The impact of familism on physical and mental health among Hispanics in the United States

The rapidly expanding number of Hispanics living in USA has increased the need for their inclusion in research on physical and mental health. Current studies that have explored health outcomes among Hispanics have often noted an 'epidemiological paradox', in which there is a discrepancy between their minority status and positive health outcomes when compared with other racial/ethnic groups. Certain socio-cultural variables, in particular the value placed on family, have been largely implicated in these findings. This review will provide a summary of the literature exploring familism within the structure of the Hispanic family and its potential impact on health. We will focus on research exploring the plausible impact that family and familism values may have on the physical health (particularly within the HIV, diabetes, and breast cancer literature) and also on health behaviours of Hispanics, as well as its effect on mental health (particularly related to acculturative stress and caregiver stress). Throughout the review, we highlight some of the potential mechanisms by which familism may impact on the health status of Hispanics. We conclude the review by noting some of the clinical and ethical implications of this research, and by offering suggestions for future work in this area.

Family caregivers' monitoring of medication usage: a qualitative study of Mexican-origin families with serious mental illness

Despite the high level of involvement of many family caregivers of adults with serious mental illness such as schizophrenia, little is known about their experiences with and beliefs about monitoring the psychiatric medication usage of their relatives. We used consensual qualitative research methods to analyze narratives on this topic by 12 Mexican-descent caregivers (160 pages of transcripts). The caregivers predominantly represented parent (mother) caregivers with levels of psychological distress and burden that were similar to those of larger samples of Mexican-descent caregivers. They represented equally high and low Expressed Emotion. We found that (a) caregivers' high knowledge (awareness) of medication usage was either tied to a hands-on monitoring approach or inferred by either the absence or the presence of their relatives' symptoms, (b) caregivers struggled with reconciling the symptom stabilization benefits of medication with the medications' side effects and limitations, and (c) most caregivers received little to no assistance from other available family members. Theory development and possible interventions involving family-assisted support of psychiatric medication usage should assess and possibly address caregivers' struggles with medications' side effects and low levels of support from available family.

Family support predicts psychiatric medication usage among Mexican American individuals with schizophrenia

BACKGROUND

Support provided by family caregivers to persons with schizophrenia is a viable intervention focus to improve psychiatric medication usage. However, little is known about the relation between medication usage and family support as well as other key caregiving factors.

METHOD

Family support and Expressed Emotion (EE) dimensions were tested as predictors of medication usage during a 9-month period following psychiatric hospital discharge in a sample of 30 individuals of Mexican descent with schizophrenia.

RESULTS

Family instrumental support predicted higher medication usage (Odds Ratio = 4.8) in multivariate analyses that statistically adjusted for the impact of emotional support, family EE, and psychiatric status (e.g., positive symptoms) on medication usage.

CONCLUSIONS

Findings suggest that efforts to improve medication usage among Mexican American individuals with schizophrenia should take into account social supportive factors such as instrumental or directive, hands-on assistance from family caregivers.

Effects of ethnicity on psychotropic medications adherence

We compared psychotropic medication adherence rates in monolingual-Hispanics (mostly Puerto Ricans), bilingual-Hispanics, and African-Americans as compared with Caucasians in 122 subjects recruited from a community mental health center (CMHC). After controlling for possible confounding factors monolingual-Hispanics and African-Americans had lower medication adherence rates (77% and 68%, respectively) than Caucasians (90%). Older age was a significant predictor of higher adherence among monolingual-Hispanics. Depressive symptoms were associated with lower adherence and more years of past treatment with higher adherence among Caucasians. Further studies are needed to better understand and improve adherence among Hispanics and African-Americans.

Problems with managed mental health care for multicultural populations

Managed mental health care has developed a system of care-giving that does not recognize that acceptable and effective services must acknowledge individual differences and cultural or racial identities. This approach is unacceptable in an era when a psychology of differences is necessary to provide services for nearly one-third of the population. This paper suggests that the adequacy of contemporary psychoparmacological and psychological interventions for multicultural populations is either unknown or unsatisfactory. Historically, interventions in the United States were designed primarily for Euro-Americans and thus were culture-specific in derivation. Managed care has reduced the availability and quality of these interventions for all patients and further limited the range of possible options. Culturally competent mental health services are described and related to quality of care. A societal agenda for implementing cultural competence is suggested.