Toward a cultural adaptation of pharmacotherapy: Latino views of depression and antidepressant therapy

Cultural pathways to psychosis care: Patient and caregiver narratives from Puebla, Mexico

The current study used the McGill Illness Narrative Interview (MINI) to explore patients' (n = 6) and caregivers' (n = 3) narratives about how they identified and sought care for psychosis. Participants were recruited from an outpatient clinic at the Hospital Psiquiátrico Dr. Rafael Serrano, a public psychiatric hospital in Puebla, Mexico. All participants consented to complete semi-structured interviews in Spanish. Thematic analyses were used to inductively identify common themes in participants' narratives. The results indicated that during the initial symptom onset, most participants noticed the presence of hallucinations but did not seek help for this hallmark symptom. Participants described seeking care only when they or their ill relative exhibited escalating aggressive behaviors or physical symptoms that were interpreted as common medical problems. As participants became connected to specialty mental health services, they began to develop a conceptualization of psychosis as a disorder of aggression. For some participants, this conceptualization of psychosis as an illness of aggression contributed to their ambivalence about the diagnosis. These results can be understood using a cultural scripts framework, which suggests that cultural norms are influenced by collective understandings of normalcy and valorization of behaviors. Implications for community campaigns are discussed.

The lived experience of depression: a bottom-up review co-written by experts by experience and academics

We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material was enriched by phenomenologically informed perspectives and shared with all collaborators in a cloud-based system. The subjective world of depression was characterized by an altered experience of emotions and body (feeling overwhelmed by negative emotions, unable to experience positive emotions, stuck in a heavy aching body drained of energy, detached from the mind, the body and the world); an altered experience of the self (losing sense of purpose and existential hope, mismatch between the past and the depressed self, feeling painfully incarcerated, losing control over one's thoughts, losing the capacity to act on the world; feeling numb, empty, non-existent, dead, and dreaming of death as a possible escape route); and an altered experience of time (experiencing an alteration of vital biorhythms, an overwhelming past, a stagnation of the present, and the impossibility of the future). The experience of depression in the social and cultural context was characterized by altered interpersonal experiences (struggling with communication, feeling loneliness and estrangement, perceiving stigma and stereotypes), and varied across different cultures, ethnic or racial minorities, and genders. The subjective perception of recovery varied (feeling contrasting attitudes towards recovery, recognizing recovery as a journey, recognizing one's vulnerability and the need for professional help), as did the experience of receiving pharmacotherapy, psychotherapy, and social as well as physical health interventions. These findings can inform clinical practice, research and education. This journey in the lived experience of depression can also help us to understand the nature of our own emotions and feelings, what is to believe in something, what is to hope, and what is to be a living human being.

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.

Experience of antidepressant use and discontinuation: A qualitative synthesis of the evidence

WHAT IS KNOWN ON THE SUBJECT?: Rates of antidepressant prescribing have been increasing. Antidepressants are not effective for many people. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Participants described how in order to receive help they had to engage with a medical pathway in which their experiences were constructed as arising from a biochemical deficit. Antidepressant prescribing was identified as being the only option available and was associated with stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses have a role to play in providing treatment options for those experiencing depression. Mental health nurses need to provide evidence-based information about antidepressants support those experiencing depression to make informed choices. ABSTRACT: Introduction There are increased prescribing rates of antidepressants associated with an increase in the diagnosis of depression. However, antidepressants are not effective for many people. There is a gap in the existing literature for a synthesis of the experiences of those with lived experience of antidepressant use to better understand their use and impact given their ubiquitous use in mental health, primary care and other secondary and tertiary care settings. Mental health nurses play direct or indirect roles in both advocating for antidepressant use and monitoring adherence. Aims To identify how people prescribed antidepressants describe their experiences of the medication including its discontinuation? Method A meta-synthesis of qualitative studies examining patients' experiences of antidepressant medication. Ovid MEDLINE, EMBASE, PsychINFO and Cochrane Library databases were searched in May 2021. One reviewer screened titles and abstracts. Two reviewers independently reviewed the retrieved papers for eligibility and data extraction. The data synthesis was conducted using thematic analysis. Two reviewers independently conducted quality appraisals. Results Twenty-seven studies with a total of 2937 participants were identified for inclusion in this review. Four themes were identified across the studies: the only option available; stigma associated with 'biochemical deficit' not myself and the vicious cycle. Implications for practice Those seeking treatment for depression need to be provided with treatment options and evidence-based information about anti-depressants to provide them with the opportunity to make informed choices.

Antidepressant Adherence Among Hispanics: Patients in an Integrated Health Care Model

Purpose

We report on antidepressant (AD) adherence among Hispanics seeking mental health services in a community primary care clinic in Texas as an ancillary outcome from a National Institutes of Health-funded study that collected data on Hispanic AD adherence over a period of two years (February 2016-February 2018). Adherence to AD medications was measured throughout the year-long trial and compared across various demographic characteristics. Since Hispanic individuals often experience stigma and cultural barriers related to AD treatment, we sought to understand what factors may increase the likelihood of non-adherence in this population.

Patients and Methods

This study focused on 69 patients who were prescribed AD medications while receiving treatment through an integrated health care model. Adherence was measured with the Patient Adherence Questionnaire, a validated 2-item questionnaire that asks patients about their medication use (missed medications or dosage changes) over the past week. We looked at patient adherence at two key time points (4-weeks and 13-weeks) and utilized logistic regression to identify factors that may increase or decrease the likelihood of adherence in Hispanic patients at a community primary care clinic.

Results

Non-adherence to AD medication was 49.3% at 4-weeks and 57% at 13-weeks post-treatment initiation. Logistic regression analyses revealed that age was the only significant predictor of AD non-adherence. As age increased, the likelihood of adherence increased by 12.2% at 13-weeks post-treatment initiation and by 11.1% at 4-weeks post-treatment initiation.

Conclusion

The likelihood of Hispanic patients to adhere to AD therapy increased with the age of the patient. Since primary care is the most likely place to be prescribed an AD for Hispanic patients, further research to better understand adherence is essential. Integrated health care interventions designed to help identify, reduce, or eliminate barriers to adherence and improve cultural understanding may help address issues of non-adherence in primary care settings.

Depression education fotonovela for engagement of Hispanic patients in treatment: a randomized clinical trial

BACKGROUND

We report the primary outcomes from a randomized clinical trial testing a novel culturally-adapted patient education intervention to increase engagement of Hispanic patients in depression treatment. The Depression Education Fotonovela (DEF), Secret Feelings, incorporates popular images, cultural norms, and vivid pictures embedded within a soap opera narrative to increase depression knowledge and dispel myths about treatment. We then assessed engagement in a integrated care treatment model in response to the education intervention and subsequent changes in depression symptoms in a large community-based clinic whose patient population is majority Hispanic.

METHOD

The sample included 150 adult Hispanic patients with a confirmed diagnosis of depression who were randomly assigned to either: [1] integrated care + fotonovela; or [2] integrated care + standard education. Differences between treatment groups were examined as were changes in depression, anxiety, depression knowledge, and stigma scores over time and engagement in treatment.

RESULTS

Results indicated that while depression scores significantly decreased over time for participants (F [2.811, 416.054] = 197.69, p < .001, η² = .572), no differences between the two education groups were found (F [1, 148] = 0.70, p = .403, η² = .005). At 12-month follow-up, 101 patients (80.8%) reported a 50% of greater reduction in depression scores from baseline.

CONCLUSIONS

We found little difference between the two education groups, suggesting that either may helpful for engaging Hispanic patients into care. Better tailoring of patient education, with the fotonovela or similarly adapted tools, will require more directly addressing the stigma associated with antidepressant medication.

TRIAL REGISTRATION

The study was registered with www.clinicaltrials.gov : NCT02702596 , on 03/20/2016. Retrospectively registered.

Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions

Stigma is integral to understanding mental health disparities among racial and ethnic minority groups in the United States. We conducted a systematic review to identify empirical studies on cultural aspects of mental illness stigma (public, structural, affiliative, self) among three racial and ethnic minority groups (Asian Americans, Black Americans, Latinx Americans) from 1990 to 2019, yielding 97 articles. In comparison studies (N = 25), racial and ethnic minority groups often expressed greater public and/or self-stigma than White American groups. In within-group studies (N = 65; Asian American, n = 21; Black American, n = 18; Latinx American; n = 26), which were primarily qualitative (73%), four major cultural themes emerged: 1) service barriers including access and quality (structural stigma); 2) family experiences including concealment for family's sake, fear of being a burden, and stigma extending to family (affiliative stigma); 3) lack of knowledge about mental illness and specific cultural beliefs (public stigma); and 4) negative emotional responses and coping (self-stigma). These findings confirmed stigma has both similar and unique cultural aspects across groups. Despite this, few studies tested stigma reduction interventions (N = 7). These cultural insights can inform contextual change at the health systems and community levels to reduce stigma, and empowerment at the interpersonal and individual levels to resist stigma.

Rural Perspectives Challenging Pharmacotherapy

Depression pharmacotherapy is the predominant treatment available in the rural United States, yet little is known about the broader contextual factors that rural consumers and providers identify as shaping pharmacotherapy use. Thematic analysis was employed to identify emergent themes from interviews and focus groups about pharmacotherapy adherence, effectiveness, and treatment decisions conducted with Appalachian Kentucky women with depression (N = 37) and diverse healthcare providers who care for this population (N = 21). Pharmacotherapy was seen as inadequate to treat depression in the context of extensive socioeconomic burdens and other health comorbidities. Participants felt that providers over-prescribed pharmacotherapy, a pattern attributed to deficiencies in the rural healthcare system overall. Efforts to improve treatment engagement must acknowledge the significant doubts that rural consumers hold about the potential of pharmacotherapy and should consider the utility of extending broader strategies to address the social conditions shaping vulnerability to depression.

Depression Screening in a Primary Care Setting: Examining Perceptions and Experiences of English- and Spanish-Speaking Patients

Depression is highly prevalent in primary care settings, but screening rates remain sub-optimal and patients' screening perspectives are poorly understood. This study examined depression screening experiences and beliefs among primary care patients (N = 100, M_age = 51.9, SD = 17.03, 49% Spanish speakers). Participants completed a survey regarding screening experiences, stigma concerns, and perceptions of screening-related importance, barriers, and concerns. While 83% of participants were screened for depression, only 44.6% had screening results explained. Levels of depression treatment-related stigma concerns were low, with English speakers endorsing higher levels of such concerns. Importance and barriers of screening scores were significantly, negatively correlated r_s = - .52, p < .001. Patients' self-identification as 'long-standing' to the clinic was associated with greater endorsed screening concerns t(98) =  - 2.08, p < .05. Results suggest that improved understanding of patients' screening-related perceptions and experiences is critical to ensuring delivery of quality care. Communication practices around screening should be studied, reviewed, and revised to ensure the success of screening efforts.

Prevalence, Barriers, and Interventions Related to Medication Adherence Among Patients With Major Depressive Disorder: A Scoping Review

The current scoping review aimed to identify the prevalence, contributing factors, methods of measurement, and interventions related to medication adherence among patients with major depressive disorder (MDD). A total of 37 articles met inclusion criteria. The prevalence of medication adherence among patients with MDD ranged from 10.6% to 85.4%. Approximately 67% of studies used self-report data collection. Illness-related factors (e.g., onset of illness, duration of illness, symptoms, illness severity), medication-related factors (e.g., adverse reactions, duration of treatment, cost of treatment), and patient-related factors (e.g., beliefs, attitudes, knowledge, self-stigma) were the most reported factors associated with medication adherence. In addition, multi-faceted interventions were recommended over single-element interventions to enhance medication adherence. There is a need to integrate appropriate and effective assessment measures of medication adherence that lead to better health care outcomes, lower risk factors, and improved interventions related to medication adherence. [Journal of Psychosocial Nursing and Mental Health Services, 59(1), 39-51.].

Defining and assessing key behavioral indicators of the Shifting Cultural Lenses model of cultural competence

Models of cultural competence highlight the importance of the sociocultural world that is inhabited by patients, and the question of how best to integrate sociocultural factors into clinical assessment and intervention. However, one significant limitation of such approaches is that they leave unclear what type of in-session therapist behaviors actually reflect cultural competence. We draw on the Shifting Cultural Lenses model to operationalize culturally competent in-session behaviors. We argue that a key component of cultural competence is the collaborative relationship between therapists and patients, in which therapists shift between their own cultural lenses and those of their clients, as they co-construct shared narratives together. Accordingly, we propose that culturally competent therapist behaviors include accessing the client's views, explicitly presenting their own views as mental health care professionals, and working towards a shared understanding. We further specify the latter set of behaviors as including the practitioner's integration of the patient's view, their encouragement of the patient to consider their professional view, and the negotiation of a shared view. We developed a coding system to identify these therapist behaviors and examined the reliability of raters across 11 couple and 4 individual therapy sessions. We assessed whether the behavioral codes varied in expected ways over the first 3 sessions of 2 therapists' couple therapy as well. Operationalizing the behavioral indicators of the Shifting Cultural Lenses model opens the door to the integration of both process- and content-oriented approaches to cultural competence.

Intersection of Cultural and Religious Beliefs About Mental Health: Latinos in the Faith-Based Setting

INTRODUCTION

Hispanics/Latinos utilize mental health care at a rate that is about half that of non-Hispanic Whites. Stigma and cultural and religious values play a significant role in mental health care utilization disparities. The purpose of this study was to explore beliefs about mental illness among Latino faith-based communities.

METHODS

A qualitative approach was used to explore perceptions of mental illness that were elicited during "El Buen Consejo," a mental health literacy intervention delivered within three faith-based settings.

RESULTS

Participants were socialized to believe that persons with mental illness were dangerous, out of control, and suffering from an incurable illness that resulted in rejection and ostracism. Most families would deny the existence of depression and mental illness, unless symptoms greatly interfered with daily functioning or were life-threatening. Religious coping such as prayer, and faith in God, were believed to be protective factors. Causal attributions for depression were both biomedical and religious, such as lack of faith, not praying, demons, and sinful behaviors of parents.

CONCLUSION

Latinos rely upon churches as a major social, educational, and spiritual resource. The cultural values among Latinos can be a source of strength but also contribute to stigma. The faith-based community is an important target for mental health literacy and antistigma interventions.

Association of Audiometric Age-Related Hearing Loss With Depressive Symptoms Among Hispanic Individuals

Importance

Age-related hearing loss is highly prevalent and has recently been associated with numerous morbid conditions of aging. Late-life depression is also prevalent and can be resistant to available treatments. Preliminary studies examining the association between hearing loss and late-life depression have been limited by subjective hearing measures, small sample sizes, and primarily white populations.

Objective

To assess whether a cross-sectional association exists between objective audiometric hearing loss and depressive symptoms in older Hispanic adults.

Design, Setting, and Participants

This cross-sectional study uses 2008-2011 Hispanic Community Health Study/Study of Latinos data collected in Miami, Florida, San Diego, California, Chicago, Illinois, or the Bronx, New York, from 5328 Hispanic adults 50 years or older who had exposure, outcome, and covariate data. Data analyses were conducted from March 2018 to September 2018.

Exposure

Audiometric hearing loss (pure-tone average).

Main Outcomes and Measures

Center for Epidemiologic Studies Depression Scale, 10-item version (CESD-10) score of 10 or higher, which indicates clinically significant depressive symptoms.

Results

The median age (interquartile range) of the 5328 participants was 58 (53-63) years, and 3283 participants (61.6%) were female. The mean (SD) CESD-10 score was 7.7 (6.4). Of the 5328 included participants, 1751 (32.9%) had clinically significant depressive symptoms. The odds of having these symptoms increased 1.44 (95% CI, 1.27-1.63) times for every 20 dB of hearing loss, adjusting for hearing aid use, age, sex, educational level, study site, geographic background, cardiovascular disease, and antidepressant use. Compared with those for individuals with normal hearing (0 dB), the odds of having clinically significant depressive symptoms was 1.81 (95% CI, 1.48-2.22) times as high in individuals with mild hearing loss (median threshold, 32.5 dB), 2.38 (95% CI, 1.77-3.20) times as high in individuals with moderate hearing loss (median threshold, 47.5 dB), and 4.30 (95% CI, 2.61-7.09) times as high in individuals with severe hearing loss (median threshold, 80 dB).

Conclusions and Relevance

Objective hearing loss appears to be associated with clinically significant depressive symptoms in older Hispanic people, with greater hearing loss seemingly associated with greater odds of having depressive symptoms. Given the high prevalence of untreated hearing loss in older adults, hearing loss may be a potentially modifiable risk factor for late-life depression.

Comprehension and acceptance of the Meaning-Centered Psychotherapy with a Puerto Rican patient diagnosed with advanced cancer: A case study

BACKGROUND

Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention that aims to improve existential and spiritual well-being in patients with advanced cancer. To validate it, several efficacy studies with predominantly non-Hispanic white patients have been done. Puerto Ricans residing on the island are a largely overlooked segment of the US Latinx population. They have a strong national identity and are embedded in a collectivist culture which shares the Spanish language, cultural traditions, and an emphasis on familism, a cultural factor that values the role of the family in ensuring the well-being of its members.

OBJECTIVE

The purpose of this study is to present a case study focused on a Puerto Rican advanced cancer patient who underwent MCP to assess the comprehension and acceptance of the MCP intervention.

METHOD

We used a mixed-methods study design that included the taking of ethnographic notes, and pre- and post-test assessments of the scores the patient received on all the measures (using validated scales). The ethnographic notes were analyzed to determine the participant's comprehension and acceptance of the MCP intervention. Content analysis was performed on the ethnographic notes by three independent coders using a deductive coding approach. Pre- and post-interview assessments were conducted to explore changes in distress, spiritual well-being, and self-perceived quality of life.

RESULTS

A Latino patient with stage III cancer, low income, and low literacy skills showed low comprehension of the concepts of meaning, the finite, legacy, and moderate comprehension and acceptance of the concepts of the search for hope, purpose in life, connecting with life, courage, life's limitations, and sources of meaning. However, the patient showed high comprehension of death and dying (i.e., meaningful death). The patient showed low acceptance of death and dying concepts and high acceptance of the integration of family members into the therapy.

SIGNIFICANCE OF RESULTS

Additional studies are needed to address cultural themes and to improve the comprehensibility and acceptance of the manual's content and the central MCP concepts. The findings suggest that MCP has the potential of being a feasible form of psychotherapy for Latinx patients suffering from distress, low spiritual well-being, and low self-perceived QOL.

Impact on an integrated psychiatric pharmacy service in a primary care clinic

Introduction

Traditionally, clinical pharmacists have been employed in the primary care setting to help manage chronic disease states, such as diabetes and hypertension. Although the benefits of pharmacists managing chronic conditions have been extensively published, published data for clinical pharmacist mental health services in primary care is limited to Veterans Affairs populations. This article describes a practice model in which pharmacists are providing psychiatric medication management and consultation in a federally qualified health center.

Methods

A period of 1 year from the psychiatric pharmacy service was analyzed from April 1, 2017, to March 31, 2018. Reports were generated that included information about psychiatric pharmacy consults, 1-on-1 psychiatric pharmacy visits, and psychotropic medication prescribing/dispensing trends. Each consult was further reviewed for additional details, including patient characteristics, medications prescribed, psychiatric diagnoses involved, and actions taken.

Results

A review of this pharmacy service showed significant pharmacist involvement in psychiatric medication consults and 1-on-1 visits. Common disease states consulted on were depressive disorders, anxiety disorders, and neurologic disorders, which reflects psychiatric disease states commonly seen in primary care practice. Provider satisfaction survey results showed that the service was valued and that providers felt their comfort in prescribing psychotropic medications improved due to the service.

Discussion

The service described here exemplifies the potential for pharmacists in the ambulatory care setting to expand beyond the traditional chronic disease state management. It also speaks to a potential role for psychiatric pharmacists in the primary care setting.

Depression screening and education: an examination of mental health literacy and stigma in a sample of Hispanic women

Background

Mental health literacy consists of knowledge of a mental disorder and of the associated stigma. Barriers to depression treatment among Hispanic populations include persistent stigma which is primarily perpetuated by inadequate disease literacy and cultural factors. U.S.-born Hispanics are more likely to have depression compared to Hispanics born in Latin America and are less likely to follow a treatment plan compared to non-Hispanic whites. Hispanic women are more likely to access treatment through a primary care provider, making it an ideal setting for early mental health interventions.

Methods

Baseline data from 319 female Hispanic patients enrolled in Project DESEO: Depression Screening and Education: Options to Reduce Barriers to Treatment, were examined. The study implemented universal screening with a self-report depression screening tool (the 9-item Patient Health Questionnaire (PHQ-9) and took place at one federally qualified health center (FQHC) over a 24-month period. The current analysis examined the relationship between four culturally adapted stigma measures and depression knowledge, and tested whether mental health literacy was comparable across education levels in a sample of Hispanic women diagnosed with depression.

Results

Almost two-thirds of the sample had less than a high school education. Depression knowledge scores were significantly, weakly correlated with each the Stigma Concerns About Mental Health Care (ρ = − .165, p = .003), Latino Scale for Antidepressant Stigma (p = .124, p = .028), and Social Distance scores (p = .150, p = .007). Depression knowledge (F[2, 312] = 11.82, p < .001, partial η² = .071), Social Distance scores (F[2, 312] = 3.34, p = .037, partial η² = .021), and antidepressant medication stigma scores (F[2, 312] = 3.33, p = .037, partial η² = .015) significantly varied by education category. Participants with at least some college education reported significantly greater depression knowledge and less stigma surrounding depression and medication than participants with lower education levels.

Conclusions

Primary care settings are often the gateway to identifying undiagnosed mental health disorders, particularly for Hispanic women with comorbid physical health conditions. This study is unique in that it aims to examine the specific role of patient education level as a predictor of mental health literacy. For Hispanic women, understanding the mental health literacy of patients in a healthcare setting may improve quality of care through early detection of symptoms, culturally effective education and subsequent engagement in treatment.

Trial registration

The study was registered with https://clinicaltrials.gov/: NCT02491034 July 2, 2015.

Knowledge and Preferences Regarding Antidepressant Medication Among Depressed Latino Patients in Primary Care

US Latinos are less likely to utilize mental health services than non-Latino whites and to take antidepressant medications. This mixed-method study followed a subset (N = 28) of a research sample of depressed Latino immigrant primary care patients, who took depression medication, with a telephone interview to study their knowledge about and experiences with antidepressant medications. Most (82%) reported taking medication for 2 months or more, and 75% reported feeling better, whereas more than half reported side effects. Most (61%) agreed that antidepressants are generally safe and helpful in treating depression (68%); however, many believed they could be addictive (39%). Fifty percent of patients who discontinued their medication did not inform their providers. Twelve of the 28 patients also participated in focus groups about interactions with providers and made suggestions for conveying information about antidepressants. Patients suggested videos as a format to disseminate medication information because they do not require written comprehension. Other patient recommendations are presented.

Integrating Professional and Indigenous Therapies: An Urban American Indian Narrative Clinical Case Study

We present a narrative case study of an urban American Indian male college student who integrated Indigenous and professional therapies during an acute period of stress, loss, and depression. The first published case of an American Indian in an urban context, this article expands on previous clinical cases by focusing on the perspective of the client relative to his own conceptions of help-seeking behaviors. Based on qualitative analysis of five audio-recorded interviews, this case utilizes an innovative methodology to portray four approaches to healing (medication, counseling, bonding, and spirituality), which contribute to holistic well-being. Implications for counseling psychologists include being aware of how some American Indian clients may (a) view professional treatment dynamics through a Native cultural lens (e.g., seeing ideal communication as a "rhythm"); (b) utilize an expanded range of therapeutic agents;

A Pilot Study of a Novel Method of Measuring Stigma about Depression Developed for Latinos in the Faith-Based Setting

In order to understand the effects of interventions designed to reduce stigma about mental illness, we need valid measures. However, the validity of commonly used measures is compromised by social desirability bias. The purpose of this pilot study was to test an anonymous method of measuring stigma in the community setting. The method of data collection, Preguntas con Cartas (Questions with Cards) used numbered playing cards to conduct anonymous group polling about stigmatizing beliefs during a mental health literacy intervention. An analysis of the difference between Preguntas con Cartas stigma votes and corresponding face-to-face individual survey results for the same seven stigma questions indicated that there was a statistically significant differences in the distributions between the two methods of data collection (χ(2) = 8.27, p = 0.016). This exploratory study has shown the potential effectiveness of Preguntas con Cartas as a novel method of measuring stigma in the community-based setting.

The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators

Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders. We conducted separate focus groups with patients, clinicians, and administrators from the psychiatry department at one community hospital and compared responses to hospital policies. Stakeholders defined cultural competence through group-based or person-centered traits despite policies recommended person-centered approaches. Administrators and clinicians named clinician techniques for psycho-education whereas patients named these techniques for enlistment in treatment planning as equals. All groups named patient cultural views and institutional challenges as barriers to care, but only patients and administrators additionally named clinician biases as possible barriers. We discuss these discrepant perceptions and possible solutions to improve research, practice, and policy on cultural competence in mental health.

Depression, Help-Seeking and Self-Recognition of Depression among Dominican, Ecuadorian and Colombian Immigrant Primary Care Patients in the Northeastern United States

Latinos, the largest minority group in the United States, experience mental health disparities, which include decreased access to care, lower quality of care and diminished treatment engagement. The purpose of this cross-sectional study of 177 Latino immigrants in primary care is to identify demographic factors, attitudes and beliefs, such as stigma, perceived stress, and ethnic identity that are associated with depression, help-seeking and self-recognition of depression. Results indicated that 45 participants (25%) had depression by Patient Health Questionnaire (PHQ-9) criteria. Factors most likely to be associated with depression were: poverty; difficulty in functioning; greater somatic symptoms, perceived stress and stigma; number of chronic illnesses; and poor or fair self-rated mental health. Fifty-four people endorsed help-seeking. Factors associated with help-seeking were: female gender, difficulty in functioning, greater somatic symptoms, severity of depression, having someone else tell you that you have an emotional problem, and poor or fair self-rated mental health. Factors most likely to be associated with self-recognition were the same, but also included greater perceived stress. This manuscript contributes to the literature by examining attitudinal factors that may be associated with depression, help-seeking and self-recognition among subethnic groups of Latinos that are underrepresented in research studies.