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Rural Hispanic Perceptions of Mental Health: A Qualitative Study

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Abstract

Introduction: In 2020, 18.4% of Hispanics experienced mental illness, yet only about a third received treatment compared with nearly half of non-Hispanic Whites. In Montana, where only 11% of the mental health needs are currently met, service utilization is low. The purpose of this study was to determine the perceptions of the Hispanic immigrant population in a rural state on mental health and professional service utilization. Methods: Using a descriptive phenomenological approach, we conducted semi-structured telephone interviews in Spanish. Audio recordings were transcribed, translated to English, and analyzed for themes. Results: We recruited a sample of 14 participants from Mexico, Ecuador, Colombia, and Venezuela ranging in age from 33 to 59. We identified five themes: definitions of mental health, maintaining mental health, familismo/socialization, stigma, and acculturation stress. Discussion: Novel findings point to the need for Spanish-language services focused on reducing stigma around mental illness and incorporating the importance of social connections.

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... Further, a structural vulnerability lens highlights how inequities shaped by legal status and rural location likely reproduced themselves in the pandemic context to exacerbate Latino immigrants' access to mental health services (Cook et al., 2017;Thomeer et al., 2022;Yang et al., 2020). For example, although there was an expansion in the availability of tele-mental health services during the pandemic that could have theoretically helped to address the demand for mental health services, rural Latino populations' disproportionate lack of health insurance due to long-standing legal status exclusions, inconsistent broadband and computer access that have resulted from a history of underinvestment in rural communities, and language barriers and distrust of medical systems may have hindered their ability to benefit from the expansion (Curtis et al., 2022;Harkness et al., 2020;Moyce et al., 2022). ...
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“In this article, the authors provide an overview of the current global and US debates on immigration as a key developmental context for immigrant-origin youth. Relying on a conceptual framework that highlights both risk and protective factors, the authors provide evidence from their longitudinal study that empirically links acculturative stress to key mental health outcomes during adolescence. They conclude with a discussion of clinical implications of their work with an emphasis on what is needed to meet the growing mental health needs of immigrant youth.”
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Religion has been implicated as a powerful contributor to physical and mental well-being across the life span; however, its links to aspects of identity and individual differences often obscure its unique contributions. Few empirical efforts have attempted to disentangle the components of religion, particularly its social and personality-related qualities, that might account for its impact. This study examined several domains of religion as contributors to mental health, distinct from personality. A sample of emerging adults ( n = 509) reported on these constructs along with measures of depression, anxiety, aggression, satisfaction with life, and flourishing. As hypothesized, hierarchical multiple regressions indicated that higher levels of religiosity were associated with better mental health outcomes above and beyond demographic characteristics and personality, and religious doubt was associated with poorer outcomes. Religiosity also differed as a function of gender and ethnicity. Clinical implications of these results are discussed along with recommendations for further research.
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Access to mental health services for older Hispanic adults is limited and often older Hispanic adults must rely on their own resources in dealing with mental health issues. The aim of this study was to understand how older Hispanic immigrants cope mental health issues (e.g. stress, anxiety, and/or depression). A qualitative, descriptive approach was used to interview 17 older Hispanic immigrants from Guatemala, Dominican Republic and Colombia. Interviews were audio recorded, transcribed and translated verbatim by bilingual research assistants. Data were analyzed using content analysis with a combination of immersion/crystallization, editing and template organizing styles. Ways of coping included spiritual beliefs and religious practices, social support, distraction, medications and professional help. Primary care providers may be more effective if they build upon the cultural constructs that undergird older Hispanic immigrants' ways of coping in addressing emotional distress and mental health issues in this population.
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Immigrant and refugee populations experience life stressors due to difficult migration journeys and challenges in leaving one country and adapting to another. These life stressors result in adverse mental health outcomes when coupled with a lack of adequate support‐enhancing resources. One area of support is access to and use of mental health services to prevent and address mental health concerns. Immigrant service providers in Canada support the integration and overall well‐being of newcomers. This study focuses on immigrant service providers’ perceptions of access to and use of mental health services for immigrants and refugees in Alberta. A qualitative descriptive design was used to collect and analyse the perspectives of 53 immigrant service providers recruited from nine immigrant serving agencies in Alberta between November 2016 and January 2017. Data were collected using a combination of individual interviews and focus groups, followed by thematic data analysis to identify relevant themes. Barriers to access and use of mental health services include language barriers, cultural interpretations of mental health, stigma around mental illness, and fear of negative repercussions when living with a mental illness. Strategies to improve mental health service delivery include developing community‐based services, attending to financial barriers, training immigrant service providers on mental health, enhancing collaboration across sectors in mental health service delivery, and advancing the role of interpreters and cultural brokers. Overall, immigrant service providers present a nuanced view of the complex and inter‐related barriers immigrants and refugees experience and identify potential approaches to enhancing mental health service delivery.
Article
Currently, 15 million Mexican and Central American individuals live in the United States, with this number projected to rise in the next few decades (Lesser & Batalova, 2017; Zong & Batalova, 2017). Research has begun to investigate the impact of the nation’s immigration practices and policies on immigrant Latino/a families and youth. Current immigration policies can create vulnerabilities, including fear and mistrust, discrimination, limited access to services, parent–child separation, and poverty. These experiences increase risk for poor mental health outcomes and may exacerbate prior exposure to traumas in the home country (e.g., violence) and during migration (e.g., extortion). This paper reviews current immigration policies for arriving Mexican and Central American immigrants and links to mental health among documented and undocumented immigrant families and youth. A discussion of positive policies and resources that may mitigate the damaging impact of immigration-related stress is included. Finally, social justice implications for clinicians and researchers are discussed, with culturally sensitive interventions, advocacy, and dissemination of research and policy as primary recommendations.
Article
Suicide has been the second leading cause of death for 18- to 24-year-olds in the United States since 2011. The stress experienced by undergraduate college students has the potential to increase one's risk for suicide. Resilience theory was used as a theoretical framework to examine the interplay between risk and protective factors. A cross-sectional and correlational design was used to assess the mediating effects of positive thinking and/or social support on suicide resilience in 131 college students 18 to 24 years old who completed an online survey. The study found an indirect effect of self-esteem on suicide resilience through positive thinking and social support indicating that as self-esteem increases, positive thinking and social support also increase, which leads to an increase in resilience. The study also found a direct effect of self-esteem, positive thinking, and social support on suicide resilience. The findings inform the development of tailored interventions to build suicide resilience in college students.
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The “DACAmented Voices in Healthcare” project examined the intersection of restrictive immigration policies and health care via photovoice, a participatory action research approach, with immigrant youth living in Arizona, who were recipients of the Deferred Action for Childhood Arrivals (DACA) program. These “DACAmented” youth took part in nine photovoice sessions exploring their health care experiences and accessibility to care using documentary photography and narratives. They poignantly illustrated their experiences through images identifying their main health concerns and strengths, facilitating the development of health policy recommendations. This article illustrates the thematic findings and discusses policy recommendations and lessons learned from presentations to policy makers and health care providers. Findings suggest that immigrant youth are knowledgeable of their family’s health care needs and hold a unique and important position within mixed-status households. Health care providers can benefit from the proposed recommendations by building bridges to care to address health equity in immigrant communities.
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This study explores how low-income rural Latino children and their mothers differ from their non-Latino white counterparts in terms of health, well-being, and health care access. A subsample of non-Latino white (n = 201) and Latino (n = 157) children and their mothers was drawn from the Rural Families Speak about Health Project, a multistate, cross-sectional data set developed through mixed purposive sampling methods. Findings suggest that Latino children's families were disadvantaged in terms of child health and access to health care, whereas non-Latino white children's families were disadvantaged in terms of child behavior problems and maternal health and depression.
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In this study, we conducted a path analysis on data from the National Latino and Asian American Study to investigate the role of religious attendance on mental health among Mexican populations. Using data from 868 Latinos of Mexican origin, we further investigated the extent to which religious attendance mediated the direct path between generation status and lifetime prevalence rates of any substance use disorder, depressive disorder, and anxiety disorder. Results indicate that Mexican immigrants endorsed lower lifetime prevalence rates of depressive disorder, anxiety disorder, and substance use disorder and endorsed higher levels of religious attendance. Second, results indicate a significant negative relationship between religious attendance and prevalence rates for depressive disorder, anxiety disorder, and substance use disorder. Third, results indicate that religious attendance was a mediator for the relationship between generation status and the lifetime prevalence rates of substance use disorder only. These results provide a contribution toward the discussion of the immigrant health paradox and further highlight the role that religious attendance plays in the relationship between generational status and the lifetime prevalence rates of substance use disorder. (PsycINFO Database Record
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Objectives: To determine whether there is a higher incidence of mental illness among immigrants, to describe the nosologic differences between immigrant and native populations, and to identify the risk factors involved of immigration. Methods: A systematic review was conducted using the PubMed, Science Direct, ISI, Scopus, Psycinfo, Cochrane, and Cuiden databases. The search strategy was conducted using the MeSH thesaurus for the controlled terms "mental disorders," "mental health," "transients and migrants," "immigrants," and "epidemiology." The quality of the articles was analyzed by using the Equator Guidelines, following checklists according to the methodological design of the studies by two independent reviewers. Results: From a total of 817 studies found, 21 met the inclusion criteria. Out of the 21 studies selected, 13 showed a higher prevalence of mental illness. Conclusions: Migration represents a major challenge, but it does not lead exclusively to mental distress. Immigrants experience more problems in depression, anxiety, and somatic disorders, pathologies related directly to the migration process and stress suffered. Resources should be oriented to primary and community care.
Article
From a public health perspective, primary care medical settings represent a strategic location to address mental health disapirty among Latinos. Yet, there is little empirical work that addresses affective vulnerability processes for mental health problems in such settings. To help address this gap in knowledge, the present investigation examined an interactive model of negative affectivity (tendency to experience negative mood states) and anxiety sensitivity (fear of the negative consequences of aversive sensations) among a Latino sample in primary care in terms of a relatively wide range of anxiety/depression indices. Participants included 390 Latino adults (Mage=38.7, SD=11.3; 86.9% female; 95.6% reported Spanish as first language) from a primary care health clinic. Primary dependent measures included depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood and anxiety disorders, and disability. Consistent with prediction, the interaction between negative affectivity and anxiety sensitivity was significantly related to suicidal, social anxiety, and anxious arousal symptoms, as well as number of mood/anxiety diagnoses and disability among the primary care Latino sample. The form of the interactions indicated a synergistic effect, such that the greatest levels of each outcome were found among those with high negative affectivity and high anxiety sensitivity. There was a trending interaction for depressive symptoms. Overall, these data provide novel empirical evidence suggesting that there is a clinically-relevant interplay between anxiety sensitivity and negative affectivity in regard to the expression of anxiety and depressive symptoms among a Latino primary care sample.
Article
The discrepancy between the growing number of Spanish speakers in the U.S. and the availability of bilingual providers creates a barrier to accessing quality mental health care. Use of interpreters provides one strategy for overcoming this linguistic barrier; however, concerns about whether sessions with interpreters, versus bilingual providers, impede therapeutic alliance remain. The current study explored associations between the use of interpreters and therapeutic alliance in a sample of 458 Spanish-speaking patients seen for integrated behavioral health visits at primary care clinics. Patients completed a brief (4 item) therapeutic alliance scale at their behavioral health appointment. In addition, to supplement the quantitative study data, a pilot study of 30 qualitative interviews was conducted with a new sample of 10 Spanish-speaking patients, 10 behavioral health consultants (BHCs), and 10 trained interpreters. Quantitative results showed that interpreter use did not relate to therapeutic alliance, even when controlling for relevant demographic variables. However, qualitative interviews suggested major themes regarding the relative benefits and challenges of using interpreters for patients, interpreters, and BHCs. In interviews, patients expressed a strong preference for bilingual providers. Benefits included greater privacy, sense of trust, and accuracy of communication. However, in their absence, interpreters were seen as increasing access to services and facilitating communication with providers, thereby addressing the behavioral health needs of patients with limited English proficiency. BHCs and interpreters emphasized the importance of interpreter training and a good collaborative relationship with interpreters to minimize negative effects on the quality of care. (PsycINFO Database Record
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Racial and ethnic microaggressions in everyday life can negatively impact the well-being of racial and ethnic minorities (REM). When microaggressions are perceived in therapy they can interfere with therapeutic progress. However, little is known about whether microaggressions are addressed in therapy and if so, does addressing them impact the therapeutic relationship. REM clients from a university counseling center (n = 120) reported on their therapy experience. Approximately 53% of clients reported experiencing a microaggression from their therapist. Clients' perceptions of microaggressions were negatively related to the working alliance, even after controlling for their current psychological well-being, number of sessions, and therapist racial and ethnic status. Of those clients who reported a microaggression, nearly 76% reported that the microaggression was not discussed. For those clients who experienced a microaggression and did not discuss it, alliance ratings were lower as compared with clients who did not experience a microaggression or who experienced a microaggression but discussed it.
Article
Compared with non-Latino Whites, Latino immigrants have a lower prevalence of depression. However, they are also less likely to seek professional mental health services. Our objective was to compare and contrast perceptions of depression and access to mental health care among four of the largest Latino immigrant subgroups in Florida (Puerto Rican, Cuban, Mexican, and Colombian). We conducted a total of 120 interviews (30 men and women from each subgroup). Thematic analysis of qualitative data revealed that participants across the four groups were aware of the signs and symptoms of depression and had similar perceptions of depression. However, notable differences by subgroup emerged with regard to perceptions of access to mental health care. We suggest that the variation stems from differences in life experiences and the immigration context. Understanding the variances and nuances of Latino immigrants' cultural construction of depression and immigration experience will enable practitioners to better serve this community. © The Author(s) 2015.
Article
This chapter addresses the mental health status of Hispanics in the United States. The prevalence and incidence of mental health disorders among different Hispanic ethnic subgroups is examined. Patterns of mental health services utilization and barriers to mental health care are also reviewed. Research specific to best mental health practices with Hispanics is stressed.
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Family caregivers' views and experiences related to treatment usage processes by their adult relatives with serious and persistent mental illness (SPMI) were empirically examined in a sample of Latino caregivers (n = 17) who were users of services at the National Alliance on Mental Illness (NAMI) in a predominantly Latino- (80%) and Mexican-descent large city in the Southwest United States. We conducted a stability check of qualitative findings with a second sample of Latino caregivers with no exposure to NAMI (n = 15). Overall, the combined sample (N = 32) compared similarly with larger samples of Latino adults and caregivers in quantitative measures of acculturation, familism, caregiver stigma, and depression symptoms. Together, caregivers' stigma and cultural beliefs, such as vergüenza (shame), use of folk healers, and lack of insurance, were major reported barriers to service usage. Family support (and lack of) for treatment also weighed heavily as a facilitator (and a barrier) of service usage, thus highlighting the complexity of family relationship contexts. Substantial portions of caregivers reported that treatment initiation was prompted by psychiatric hospitalization (50%), and that positive experiences with service providers were influential in treatment retention (72%). Given the high levels of family involvement reported among Latino caregivers, the findings underscore the potential role of family caregivers in treatment engagement and retention. Future research is needed that examines family caregivers' role in treatment with models that consider the interplay between cultural background, family level relationships, and service system contexts. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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This study employed qualitative research to describe the relationship between spirituality and overall health among a sample of Latino women. A framework is presented for understanding this complex relationship. Findings are presented from a qualitative analysis of six 1.5-hour focus group sessions. The research was conducted among Latino women living in Chicago, Illinois, and Northeastern New York communities. We employed a community-based participatory research approach in which community members were active participants throughout the research process. Subjects were 47 Latino women 31 to 81 years, all of whom were Christian and the majority (43%) of whom had less than a high school education. Twenty-seven percent reported having high school diplomas, and the same percentage reported at least some college. Of the women who answered the questions, one did not have health insurance, 69% had public health insurance, and 29% had private health insurance. Grounded theory using selective coding was employed to understand the relationship between spirituality and health and to develop the conceptual framework. Spirituality was expressed as a vital component of health, and the belief in a need for balance of physical, mental, and spiritual health was described. An active and a passive relationship between spirituality and health emerged, with active being most common. Asking God for help or faith as a coping strategy were subdomains of the active relationship, and God responsible for health fell under the passive domain. These relationship types influenced beliefs about participation in one's own health. The findings that emerged contribute to an understanding of how spirituality plays a role in health beliefs among Latino women, which has implications for health promotion research and program development for addressing health disparities.