Latinos' Conceptualization of Depression, Diabetes, and Mental Health-Related Stigma

Caregivers' and Health Care Providers' Cultural Perceptions of and Experiences With Latino Patients With Dementia

Background and Objectives

The prevalence of Alzheimer dementia in the US Latino population in 2060 is projected to increase 7-fold, the highest among any other major ethnic/racial group. One vital question is how clinicians can tailor their care for Latinos. Given this rapidly growing prevalence, we sought to characterize the experiences and perspectives of Latino caregivers by analyzing interview data from both caregivers and experienced providers that specifically work with Latino populations. In this study, we present 6 themes that emerged along with tailored solutions and recommendations to implement in clinical practice to improve patient care and outcomes.

Methods

This qualitative analysis uses coded interview transcripts from 2 studies, one in Southern California and another in Washington State. The combined dataset included interview transcripts with 51 caregivers and 20 providers. A thematic analysis was performed on the coded interview transcripts to identify themes related to tailoring care for Latino populations.

Results

Six themes emerged from the analysis: (1) multiple caregivers involved within a family-oriented Latino household; (2) need for encouragement in advocating for loved ones in the clinician's office; (3) challenges in reaching and communicating with the Latino population; (4) increasing use of technology by patients and caregivers despite some challenges; (5) stigma associated with mental health issues within the Latino culture; and (6) limited understating of dementia leading to a delay in care in the Latino population.

Discussion

Many Latino households have a strong sense of familism, thus care coordination with multiple caregivers is essential to high-quality care. Improved shared decision-making strategies tailored to a population that may be culturally deferential to authoritative figures can aid caregiver understanding and engagement with the provider. These interactions can often be more authentic when communicating with a member of the care team in Spanish. A cultural stigma of mental illness was also identified; clinicians can work toward normalizing discussion of mental illness and its treatment by openly discussing mental health during annual visits. Through these themes, we demonstrate some of the strengths and weaknesses of the current care delivery model within a sociocultural context to improve patient care and outcomes for Latino families caring for individuals living with dementia.

Why Culture and Context Matters: Examining Differences in Mental Health Stigma and Social Distance Between Latino Individuals in the United States and Mexico

This study examines the influence of cultural context on social distance and perceptions of stigma towards mental health conditions among Latino populations in Houston, TX, USA and Mexico City, Mexico. We employed a community-based experimental vignette survey to assess perceptions towards individuals experiencing symptoms of alcohol misuse, depression, and psychosis. Participants (n = 513) from Houston and Mexico City were asked about their willingness to accept community members experiencing mental health symptoms in various social roles, their perceptions of stigma related to these symptoms, anticipated danger, possible positive outcomes, and the community member's ability to change. Findings demonstrate significant differences in stigma perceptions between Latino respondents in the US and in Mexico. Houston participants reported lower public stigma and perceived dangerousness of someone with mental health concerns compared to respondents in Mexico City. Furthermore, the cultural context may influence the association between various dimensions of stigma, with some inverse relationships occurring based on location of data collection. Findings illuminate the complex interplay between cultural context, mental health symptoms, and stigma, and underscores the need for culturally nuanced interventions to reduce mental health stigma and promote service utilization in Latino communities.

Ethnic Determinants of Health and Medication Use for Depression Among US Latinx Adults

BACKGROUND

Medication use for depression among US Latinx adults is low (34%) and commonly associated with systems-related and individual-related cultural factors. Social determinants of health (SDH) include economic, environmental, educational, community, and healthcare systems factors. Ethnic determinants of health (EDH) are SDH factors specific to an ethnic group and described by an ethnic and disparities framework.

OBJECTIVE

To assess relationships between EDH factors and depression medication use among non-Latinx White (NLW) and Latinx adult populations using data from a weighted national sample for hypothesis building.

METHODS

Weighted responses to 2015-2018 National Survey on Drug Use and Health surveys from NLW, Latinx, and Latinx adult respondents from Puerto Rico, Mexico, and other Latinx countries were compared. Bivariate analyses were conducted using 2-way cross tabulation and a Wald chi-square test of association. EDH variables were characterized within the construct domains of systems-related geographic location, education, and economic stability, and individual-related cultural factors.

RESULTS

Prescription medication use for depressive symptoms is 16.6% (P < 0.05) lower among a national sample of Latinx compared with NLW adults with major depressive episode (MDE). Many differences among systems-level EDH variables between Latinx and NLW populations with MDE were also found between populations with depression medication use. Of note, seeing a primary care provider or psychologist or social worker was significantly different among populations with MDE but not for those with depression medication use. Individual-related cultural EDH variables of overall health and serious psychological distress were significantly worse for Latinx than NLW populations with depression medication use. However, stigma, healing beliefs, and religious beliefs were not different between populations with MDE or depression medication use. Differences between certain Latinx populations with depression medication use were found with limited English proficiency and living in poverty. EDH variables for environment-physical characteristics or community and interpersonal levels of analysis were not represented within the NSDUH survey.

CONCLUSION

Seeing a primary care provider or behavioral health specialist, depression severity, and overall health status appear to be important factors related to depression medication use among Latinx adults. Given the limitations of these analyses, multivariate analyses of EDH factors and other Latinx populations are warranted.

"It's Not That We Care Less": Insights into Health Care Utilization for Comorbid Diabetes and Depression among Latinos

Despite robust knowledge regarding the socio-economic and cultural factors affecting Latino* access to healthcare, limited research has explored service utilization in the context of comorbid conditions like diabetes and depression. This qualitative study, embedded in a larger mixed-methods project, aimed to investigate perceptions held by Latinos and their social support systems (i.e., family members) regarding comorbid diabetes and depression and to identify barriers and facilitators to their help-seeking behaviors and treatment engagement. Bilingual and bicultural researchers conducted eight focus groups with 94 participants in a large U.S. metropolitan area and were primarily conducted in Spanish. The participants either had a diagnosis of diabetes and depression or were closely associated with someone who did. This study identified key individual and structural barriers and facilitators affecting healthcare access and treatment for Latinos living with comorbid diagnoses. A thematic analysis revealed structural barriers to healthcare access, including financial burdens and navigating healthcare institutions. Personal barriers included fears, personal responsibility, and negative family dynamics. Facilitators included accessible information, family support, and spirituality. These findings underscore the need to address these multi-level factors and for healthcare institutions and providers to actively involve Hispanic community members in developing services and interventions.

Biopsychosocial Factors of Depression Among Hispanic Women Aged ≥50 Years

The purpose of the current study was to identify biopsychosocial factors associated with depressive symptoms among Hispanic women aged ≥50 years. Cross-sectional data related to 10 biological, psychological, and social factors were analyzed. Center for Epidemiologic Studies Depression Scale scores suggested that 32% of the sample had depressive symptoms. Self-esteem, self-perception of health status, income, and chronic pain had statistically significant associations with depressive symptoms. A logistic regression analysis showed that increasing self-esteem scores were associated with decreases in the likelihood of having depressive symptoms. Findings underscore that depression is associated with biological, psychological, and social factors. Culturally tailored interventions that aim at targeting these factors may have an impact on Hispanic women's depression and overall well-being. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 32-42.].

Mental Health Stigma Among Spanish-Speaking Latinos in Baltimore, Maryland

To assess mental health-related stigma in an emerging Latino immigrant community and explore demographic characteristics associated with stigma. We surveyed 367 Spanish-speaking Latino adults recruited at community-based venues in Baltimore, Maryland. The survey included sociodemographic questions, the Depression Knowledge Measure, Personal Stigma Scale, and the Stigma Concerns about Mental Health Care (SCMHC) assessment. Multiple regression models examining associations between personal stigma and stigma concerns about mental health care, respectively, were constructed using variables that were statistically significant in bivariate analyses. Being male, having less than high school education, reporting high importance of religion, and having lower depression knowledge contributed to higher personal stigma. When controlling for other variables, only depression knowledge contributed unique variance to the prediction of higher SCMHC. Efforts to improve access to and quality of mental health care must be paralleled by ongoing efforts to reduce depression stigma within emergent immigrant Latino communities.

Predictors of Stigma toward Alcohol Misuse in Mexico

Objective: This study explored factors associated with public stigma toward individuals misusing alcohol in Mexico. Methods: A randomized experimental vignette methodology was used to assess multiple domains of substance use-related stigma and their relationship to the gender of the vignette subject and the sociodemographic characteristics of respondents. Results: Although levels of stigma toward women who were misusing alcohol did not differ significantly from stigma toward men misusing alcohol, stigma levels and type of stigma reported varied with the sociodemographic characteristics of respondents. Education level, gender, self-stigma and openness to seeking mental health services were differentially associated with the three stigma domains. Conclusions: Accordingly, targeted community based stigma reduction efforts are needed to decrease stigma toward those misusing alcohol, and to support treatment initiation, ongoing treatment engagement and long term recovery efforts. Suggestions for future research on the relationship between substance use and stigma are offered.

Caregiver Characteristics of Adults with Acute Traumatic Brain Injury in the United States and Latin America

Objectives: To compare characteristics of caregivers of adults with acute traumatic brain injury (TBI) in the U.S. and Latin America (Mexico and Colombia). Design: Secondary data analysis of two cohorts. Cohort 1: English-speaking caregivers of adults with TBI in the U.S. (n = 80). Cohort 2: Spanish-speaking caregivers of adults with TBI in Mexico or Colombia (n = 109). Results: Similarities between the U.S. and Latin American caregiver groups, respectively, were: predominantly women (81.3%, 81.7%, respectively); spouses/domestic partners (45%, 31.2%); and motor vehicle accident (41.5%, 48.6%) followed by fall etiologies (40%, 21.1%). Differences between U.S. and Latin American caregivers were: age (49.5 years, 41.5 years, p < 0.001); employment status ((Χ52 = 59.63, p < 0.001), full-time employment (63.7%, 25.7%), homemaker (2.5%, 31.2%), and retired (17.5%, 1.8%)); violence-related etiology (2.5%, 15.6%); and severity of depressive symptoms (M = 7.9, SD = 5.8; M = 5.8, SD = 5.7; p = 0.014). Conclusions: TBI caregivers in the U.S. were older and employed full-time or retired more often than those in Latin America. Violence-related etiology was nearly five times more common in Latin America, raising concerns for potential implications of post-traumatic stress and family adjustment after injury. Although both groups likely could use mental health support, this was particularly true of the U.S. cohort, maybe due to differential demographics, mechanisms of injury, or family and community support.