big data from open-source digital conversations among Hispanics with regard to depression, specifically attitudes toward depression comparing Hispanics and non-Hispanics using machine learning technology.

METHODS

Advanced machine-learning empowered methodology was used to mine and structure open-source digital conversations of self-identifying Hispanics and non-Hispanics who endorsed suffering from depression and engaged in conversation about their tone, topics, and attitude towards depression. The search was limited to 12 months originating from US internet protocol (IP) addresses. In this cross-sectional study, only unique posts were included in the analysis and were primarily analyzed for their tone, topic, and attitude towards depression between the two groups using descriptive statistical tools.

RESULTS

A total of 441,000 unique conversations about depression, including 43,000 (9.8%) for Hispanics, were posted. Source analysis revealed that 48% of conversations originated from topical sites compared to 16% on social media. Several critical differences were noted between Hispanics and non-Hispanics. In a higher percentage of Hispanics, their conversations portray "negative tone" due to depression (66% vs 39% non-Hispanics), show a resigned/hopeless attitude (44% vs. 30%) and were about 'living with' depression (44% vs. 25%). There were important differences in the author's determined sentiments behind the conversations among Hispanics and non-Hispanics.

CONCLUSION

In this first of its kind big data analysis of nearly a half-million digital conversations about depression using machine learning, we found that Hispanics engage in an online conversation about negative, resigned, and hopeless attitude towards depression more often than non-Hispanic.

Training non-mental health professionals to assess and manage suicide risk: Community level intervention for suicide prevention in Guatemala

BACKGROUND

Domestic violence, childhood physical and sexual abuse, and gang violence are prevalent and growing problems for Guatemalan youth, particularly in low socioeconomic (SES) areas. Resources in the community for psychosocial support are greatly lacking. Schools often serve as the main source of support for these highly vulnerable adolescents. Yet, many teachers lack the training to manage the psychological distress of their at-risk students and to properly engage, assess, and manage the psychological needs of their students. We developed a brief risk assessment and management training for teachers to address this gap.

AIMS

We present the acceptability and preliminary effectiveness of the training at increasing teacher's knowledge and understanding of how to engage and work with their at-risk students around their thoughts and feelings of suicide.

METHOD

Twenty-two teachers from a school in a low SES community in Guatemala participated in the training program. Mixed methods were used to explore effectiveness, acceptability, and satisfaction with the training. Primary outcomes assessed were changes in self-reported knowledge and understanding of engaging and working with students at risk of suicide.

RESULTS

Participants reported increased knowledge and understanding of all training targets (p < .05). Acceptability was high as no participants dropped out and all participants rated the training as useful for their professional development, meeting their expectations, and as highly satisfying.

CONCLUSION

Brief, focused training on suicidality can be effective and is acceptable to lay professionals. Further examination of the effectiveness of the training in a larger sample is required to assess the long-term impact of the training and its transportability to other communities.

Mothering in the Context of Mental Disorder: Effect of Caregiving Load on Maternal Health in a Predominantly Hispanic Sample

BACKGROUND

Mothering in the context of mental disorders presents with multiple challenges. However, this phenomenon is poorly understood: It is not known how child caregiving affects the health of their mothers.

AIMS

The purpose of this study was to examine associations between child caregiving load and health indicators in mothers receiving outpatient behavioral health services for mental or substance use disorders.

METHOD

A total of 172 mothers (80% Hispanic/Latina) completed surveys on their mental and physical health, and children's behaviors and medical problems. Child caregiving load consisted of number of children living with the mother, and presence of children's internalizing, externalizing, or medical problems.

RESULTS

Child caregiving load had significantly positive associations with mother's psychological distress, fatigue, pain, and body mass index. Child internalizing and medical problems were associated with mothers' poor health status.

CONCLUSIONS

Hispanics/Latinos experience health disparities, and Hispanic/Latina mothers who are already at risk due to their mental disorders experience an additional health burden associated with caring for children with emotional or health problems. Psychiatric and mental health nurse practitioners should assess child caregiving impact on mothers with mental disorders and seek to mitigate their caregiving burden and maintain their health. Further research is needed to clarify child characteristics and the mechanisms associated with maternal caregiver burden, suboptimal self-care, and adverse health outcomes. Structural Ecosystems Therapy for women in Recovery (SET-R) study/Healthy Home; Clinical Trial ID NCT02702193.

Mental health service utilization among African immigrants in the United States

This study utilized Andersen's model of health behavior to explore factors associated with mental health service utilization. We also examine rates for mental health service use, treatment preferences, and barriers to care. Data were collected utilizing web-based surveys. The sample consisted of first and second-generation African immigrants who had struggled with emotional or behavioral problems in the past 12 months (N = 323). Hierarchical logistic regression analyses were conducted to examine predictors of mental health service utilization. The majority of participants (79.5%) met criteria for probable major depression, and 63% sought mental health services. Findings showed that mental health service utilization was more significantly predicted by enabling and need factors. Age (odds ratio [OR] = 1.03), religiosity (OR = 1.11), acculturative stress (OR = 1.68), neighborhood risk (OR = 0.54), and work-productivity loss (OR = 2.93) were associated with increased likelihood of mental health service use (p < 0.05). Most common barriers to service use were hopes of self-healing (56.3%) followed by financial barriers (46.2%). Findings highlight the need for public health initiatives to increase mental health literacy and financial accessibility to mental health services in response to the high mental health need and identified barriers to care in this population.

A mixed-methods study of social identities in mental health care among LGBTQ young adults of color

Social identities have been shown to reflect normative beliefs and practices that can impact important health behaviors. A better understanding of how this process unfolds among young people with marginalized identities can help inform strategies to decrease mental health disparities and improve their overall health outcomes. A mixed method, convergent parallel design was used to examine identity centrality, mental health treatment history, and cultural experiences of a purposeful sample, consisting of 31 Black and Latinx young adults (Mage = 22.16) who identified as sexual and gender minorities in New York City. Data from validated measures and in-depth interviews were triangulated to strengthen and add context to findings. Participants with higher social identity centrality scores, particularly on community belonging and sexual identity, were more likely to continuously use mental health services. Seven social identities were prominent in qualitative data: Sexual, Ethnic-racial, Religious, Socioeconomic, Gender, Family, and Generational. These social identities were described as interconnected, and as both significant barriers and facilitators to participants' involvement in treatment. Results suggested that young lesbian, gay, bisexual, transgender, queer (LGBTQ) people of color seeking mental health care might need more support to navigate experiences related to intersecting identities. Interventions to improve services and maintain these youth in treatment should employ strategies to assess and support positive minority identity development, while also addressing self-stigma and discrimination experienced through culture, family, and mental health professionals. Considering social identity development is conceptually useful for adapting services for diverse youth because it is a major focus of transitioning to adulthood and calls attention to multiple minority identities impacting individual clients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

Social support and strain and emotional distress among Latinos in the northeastern United States

Background

US Latinos report high levels of emotional distress. Having positive familial and friend social support buffers emotional distress among US Latinos, but thus far no research has been done on social support and ataque de nervios in that population, or on social strain and emotional distress.

Methods

This paper assesses social support and strain across three relationship types (partner, family, and friends) with three measures of emotional distress (depression, anxiety, and ataque de nervios). The sample for partner, family, and friend support included 508 Latino adults 21 and older. Multivariate logistic regression models were used to assess the association of social support and strain with each outcome.

Results

As all social support types increased, the odds of emotional distress symptoms decreased. Conversely, as each unit of partner and family strain increased, the odds of emotional distress symptoms increased. Increased friend strain was associated with greater odds of depressive and anxiety symptoms only.

Conclusion

Social support in all three network types (partner, family, and friend) was associated with a decrease in the odds of emotional distress, assessed as symptoms of depression, anxiety, and ataque de nervios.

Impact of the Medicare Shared Savings Program on utilization of mental health and substance use services by eligibility and race/ethnicity

OBJECTIVE

To assess the impact of the Medicare Shared Savings Program (MSSP) ACOs on mental health and substance use services utilization and racial/ethnic disparities in care for these conditions.

DATA SOURCES

Five percent random sample of Medicare claims from 2009 to 2016.

STUDY DESIGN

We compared Medicare beneficiaries in MSSP ACOs to non-MSSP beneficiaries, stratifying analyses by Medicare eligibility (disability vs age 65+). We estimated difference-in-difference models of MSSP ACOs on mental health and substance use visits (outpatient and inpatient), medication fills, and adequate care for depression adjusting for age, sex, race/ethnicity, region, and chronic medical and behavioral health conditions. To examine the differential impact of MSSP on our outcomes by race/ethnicity, we used a difference-in-difference-in-differences (DDD) design.

DATA COLLECTION/EXTRACTION METHODS

Not applicable.

PRINCIPAL FINDINGS

MSSP ACOs were associated with small reductions in outpatient mental health (Coeff: -0.012, P < .001) and substance use (Coeff: -0.001, P < .01) visits in the disability population, and in adequate care for depression for both the disability- and age-eligible populations (Coeff: -0.028, P < .001; Coeff: -0.012, P < .001, respectively). MSSP ACO's were also associated with increases in psychotropic medications (Coeff: 0.007 and Coeff: 0.0213, for disability- and age-eligible populations, respectively, both P < .001) and reductions in inpatient mental health stays (Coeff:-0.004, P < .001, and Coeff:-0.0002, P < .01 for disability- and age-eligible populations, respectively) and substance use-related stays for disability-eligible populations (Coeff:-0.0005, P<.05). The MSSP effect on disparities varied depending on type of service.

CONCLUSIONS

We found small reductions in outpatient and inpatient stays and in rates of adequate care for depression associated with MSSP ACOs. As MSSP ACOs are placed at more financial risk for population-based treatment, it will be important to include more robust behavioral health quality measures in their contracts and to monitor disparities in care.

Does childhood mental health service use predict subsequent mental health service use during Latino youth transition to young adulthood? Evidence from the Boricua Youth Study

PURPOSE

Studies document the substantial underutilization of mental health services by US Latinos in young adulthood. Rates of service use are higher in childhood, raising questions about whether mental health service use during childhood may facilitate access to services later in life. This article examines the extent to which utilization of mental health services in childhood is predictive of utilization in young adulthood among US Latinos.

METHODS

Data come from the Boricua Youth Study, a longitudinal study of Puerto Rican youth at two sites (South Bronx, New York, and the standard metropolitan area of San Juan, Puerto Rico). Data were collected in three waves during childhood (ages 5-13; surveyed 1 year apart), with an approximately 11-year follow-up in young adulthood (ages 16-29). In childhood, parents reported on youth mental health service use (Waves 1-3). In Wave 4, as youth transitioned to young adults (N = 2004), they reported on their past year mental health service use.

RESULTS

Whereas 30.2% of parents reported their child received mental health services, only 3.5% of young adults reported mental health service use in the past year. After controlling for young adult disorders and their severity, childhood disorders were associated with increased likelihood of mental health service use in young adulthood. Childhood mental health service use was also associated with young adult service use; however, this association attenuated when controlling for childhood disorders.

CONCLUSION

Findings suggest the importance of specifically considering childhood disorders in understanding mechanisms for improving access to mental health services among Latino young adults.

Media language preferences and mental illness stigma among Latinx adolescents

PURPOSE

Media-a powerful influence on mental illness stigma-varies by language and culture. Nevertheless, recent meta-analyses have demonstrated scant attention to Spanish language media as well as historically low Latinx participation in mental illness anti-stigma intervention. To better inform how to improve equity in mental health service utilization, this study assessed how language preferences in mass media influence stigma among Latinx adolescents, compared to family language and social preferences.

METHODS

Sixth-graders self-identifying as Latinx self-completed assessments of mental illness knowledge/positive attitudes and desired separation from peers and adolescent vignette characters experiencing mental illness (N = 179; Texas, U.S., 2011-2012). Participants also responded to measures of language preferences (any Spanish versus only English) for consuming media (film/television, music/radio) and speaking with family (parents/grandparents), and social preferences for parties or social gatherings (Latinx versus Anglo persons). Linear regression models adjusting for student and household factors examined the associations between media and family language and social preferences on mental illness stigma.

RESULTS

Latinx adolescents preferring any Spanish versus English-only media reported less mental illness knowledge/positive attitudes and greater social separation from peers and vignette characters with a mental illness, net of all covariates. Family language and social preferences were not associated with any mental illness stigma outcomes.

CONCLUSIONS

Spanish media preference is associated with greater stigma suggesting more stigmatization may exist in Spanish- versus English-media. Ensuring anti-stigma messaging in Spanish media may reduce disparities in mental illness stigma among Latinx adolescents. These findings have implications for populations with other non-English media preferences.

Depression Among Older Adults in the United States by Disaggregated Race and Ethnicity

BACKGROUND AND OBJECTIVES

As the population becomes increasingly diverse, it is important to understand the prevalence of depression across a racially and ethnically diverse older population. The purpose of this study was to compare rates of depression by age and disaggregated racial and ethnic groups to inform practitioners and target resource allocation to high risk groups.

RESEARCH DESIGN AND METHODS

Data were from the Centers for Medicare and Medicaid Services Health Outcomes Survey, Cohorts 15 and 16, a national and annual survey of a racially diverse group of adults aged 65 and older who participate in Medicare Advantage plans (N = 175,956). Depression was operationalized by the Patient Health Questionnaire-2 (PHQ-2); we estimated a logistic regression model and adjusted standard errors to account for 403 Medicare Advantage Organizations.

RESULTS

Overall, 10.2% of the sample (n = 17,957) reported a PHQ-2 score of 3 or higher, indicative of a positive screen for depression. After adjusting for covariates, odds of screening positively for depression were higher among participants self-reporting as Mexican (odds ratio [OR] = 1.19), Puerto Rican (OR = 1.46), Cuban (OR = 1.57), another Hispanic/Latino (OR = 1.29), and multiple Hispanic/Latino (OR = 1.84) ethnicities, compared with non-Hispanic whites. Odds were also higher among participants reporting that their race was black/African American (OR = 1.20), Asian Indian (OR = 1.67), Filipino (OR = 1.30), Native Hawaiian/Pacific Islander (OR = 1.82), or two or more races (OR = 1.50), compared with non-Hispanic whites.

DISCUSSION AND IMPLICATIONS

Prevalence varied greatly across segments of the population, suggesting that certain racial/ethnic groups are at higher risk than others. These disparities should inform distribution of health care resources; efforts to educate and ameliorate depression should be culturally targeted.

Perception of treatment need among adults with substance use disorders: Longitudinal data from a representative sample of adults in the United States

BACKGROUND

Most individuals with substance use disorders (SUDs) do not seek treatment. Lack of perceived treatment need (PTN) is one contributing factor, but little is known about PTN over time. We estimated whether PTN changed over three years among those with SUDs in the United States and identified select variables, including sociodemographics and symptom burden, that predict malleability vs. stability of PTN.

METHODS

Data were from Waves 1 (collected 2001-2002) and 2 (collected 2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); 1695 adults who met DSM criteria for alcohol or non-alcohol SUD at Wave 1 and maintained ≥1 diagnostic symptom at Wave 2 were included.

RESULTS

Most individuals with SUDs (77.2%) did not perceive a need for treatment at Wave 1 baseline. Only about 1 in 8 individuals not perceiving a need for treatment in Wave 1 came to perceive a need in Wave 2 (adjusted odds ratio = 0.18, 99% confidence interval = 0.11-0.29). In contrast, about half the individuals who perceived a need for treatment in Wave 1 no longer did so in Wave 2, despite maintaining ≥1 SUD symptom. Married respondents, and respondents with more SUD symptoms, were more likely to transition from low- to high-PTN status three years later. Respondents with incomes >$35,000 were less likely to transition to high-PTN status three years later.

CONCLUSIONS

PTN was more likely to decline than increase over time. Low PTN appears to be stable among adults with SUDs in the United States, presenting a potentially enduring barrier to treatment-seeking.

Provider Perspectives on Stressors, Support, and Access to Mental Health Care for Latinx Youth

Despite risk for mental health difficulties, Latinx youth have among the lowest rates of mental health care utilization. With this study, we contribute to our ongoing community-based participatory research (CBPR) efforts to explore stressors and protective factors experienced by low-socioeconomic status (SES) Latinx youth, and how these factors influence mental health care utilization. We interviewed community providers and stakeholders (N = 11) from organizations serving low-SES Latinx youth. Coded data yielded seven categories of specific stressors, protective factors, and processes by which these factors influence service utilization. Across categories, providers emphasized how combined family and socioeconomic risk contributed to disengagement from services and described schools and community programs as buffering this risk. Findings suggest that the unique experiences of low-SES Latinx youth contribute to low rates of service utilization, and that intervention should address specific factors at the family, school, and community level to improve access to care.

Assessing the Psychometric Proprieties of the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF) Among Latino Adults

The Latino population continues to underutilize mental health services at an alarming rate. The Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF) is one of the most commonly used instruments to assess help-seeking attitudes. The current study sought to evaluate the factor structure and test for the presence of differential item functioning on the ATSPPH-SF with a sample of Latino adult individuals across nativity status (U.S.- vs. foreign-born), language format (English vs. Spanish), and gender. The analyses revealed two relatively independent factors named Openness to Seeking Treatment and Value and Need in Seeking Treatment. Measurement equivalence and practical implications are discussed in the context of use with Latino individuals.

Identity negotiation processes among Black and Latinx sexual minority young adult mental health service users

The transition to adulthood presents particular challenges for Black and Latinx sexual minorities in need of mental health services. Identity formation and marginalization during this developmental period can interfere with help-seeking and lead to health disparities. Identity-specific psychosocial supports are needed to assist young adults to successfully navigate these challenges, but research on identity processes, help-seeking, and service-utilization among sexual minority young people of color is very limited. To better understand how multiple minority young people navigate their identities in the context of using, or choosing not to use, mental health services, this study qualitatively explored the experiences of 31 emerging adults. Through in-depth interviews, analyses revealed that young adults negotiated social identity norms about mental health help-seeking by separating from unhelpful norms, managing stigmatized aspects of identity, integrating helpful identity alternatives, and forming individualized perspectives on help-seeking that allowed them to maintain important connections to their minority group identities. Findings are discussed in relation to previous research on ethnic and sexual minority identity development and service utilization. Practice and research recommendations for increasing knowledge, improving help-seeking, and promoting resilience around young adults' intersectional identities are offered.

An Analysis of Acculturation Status and Healthcare Coverage for the Needs of Mental Health Service Utilization among Latinos in Mississippi, Louisiana, and Alabama

Background: The use of mental health services by Latinos is only 7.3%, despite the high prevalence of depression rates of between 27.0% and 38.0% in the United States. Research is limited concerning Latinos’ acculturation status and healthcare coverage on mental healthcare service utilization in Mississippi, Louisiana, and Alabama. Therefore, the objective of this study is to examine the association of acculturation status and healthcare coverage with mental health service utilization in the Latino population. Methods: During 2011–2012, a Latino Community Health Needs Assessment was administered by a trained bilingual interviewer using participants’ preferred language. Four hundred and eleven community members and leaders participated in the study. Acculturation status and self-reported mental health service utilization were retrieved from the survey instrument. Multivariate logistic regression analyses were performed. Results: In multivariate logistic regression that included gender, education level, healthcare coverage, depression, and acculturation status, individuals with a high acculturation score (3–5) were 1.53 times more likely to utilize mental health services compared to those with a low acculturation score (0–2). Individuals with healthcare coverage were 2.75 times more likely to utilize mental health services compared to those with not having healthcare coverage. Healthcare coverage is only a significant determinant of mental health service utilization. Conclusions: This result underscores the importance of having healthcare coverage for the need of mental health service utilization. Future research should consider the impact of acculturation and healthcare coverage on mental health service utilization.

Engagement in linkage to mental health care program in the Rockaways after Hurricane Sandy

The Rockaways area of New York City was especially devastated by Hurricane Sandy. This study examined participant characteristics associated with acceptance of a linkage to and attendance at appointments for mental health difficulties (MHD). Participants (N = 1,011) completed questionnaires to assess mental health symptoms. Participants who met screening criteria (n = 442) were offered linkage to care. Individuals who had a higher mental health symptom burden (MHSB; i.e., those who screened in on more than one criteria vs. only one criterion) had 2.68 greater odds of accepting services (95% confidence interval [1.68, 4.26]). MHSB was not associated with attending a first appointment (p = 0.80). Female gender and Hispanic ethnicity were also associated with acceptance of linkage to care, though not attendance. Reducing stigma around MHD associated with natural disasters and increasing knowledge about the mental health care system could promote help-seeking behavior among survivors.

Mental health stigma in depressed Latinos over the course of therapy: Results from a randomized controlled trial

OBJECTIVE

The current study examined the course, correlates, and predictors of mental health stigma among depressed, Spanish-speaking Latinos that were receiving treatment. This population faces significant disparities in mental health treatment and carries high levels of mental health stigma.

METHOD

The study utilized data generated from a randomized clinical trial (N = 46) that evaluated the efficacy of Behavioral Activation and Supportive Counseling for depression among Latinos.

RESULTS

Mental health stigma decreased over time; these decreases were more pronounced among individuals who were randomized to Supportive Counseling. Mental health stigma was positively associated with depressive symptoms and therapeutic alliance over time. Mental health stigma was not related to treatment attrition.

CONCLUSIONS

These preliminary findings indicate that mental health stigma continues to be relevant among individuals who are actively participating in treatment. Receiving mental health treatment may be sufficient to dispel some of the stigmatizing views endorsed by underserved clinical populations.

The role of racial/ethnic identity in the association between racial discrimination and psychiatric disorders: A buffer or exacerbator?

The present study tests whether and how racial/ethnic identity moderates the psychological burden associated with racial discrimination. The theoretical concept of identity-relevant stressors suggests that racial discrimination will be associated with stronger psychological burden for people who put more values on their racial/ethnic backgrounds (i.e., racial/ethnic identity as an exacerbator). Conversely, racial/ethnic identity may be a protective resource to buffer any negative mental health consequences of racial discrimination (i.e., racial/ethnic identity as a buffer). We adjudicate these two competing hypotheses, while also examining whether the moderating effect of racial/ethnic identity varies by race/ethnicity or nativity. The data are from the 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Our findings reveal a race/ethnicity-dependent pattern: High racial/ethnic identity functions as an exacerbator for Whites, American Indians/Alaska Natives, and Latinxs, but moderate racial/ethnic identity functions as a buffer for Asians and Blacks in handling racial discrimination. In addition, the moderating effect of racial/ethnic identity is more pronounced among the U.S.-born than the foreign-born. The present study contributes to the knowledge base by showing that racial/ethnic identity does not universally protect-nor does it universally exacerbate-the psychiatric burden of racial discrimination. Rather, whether it mitigates or intensifies the mental burden of racial discrimination depends on its level and race/ethnicity.

Language and Latino immigrants living with spina bifida: Social determinants of health - the missing dimension in quality of life research

PURPOSE

Aware of the higher birth prevalence of spina bifida (SB) among Hispanics/Latinos, we aimed to appraise the literature as it relates to cultural context through a review of quality of life (QOL) studies conducted among individuals with SB in order to improve care among immigrant families.

METHODS

A systematic review was conducted consistent with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The inclusion criteria were: (1) children and adolescents (5-21 years of age) with SB and/or myelomeningocele; (2) quantitative studies; (3) health-related QOL outcome measured by validated instrument determinants; and (4) US-based studies. Articles meeting inclusion criteria were assessed using the focused conceptual framework informing the study (i.e., social determinants of health).

RESULTS

Eighteen studies met inclusion criteria, with eight different QOL instruments represented. The majority of studies used generic assessments of QOL (72%), two reported the use of both a generic and a SB-specific QOL measure (11%), and three (17%) documented QOL utilizing a SB-specific validated instrument. Only seven (39%) of the studies stated that they included Hispanics/Latinos and only six (33%) reported including Spanish-speaking individuals.

CONCLUSIONS

QOL in individuals with SB is mediated by a wide-range of interrelated factors. In order to better serve this vulnerable population as they transition across the lifespan, multilingual condition-specific QOL measures need to be further developed and implemented among Hispanic/Latino individuals with SB, especially those who are recent immigrants.

Intra-Ethnic Coverage Disparities among Latinos and the Effects of Health Reform

OBJECTIVE

To examine the patterns of insurance coverage among nine Latino subgroups and assess heterogeneous effects of the Affordable Care Act (ACA) among these groups.

DATA SOURCES

American Community Survey (2010-2014).

STUDY DESIGN

We examined pre-ACA disparities in coverage using linear probability models. Then, we used interrupted time series and triple-difference models to evaluate coverage changes associated with the ACA and Medicaid expansion, respectively.

PRINCIPAL FINDINGS

Pre-ACA coverage disparities between Latino subgroups were nearly 30 percentage points-larger than the gap between whites and Latinos as a whole. Coverage changes associated with the ACA and Medicaid expansion differed significantly between subgroups, with the largest gains among South Americans, Central Americans, and Mexicans.

CONCLUSIONS

Latino subgroups show marked heterogeneity in baseline coverage rates and responses to the ACA.

Homework completion via telephone and in-person Cognitive Behavioral Therapy among Latinos

Homework completion in cognitive behavioral therapy (CBT) for depression is an integral ingredient in treatment that often goes unreported. Furthermore, many studies of homework completion focus on patient adherence without considering the therapists' role in reviewing and reinforcing this behavior. No studies to date have assessed the relationship between homework variables and outcomes among Latinos receiving CBT for depression. Since this population has often been difficult to engage in CBT, this study aims to assess whether homework completion and therapist review of homework are related to improved outcomes in a CBT intervention (telephone or in person) for Latinos with depression. We found that higher homework completion was significantly related to lower depression scores at the end of final treatment (as measured by PHQ-9) (B = -1.38, p < 0.01). However, the significant association of homework with depression went away when clinician review of homework was included in a subsequent step of the model (B = -0.42, p = 0.45). The number of times a clinician actively reviewed homework was still significantly related to a decrease in PHQ-9 when controlling for demographic factors (B = -1.23, p < 0.01). This study found that homework is a predictor of improved outcomes in CBT for depression but highlights the role of therapists reviewing homework as a predictor of lower depression symptoms among Spanish speaking Latinos from low socioeconomic backgrounds.

Latina young adults' use of health care during initial months in the United States

We examined social ecological predictors of health care utilization among Latina young adults during their initial year after immigration to the United States. Participants were 530 Latinas (ages 18-23) who immigrated to Miami-Dade County, Florida, 11.5 months before assessment. We used multiple logistic regression to test predictors of health care usage. Approximately 36% utilized care. Dimensions of marianismo differentially associated with usage. Usage also was more likely for participants who reported more social network attachment, better health, greater neighborhood cohesion, and possessed a job and health insurance. Findings inform interventions to increase health care usage globally among women after immigration.

Barriers to and Correlates of Retention in Behavioral Health Treatment Among Latinos in 2 Different Host Countries: The United States and Spain

CONTEXT

Latino immigrants constitute a large portion of the Spanish and US immigrant populations, yet a dearth of research exists regarding barriers to retention in behavioral health care.

OBJECTIVES

To identify and compare perceived barriers related to behavioral health care among first- and second-generation Latinos in Boston, Madrid, and Barcelona, and evaluate whether the frequency of behavioral health care use in the last year was related to these barriers.

DESIGN, SETTING, AND PARTICIPANTS

Data were obtained from the International Latino Research Partnership project. First- or second-generation self-identified Latino immigrants aged 18 years and more who resided more than 1 year in the host country were recruited from community agencies and primary care, mental health, substance abuse, and HIV clinics.

MAIN OUTCOME MEASURES

Eleven barriers were assessed and compared across sites. The relationship between barriers and behavioral services visits within the last year was evaluated, adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors.

RESULTS

Wanting to handle the problem on one's own, thinking that treatment would not work, and being unsure of where to go or who to see were the most frequently reported barriers for Latino immigrants. Previous treatment failure, difficulties in transportation or scheduling, and linguistic barriers were more likely to be reported in Boston; trying to deal with mental health problems on one's own was more commonly reported in Barcelona and Madrid. Two barriers associated with the number of visits were concerns about the cost of services and uncertainty about where to go or who to see.

CONCLUSIONS

After adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors, barriers still differed significantly across sites. Efforts to improve behavioral health services must be tailored to immigrants' context, with attention to changing attitudes of self-reliance and outreach to improve access to and retention in care.

Latino Family Participation in Youth Mental Health Services: Treatment Retention, Engagement, and Response

Although researchers have identified a multitude of factors that contribute to family participation in mental health services, few studies have examined them specifically for Latino youth and their families in the U.S., a population that continues to experience significant disparities related to the availability, accessibility, and quality of mental health services. Latino youth and their families are at greater risk of dropping out of treatment prematurely and demonstrating poor treatment engagement, both of which have subsequent negative effects on treatment response outcomes. In order to help to guide efforts to improve the accessibility and quality of mental health services for Latino youth and their families, the current paper integrates modern conceptualization of family participation in youth mental health services and provides a summary of contextual factors within an ecological framework (Bronfenbrenner in The ecology of human development: experiments by nature and design, Harvard University Press, Cambridge, 1979). The current review aims to integrate empirical research on the impact of various contextual factors across multiple levels (i.e., culture, community, mental health system, family, parent/caregiver, and child/adolescent) on Latino family participation in youth mental health services, including treatment retention, engagement, and response. Clinical implications will be discussed, and an integrated, conceptual model will be presented. Not only does this model help to demonstrate the way in which existing literature is conceptually linked, but it also helps to highlight factors and underlying processes that health care providers, administrators, and policy makers must consider in working to improve mental health services for Latino youth and their families living in the U.S.

Use of a Smartphone Recovery Tool for Latinos with Co-Occurring Alcohol and Other Drug Disorders and Mental Disorders

OBJECTIVE

Addressing alcohol and other drug disorders and other mental disorders among adult Hispanics/Latinos is of critical concern, as they are one of the fastest-growing ethnic groups with a disproportionate rate of disease, mental disorders, and poverty. Although improvement in outcomes is associated with sustained participation in ongoing treatment for co-occurring alcohol and other drug disorders/mental disorders, continuing care is rare for these chronic conditions, especially for Latinos with more limited access to culturally and linguistically competent services.

METHODS

The evidence-based smartphone recovery application Addiction-Comprehensive Health Enhancement Support System (A-CHESS) was translated and adapted for Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders, thus developing CASA-CHESS to address a high level of need for services, high rates of relapse, and lack of existing culturally competent services for Latinos.

RESULTS

Of the 79 Latino clients who completed residential treatment and received a smartphone equipped with CASA-CHESS, 26.6% discontinued using CASA-CHESS and 73.4% remained active for four or more months. CASA-CHESS usage was sustained over the four months across all three tenets of self-determination theory (competence, relatedness, and autonomy), with the most commonly utilized services being relevant to relatedness (e.g., messaging, discussion boards). CASA-CHESS clients demonstrated a similar pattern of usage to A-CHESS clients.

CONCLUSIONS

Findings illustrate that Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders will use a smartphone application to assist with their recovery, continuing their access to resources, case management, and quality information after leaving residential treatment. Consistent with previous findings, our results also emphasize the importance of social support during the four months post-discharge. Such evidence-based, theory-driven digital interventions may extend access to culturally and linguistically competent services.