Abstract
Pregnancy is a developmental period with distinct practical and attitudinal factors that affect mental health help-seeking. Within the Latine community, the inclusion of family values in therapy is associated with positive outcomes, suggesting that social relationships may contribute to help-seeking behavior for this population. This study aimed to describe the roles that social relationships play in pregnant Latines’ consideration of psychotherapy. We conducted an inductive qualitative content analysis of 25 interview transcripts assessing the acceptability of an evidence-based psychological intervention, exposure therapy, among English-speaking pregnant Latines with elevated anxiety. Emergent themes revealed that participants were motivated to seek anxiety treatment to improve family well-being, experienced internal conflict between prioritizing care for self and fulfilling their familial role, and were impacted by their close others’ attitudes toward and experiences with therapy. Findings suggest a need to address both positive and negative influences of social relationships when engaging pregnant Latines in prospective psychotherapeutic care to improve motivation, engagement, and potential outcomes, which may reduce care disparities during pregnancy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Notes
This study did not explicitly inquire about participants’ gender identity, and thus uses Latine as a gender-inclusive term to refer to people with a Latin American cultural background regardless of race. The authors acknowledge that individuals in this group may also identify with alternative terms such as Hispanic, Latino/a, or Latinx.
Hispanic/Latina was used over Latine in participant-facing documents to promote increased recognition within the recruitment population. While gender-neutral terminology such as Latine and Latinx have risen in populatirty in recent years, particularly among academics, their use in the general U.S. population is not common practice and varies across demographic subgroups including age, gender, nativity, and level of education (Noe-Bustamante et al., 2020).
References
Arch, J. J. (2014). Cognitive behavioral therapy and pharmacotherapy for anxiety: Treatment preferences and credibility among pregnant and non-pregnant women. Behaviour Research and Therapy, 52, 53–60. https://doi.org/10.1016/J.BRAT.2013.11.003
Byatt, N., Biebel, K., Lundquist, R. S., Moore Simas, T. A., Debordes-Jackson, G., Allison, J., & Ziedonis, D. (2012). Patient, provider, and system-level barriers and facilitators to addressing perinatal depression. Journal of Reproductive and Infant Psychology, 30(5), 436–449. https://doi.org/10.1080/02646838.2012.743000
Campos, B., Schetter, C. D., Abdou, C. M., Hobel, C. J., Glynn, L. M., & Sandman, C. A. (2008). Familialism, social support, and stress: Positive implications for pregnant Latinas. Cultural Diversity & Ethnic Minority Psychology, 14(2), 155–162. https://doi.org/10.1037/1099-9809.14.2.155
Chang, J., Chen, C.-N., & Alegría, M. (2014). Contextualizing social support: Pathways to help seeking in Latinos, Asian Americans, and Whites. Journal of Social and Clinical Psychology, 33(1), 1–24. https://doi.org/10.1521/jscp.2014.33.1.1
Clinkscales, N., Golds, L., Berlouis, K., & MacBeth, A. (2022). The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta-analysis. Psychology and Psychotherapy: Theory, Research and Practice, 96(2), 265–541. https://doi.org/10.1111/papt.12441
Clout, D., & Brown, R. (2015). Sociodemographic, pregnancy, obstetric, and postnatal predictors of postpartum stress, anxiety and depression in new mothers. Journal of Affective Disorders, 188, 60–67. https://doi.org/10.1016/J.JAD.2015.08.054
Cohen, L. S., Wang, B., Nonacs, R., Viguera, A. C., Lemon, E. L., & Freeman, M. P. (2010). Treatment of mood disorders during pregnancy and postpartum. Psychiatric Clinics of North America, 33(2), 273–293. https://doi.org/10.1016/J.PSC.2010.02.001
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37–70. https://doi.org/10.1177/1529100614531398
Dagher, R. K., Pérez-Stable, E. J., & James, R. S. (2021). Socioeconomic and racial/ethnic disparities in postpartum consultation for mental health concerns among US mothers. Archives of Women’s Mental Health, 24, 781–791. https://doi.org/10.1007/s00737-021-01132-5
Deane, F. P., & Todd, D. M. (1996). Attitudes and intentions to seek professional psychological help for personal problems or suicidal thinking. Journal of College Student Psychotherapy, 10(4), 45–59. https://doi.org/10.1300/J035v10n04_06
Deane, F. P., Skogstad, P., & Williams, M. W. (1999). Impact of attitudes, ethnicity and quality of prior therapy on New Zealand male prisoners’ intentions to seek professional psychological help. International Journal for the Advancement of Counselling, 21(1), 55–67. https://doi.org/10.1023/A:1005346703753
Dennis, C. L., & Chung-Lee, L. (2006). Postpartum depression help-seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth, 33(4), 323–331. https://doi.org/10.1111/j.1523-536X.2006.00130.x
Dennis, C., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. British Journal of Psychiatry, 210(5), 315–323. https://doi.org/10.1192/bjp.bp.116.187179
Ding, X.-X., Wu, Y.-L., Xu, S.-J., Zhu, R.-P., Jia, X.-M., Zhang, S.-F., Huang, K., Zhu, P., Hao, J.-H., & Tao, F.-B. (2014). Maternal anxiety during pregnancy and adverse birth outcomes: A systematic review and meta-analysis of prospective cohort studies. Journal of Affective Disorders, 159, 103–110. https://doi.org/10.1016/j.jad.2014.02.027
Eghaneyan, B. H., & Murphy, E. R. (2020). Measuring mental illness stigma among Hispanics: A systematic review. Stigma and Health, 5(3), 351. https://doi.org/10.1037/sah0000207
Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing. https://doi.org/10.1111/j.1365-2648.2007.04569.x
Fonseca, A., & Canavarro, M. C. (2017). Women’s intentions of informal and formal help-seeking for mental health problems during the perinatal period: The role of perceived encouragement from the partner. Midwifery, 50, 78–85. https://doi.org/10.1016/j.midw.2017.04.001
Garcés, I. C., Scarinci, I. C., & Harrison, L. (2006). An examination of sociocultural factors associated with health and health care seeking among Latina immigrants. Journal of Immigrant and Minority Health, 8(4), 377–385. https://doi.org/10.1007/s10903-006-9008-8
Goger, P., & Weersing, V. R. (2021). Family based treatment of anxiety disorders: A review of the literature (2010–2019). Journal of Marital and Family Therapy, 48, 1–107. https://doi.org/10.1111/jmft.12548
Grobman, W. A., Parker, C., Wadhwa, P. D., Willinger, M., Simhan, H., Silver, B., Wapner, R. J., Parry, S., Mercer, B., Haas, D., Peaceman, A. M., Hunter, S., Wing, D., Caritis, S., Esplin, S., Hoffman, M., Ludmir, J., Iams, J., Long, E., & Reddy, U. M. (2016). Racial/ethnic disparities in measures of self-reported psychosocial states and traits during pregnancy. American Journal of Perinatology, 33(14), 1426–1432. https://doi.org/10.1055/s-0036-1586510
Henshaw, E., Sabourin, B., & Warning, M. (2013). Treatment-seeking behaviors and attitudes survey among women at risk for perinatal depression or anxiety. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42(2), 168–177. https://doi.org/10.1111/1552-6909.12014
Holsti, O. R. (1969). Content analysis for the social sciences and humanities. Addison-Wesley.
Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288. https://doi.org/10.1177/1049732305276687
Keefe, R. H., Brownstein-Evans, C., & RoulandPolmanteer, R. S. (2016). Having our say: African-American and Latina mothers provide recommendations to health and mental health providers working with new mothers living with postpartum depression. Social Work in Mental Health, 14(5), 497–508. https://doi.org/10.1080/15332985.2016.1140699
Keeler, A. R., Siegel, J. T., & Alvaro, E. M. (2014). Depression and help seeking among Mexican-Americans: The mediating role of familism. Journal of Immigrant and Minority Health, 16(6), 1225–1231. https://doi.org/10.1007/s10903-013-9824-6
Kozhimannil, K. B., Trinacty, C. M., Adams, A. S., Huskamp, H. A., & Busch, A. B. (2014). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services, 62(6), 619. https://doi.org/10.1176/ps.62.6.pss6206_0619
Krippendorff, K. (2011). Computing Krippendorff’s alpha-reliability. http://repository.upenn.edu/asc_papers/43
Lara-Cinisomo, S., & Wisner, K. L. (Eds.). (2013). Perinatal depression among Spanish-speaking and Latin American women: A global perspective on detection and treatment. Springer Science & Business Media
Lombard, M., Snyder-Duch, J., & Bracken, C. C. (2002). Content analysis in mass communication: Assessment and reporting of intercoder reliability. Human Communication Research, 28(4), 587–604. https://doi.org/10.1111/j.1468-2958.2002.tb00826.x
Loughnan, S. A., Wallace, M., Joubert, A. E., Haskelberg, H., Andrews, G., & Newby, J. M. (2018). A systematic review of psychological treatments for clinical anxiety during the perinatal period. Archives of Women’s Mental Health, 21(5), 481–490. https://doi.org/10.1007/s00737-018-0812-7
Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 46(3), 266–274. https://doi.org/10.1097/MLR.0b013e318160d093
MacPhail, C., Khoza, N., Abler, L., & Ranganathan, M. (2016). Process guidelines for establishing intercoder reliability in qualitative studies. Qualitative Research, 16(2), 198–212. https://doi.org/10.1177/1468794115577012
Madigan, S., Oatley, H., Racine, N., Fearon, R. M. P., Schumacher, L., Akbari, E., Cooke, J. E., & Tarabulsy, G. M. (2018). A meta-analysis of maternal prenatal depression and anxiety on child socioemotional development. Journal of the American Academy of Child & Adolescent Psychiatry, 57(9), 645–657. https://doi.org/10.1016/J.JAAC.2018.06.012
Maguire, P. N., Clark, G. I., & Wootton, B. M. (2018). The efficacy of cognitive behavior therapy for the treatment of perinatal anxiety symptoms: A preliminary meta-analysis. Journal of Anxiety Disorders, 60, 26–34. https://doi.org/10.1016/j.janxdis.2018.10.002
Miller, L. J. (2014). Assessment, engagement, and treatment entry for Latina women with perinatal depression. In Lara-Cinisomo, S., Wisner, K. (eds), Perinatal depression among Spanish-speaking and Latin American women, 39–50. Springer. https://doi.org/10.1007/978-1-4614-8045-7_3
Noe-Bustamante, L., Mora, L., & Lopez, M. H. (2020). About one-in-four U.S. Hispanics have heard of Latinx, but just 3% use it. Pew Research Center. https://www.pewresearch.org/hispanic/2020/08/11/about-one-in-four-u-s-hispanics-have-heard-of-latinx-but-just-3-use-it/
O’Mahen, H., Fedock, G., Henshaw, E., Himle, J. A., Forman, J., & Flynn, H. A. (2012). Modifying CBT for perinatal depression: What do women want? A qualitative study. Cognitive and Behavioral Practice, 19(2), 359–371. https://doi.org/10.1016/j.cbpra.2011.05.005
Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33(3), 557–577. https://doi.org/10.1016/j.psc.2010.04.002
Ponting, C., Chavira, D. A., DunkelSchetter, C., & Urizar, G. G. (2022a). Cognitive behavioral stress management effects on prenatal anxiety among low-income women. Journal of Consulting and Clinical Psychology, 90(2), 148–160. https://doi.org/10.1037/ccp0000699
Ponting, C., Urizar, G. G., Jr., & Schetter, C. D. (2022b). Psychological interventions for prenatal anxiety in Latinas and Black women: A scoping review and recommendations. Frontiers in Psychiatry, 13, 820343. https://doi.org/10.3389/fpsyt.2022.820343
Ponting, C., Ong, E., Dunkel Schetter, C., & Chavira, D. A. (2023). Exposure therapy acceptability among pregnant Latinas with anxiety: A qualitative content analysis. Cultural Diversity and Ethnic Minority Psychology. Advance online publication. https://doi.org/10.1037/cdp0000589
Ramos, L. Y. (2019). Therapists’ inclusion of familismo cultural values during therapy and client’s rating of the quality of the therapeutic alliance (Publication No. 27740181). [Doctoral dissertation, California School of Professional Psychology]. ProQuest Dissertations & Theses Global. https://www.proquest.com/dissertations-theses/therapists-inclusion-familismo-cultural-values/docview/2378935594/se-2
Riem, M. M., Bakermans-Kranenburg, M. J., & Cima, M. (2023). Grandparental support and maternal postpartum mental health: A review and meta-analysis. Human Nature, 34, 25–45. https://doi.org/10.1007/s12110-023-09440-8
Rini, C. K., Dunkel-Schetter, C., Wadhwa, P. D., & Sandman, C. A. (1999). Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy. Health Psychology, 18(4), 333. https://doi.org/10.1037/0278-6133.18.4.333
Rubinchik, S. M., Kablinger, A. S., & Gardner, J. S. (2005). Medications for panic disorder and generalized anxiety disorder during pregnancy. Primary Care Companion to the Journal of Clinical Psychiatry, 7(3), 100–105. https://doi.org/10.4088/pcc.v07n0304
Ruggiano, N., & Perry, T. E. (2019). Conducting secondary analysis of qualitative data: Should we, can we, and how? Qualitative Social Work, 18(1), 81–97. https://doi.org/10.1177/1473325017700701
Sampson, M., Yu, M., Mauldin, R., Mayorga, A., & Gonzalez, L. G. (2021). ‘You withhold what you are feeling so you can have a family’: Latinas’ perceptions on community values and postpartum depression. Family Medicine and Community Health, 9(3). https://doi.org/10.1136/fmch-2020-000504
Sekhon, M., Cartwright, M., & Francis, J. J. (2017). Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework. BMC Health Services Research, 17(1), 88. https://doi.org/10.1186/s12913-017-2031-8
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166(10), 1092. https://doi.org/10.1001/archinte.166.10.1092
Spoont, M. R., Nelson, D. B., Murdoch, M., Rector, T., Sayer, N. A., Nugent, S., & Westermeyer, J. (2014). Impact of treatment beliefs and social network encouragement on initiation of care by VA service users with PTSD. Psychiatric Services, 65(5), 654–662. https://doi.org/10.1176/appi.ps.201200324
Staneva, A. A., Bogossian, F., & Wittkowski, A. (2015). The experience of psychological distress, depression, and anxiety during pregnancy: A meta-synthesis of qualitative research. Midwifery, 31(6), 563–573. https://doi.org/10.1016/j.midw.2015.03.015
Sullivan-Bolyai, S., Bova, C., & Harper, D. (2005). Developing and refining interventions in persons with health disparities: The use of qualitative description. Nursing Outlook, 53(3), 127–133. https://doi.org/10.1016/j.outlook.2005.03.005
Thériault, F. L., & Colman, I. (2017). Awareness of treatment history in family and friends, and mental health care seeking propensity. Social Psychiatry and Psychiatric Epidemiology, 52(4), 485–492. https://doi.org/10.1007/s00127-017-1349-1
Uebelacker, L. A., Marootian, B. A., Pirraglia, P. A., Primack, J., Tigue, P. M., Haggarty, R., Velazquez, L., Bowdoin, J. J., Kalibatseva, Z., & Miller, I. W. (2012). Barriers and facilitators of treatment for depression in a Latino community: A focus group study. Community Mental Health Journal, 48(1), 114–126. https://doi.org/10.1007/s10597-011-9388-7
Urizar, G. G., Yim, I. S., Rodriguez, A., & Schetter, C. D. (2019). The SMART Moms program: A randomized trial of the impact of stress management on perceived stress and cortisol in low-income pregnant women. Psychoneuroendocrinology, 104, 174–184. https://doi.org/10.1016/J.PSYNEUEN.2019.02.022
Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing and Health Sciences, 15, 398–405. https://doi.org/10.1111/nhs.12048
Wilhelmsen, M., Lillevoll, K., Risør, M. B., Høifødt, R., Johansen, M., Waterloo, K., Eisemann, M., & Kolstrup, N. (2013). Motivation to persist with internet-based cognitive behavioural treatment using blended care: a qualitative study. BMC Psychiatry, 13(296). https://doi.org/10.1186/1471-244X-13-296
Zhong, Q.-Y., Gelaye, B., Zaslavsky, A. M., Fann, J. R., Rondon, M. B., Sánchez, S. E., & Williams, M. A. (2015). Diagnostic validity of the Generalized Anxiety Disorder-7 (GAD-7) among pregnant women. Plos One, 10(4). https://doi.org/10.1371/journal.pone.0125096
Funding
This work was supported by the NIMH under Grant NIH 5T32MH015750-38, The American Psychological Association’s Dissertation Research Award and an Academic Senate Grant from UCLA.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ong, E., Ponting, C. & Chavira, D.A. A Qualitative Content Analysis of Social Influences on Mental Health Care Seeking Considerations Among Pregnant Latines. Int J Adv Counselling (2024). https://doi.org/10.1007/s10447-024-09556-1
Accepted:
Published:
DOI: https://doi.org/10.1007/s10447-024-09556-1