Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders

Department of Psychiatry, Columbia University, New York, New York, United States
Psychiatric Services (Impact Factor: 2.41). 04/2007; 58(3):385-94. DOI: 10.1176/
Source: PubMed


This article reports on the outcome of an expert consensus meeting in August 2005 sponsored by the National Institute of Mental Health, which assembled 15 senior researchers with a background in treatment and services research with the Hispanic population. The purpose of the workshop was to identify research issues most pertinent for improving quality and effectiveness of treatment for Hispanics experiencing persistent mental disorders, defined as psychiatric syndromes that are of sufficient severity and duration to cause long-term impairment in social and occupational functioning and significant disability. The spectrum of ideas and recommendations advanced at the one-day meeting was wide and overlapping; therefore, the rich body of material was subsequently organized into five topics: diagnosis, quality of care and culturally appropriate services, psychosocial intervention development, psychopharmacologic interventions, and access to care. Although the authors recognize that the review was broad and the agenda presented is ambitious and in many instances generalizes to priority areas in overall mental health services and treatment research, the recommendations are intended to stimulate research for addressing the unique problems and research deficits that affect Hispanics with persistent mental disorders.

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    • "Although MDD is generally highly treatable, many barriers preclude Latinos with LEP from accessing quality mental health care [12,13]. In general, less than 5% of Latino immigrants afflicted with psychological disorders seek mental health services from specialized practitioners [14] due to a combination of linguistic and economic barriers, cultural stigma, and the lack of empirically supported treatments for this population [13-15]. Moreover, this group’s rates of treatment attrition are significantly higher than for non-Latino White-Americans [16,17]. "
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    ABSTRACT: Background Major depressive disorder is highly prevalent among Latinos with limited English language proficiency in the United States. Although major depressive disorder is highly treatable, barriers to depression treatment have historically prevented Latinos with limited English language proficiency from accessing effective interventions. The project seeks to evaluate the efficacy of behavioral activation treatment for depression, an empirically supported treatment for depression, as an intervention that may address some of the disparities surrounding the receipt of efficacious mental health care for this population. Methods/design Following a pilot study of behavioral activation treatment for depression with 10 participants which yielded very promising results, the current study is a randomized control trial testing behavioral activation treatment for depression versus a supportive counseling treatment for depression. We are in the process of recruiting 60 Latinos with limited English language proficiency meeting criteria for major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th and 5th Edition for participation in a single-center efficacy trial. Participants are randomized to receive 10 sessions of behavioral activation treatment for depression (n = 30) or 10 sessions of supportive counseling (n = 30). Assessments occur prior to each session and at 1 month after completing treatment. Intervention targets include depressive symptomatology and the proposed mechanisms of behavioral activation treatment for depression: activity level and environmental reward. We will also examine other factors related to treatment outcome such as treatment adherence, treatment satisfaction, and therapeutic alliance. Discussion This randomized controlled trial will allow us to determine the efficacy of behavioral activation treatment for depression in a fast-growing, yet highly underserved population in US mental health services. The study is also among the first to examine the effect of the proposed mechanisms of change of behavioral activation treatment for depression (that is, activity level and environmental reward) on depression over time. To our knowledge, this is the first randomized controlled trial to compare an empirical-supported treatment to a control supportive counseling condition in a sample of depressed, Spanish-speaking Latinos in the United States. Trial registration Clinical Trials Register: NCT01958840; registered 8 October 2013.
    Trials 06/2014; 15(1):231. DOI:10.1186/1745-6215-15-231 · 1.73 Impact Factor
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    • "Research has indicated that incorporating cultural components into existing treatment can be beneficial for ethnic minority and underserved populations (Shea & Leong, 2012; Vega et al., 2007). Resnicow, Soler, Braithwaite, Ahluwalia, and Butler (2000) suggested that cultural sensitivity and adaptation can occur on two levels. "
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    ABSTRACT: Data on the compatibility of evidence-based treatment in ethnic minority groups are limited. This study utilized focus group interviews to elicit Mexican American women's (N = 12) feedback on a cognitive behavior therapy guided self-help program for binge eating disorders. Findings revealed 6 themes to be considered during the cultural adaptation process and highlighted the importance of balancing the fidelity and cultural relevance of evidence-based treatment when disseminating it across diverse racial/ethnic groups.
    Journal of counseling and development: JCD 07/2012; 90(3):308-318. DOI:10.1002/j.1556-6676.2012.00039.x · 0.62 Impact Factor
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    • "In addition, low-income levels may also pose a barrier to treatment for Latinos, as Latinos are disproportionately financially disadvantaged, and, thus, less able to access specialty care compared to Caucasians (Alegria et al., 2002). As only 1% of licensed US psychologists are Hispanic, language continues to be another barrier to treatment, illustrating an urgent need for more Hispanic and Spanish-speaking professionals (Vega et al., 2007). "
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    ABSTRACT: Previous research has documented that ethnic minorities, particularly Latinos, obtain fewer mental health services than Caucasians (Kearney, Draper, & Baron 2005; Sue, Fujino, Hu, Takeuchi, & Zane, 1991). Conceivably, this may be due to a wide array of cultural issues (e.g., negative stigma attached to mental health, and language, socio-economic, and acculturation barriers), symptom disparities across Caucasian and Latino groups, or lack of effective outreach methods by clinicians and researchers. However, research is limited. As a result, Latinos may be insufficiently represented in clinical studies for OCD, making it unclear whether evidence-based treatments demonstrate the same efficacy and effectiveness for Latinos as has been demonstrated for Caucasians. The current study takes an in-depth analysis of 98 efficacy and effectiveness studies for OCD from across the Western hemisphere and reports the rates of Latino inclusion from each sample. Ninety clinical studies in the US and Canada, as well as eight clinical studies in Mexico and Central America were reviewed. Findings showed that only 11 (24%) US and Canadian studies included Latino participants, illustrating an overwhelming underrepresentation of Latinos in clinical studies for OCD. Further explanation of the results and their implications are discussed, along with suggestions for effectively improving access to mental health research and appropriate treatments.
    Journal of Obsessive-Compulsive and Related Disorders 04/2012; 1(4):85-97. DOI:10.1016/j.jocrd.2011.12.001 · 1.18 Impact Factor
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