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“It’s Like Being in a Labyrinth:” Hispanic Immigrants’ Perceptions of Depression and Attitudes Toward Treatments

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Abstract

This study aimed to describe Hispanic immigrants’ perceptions of depression and attitudes toward treatments and to examine how demographics, acculturation, clinical factors, and past service use were associated with their perceptions and attitudes. A convenience sample of 95 Hispanic immigrant patients was presented a vignette depicting an individual with major depression. Structured interviews that included standardized instruments and open-ended questions were used to query patients about their views of depression and its treatments. Findings showed that Hispanic immigrants perceived depression as a serious condition caused by interpersonal and social factors. Consistent with existing literature, most patients endorsed positive attitudes toward depression treatments yet reported apprehensions toward antidepressants. Demographic factors, acculturation, depressive symptoms, and past mental health service use were related to patients’ views of depression and attitudes toward care. This study emphasizes the need to incorporate Hispanic immigrants’ perceptions and attitudes into depression treatments.

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References

  1. Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, Lohr KN: Screening for depression in adults: A summary of the evidence for the U.S. preventive services task force. Ann Intern Med 2002;136(10):765–776

    PubMed  Google Scholar 

  2. U.S. Preventive Task Force: Screening for depression: Recommendations and rationale. Ann Intern Med 2002;136(10):760–764

    Google Scholar 

  3. United States Department of Health and Human Services: Mental health: Culture, race, and ethnicity: A supplement to mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Services, Office of the Surgeon General; 2001

  4. Institute of Medicine: Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academies Press; 2003

    Google Scholar 

  5. Young AS, Klap R, Sherbourne CD, Wells KB: The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry 2001;58:55–61

    Article  PubMed  CAS  Google Scholar 

  6. Borowsky SJ, Rubenstein LV, Meredith LS, Camp P, Jackson-Triche M, Wells KB: Who is at risk of nondetection of mental health problems in primary care? J Gen Intern Med 2000;15:381–388

    Article  PubMed  CAS  Google Scholar 

  7. Sclar DA, Robison LM, Skaer TL, Galin RS: Ethnicity and the prescribing of antidepressant pharmacotherapy: 1992–1995. Harv Rev Psychiatry 1999;7:26–36

    Article  Google Scholar 

  8. Vega WA, López SR: Priority issues in Latino mental health services research. Ment Health Serv Res 2001;3(4):189–200

    Article  PubMed  CAS  Google Scholar 

  9. Rogler LH, Cortes DE: Help-seeking pathways: A unifying concept in mental health care. Am J Psychiatry 1993;150:554–561

    PubMed  CAS  Google Scholar 

  10. Angel R, Thoits P: The impact of culture on the cognitive structure of illness. Cult Med Psychiatry 1987;11:465–494

    Article  PubMed  CAS  Google Scholar 

  11. Kirmayer LJ, Young A, Robbins JM: Symptom attribution in cultural perspective. Can J Psychiatry 1994;39:584–595

    PubMed  CAS  Google Scholar 

  12. Kleinman A: Rethinking psychiatry: From cultural category to personal experience. New York: Free Press; 1988

    Google Scholar 

  13. Leventhal A, Deifenbach M, Leventhal EA: Illness cognition: Using common sense to understand adherence and affect cognition interactions. Cognit Ther Res 16(2):143–163

  14. Cameron LD, Leventhal H (Eds.): The self-regulation of health and illness behaviour. London: Routledge; 2003

    Google Scholar 

  15. Deifenbach MA, Leventhal A: The common-sense model of illness representation: Theoretical and practical considerations. J Soc Distress Homeless 1996;5(1):11–38

    Article  Google Scholar 

  16. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D: The revised illness perception questionnaire (IPQ-R). Psychol Health 2002;17(1):1–16

    Article  Google Scholar 

  17. Weinmen J, Petries KJ, Moss-Morris R, Horne R: The illness perception questionnaire: A new method for assessing the cognitive representation of illness. Psychol Health 1996;11:431– 445

    Google Scholar 

  18. Petrie KJ, Broadbent E, Meechan G: The self-regulation of health and illness behaviour. London: Routledge; 2003

    Google Scholar 

  19. Fortune G, Barrowclough C, Lobban F: Illness representations in depression. Br J Clin Psychol 2004;43:347–364

    Article  PubMed  Google Scholar 

  20. Karasz A: Cultural differences in conceptual models of depression. Soc Sci Med 2005;60:1625–1635

    Article  PubMed  Google Scholar 

  21. Lobban F, Barrowclough C, Jones S: A review of the role of illness models in severe mental illness. Clin Psychol Rev 2002;23:171–196

    Article  Google Scholar 

  22. Brown C, Dunbar-Jacob J, Palenchar DR, Kelleher KJ, Bruehlman RD, Sereika S, Thase ME: Primary care patients’ personal illness models for depression: a preliminary investigation. Fam Pract 2001;18(3):314–320

    Article  PubMed  CAS  Google Scholar 

  23. Karasz A, Sacajiu G, Garcia N: Conceptual models in psychological distress among low-income patients in an inner-city primary care clinic. J Gen Intern Med 2003;18:475–477

    Article  PubMed  Google Scholar 

  24. Guarnaccia PJ, Parra P, Deschamps A, Milstein G, Argiles N: Si Dios quiere: Hispanic families’ experiences of caring for a seriously mentally ill family member. Cult Med Psychiatry 1992;16(2):271–236

    Article  Google Scholar 

  25. Jenkins JH: Conception of schizophrenia as a problem of nerves: A cross-cultural comparison of Mexican-Americans and Anglo-Americans. Soc Sci Med 1988;26(12):1233–1243

    Article  PubMed  CAS  Google Scholar 

  26. Rogler LH, Hollingshead AB: Trapped: Puerto Rican families and Schizophrenia. Maplewood, NJ: Waterfront; 1965

    Google Scholar 

  27. Guarnaccia PJ, Lewis-Fernandez R, Marano MR: Toward a Puerto Rican popular nosology: Nervios and ataque de nervios. Cult Med Psychiatry 2003;27:339–366

    Article  PubMed  Google Scholar 

  28. Guarnaccia PJ, Parra P: Ethnicity, social status and families’ experiences of caring for a mentally ill family member. Community Ment Health J 1996;36(3):243–260

    Article  Google Scholar 

  29. Rogler LH, Malgady RG, Rodriguez O: Hispanic and mental health: A framework for research. Malabar, FL: Robert F. Kreiger Publishing; 1989

    Google Scholar 

  30. Alvidrez J: Ethnic variations in mental health attitudes and service use among low-income African-Americans, Latina and European American young women. Community Ment Health J 1999;35(6):515–530

    Article  PubMed  CAS  Google Scholar 

  31. Van Hook MP: Women’s help-seeking patterns for depression. Soc Work Health Care 1999;29(1):15–34

    Article  PubMed  CAS  Google Scholar 

  32. Copper LA, Gonzales JJ, Gallo JJ, Rost KM, Meredith LS, Rubenstein LV, Wang NY, Ford DE: The acceptability of treatment for depression among African-American, Hispanic and white primary care patients. Med Care 2003;41(4):479–489

    Article  Google Scholar 

  33. Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA: Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. Am J Public Health 1999;89(9):1328–1333

    PubMed  CAS  Google Scholar 

  34. Bravo M, Woodbury-Farina M, Canino GJ, Rubio-Stipec M: The Spanish translation and cultural adaptation of the diagnostic interview schedule for children (DISC) in Puerto Rico. Cult Med Psychiatry 1993;17:329–44

    Article  PubMed  CAS  Google Scholar 

  35. Brislin RW: Field methods in cross-cultural research. Beverly Hills: SAGE; 1986

    Google Scholar 

  36. Lanza ML, Carifio J: Use of a panel of experts to establish validity for patient assault vignette. Eval Rev 1992;17(1):82–92

    Google Scholar 

  37. Poulou M: The role of vignettes in the research of emotional and behavioural difficulties. Behav Brain Res 2001;6(1):50–62

    Google Scholar 

  38. Gliner JA, Haber E, Weise J: Use of controlled vignettes in evaluation: Does type of response method make a difference? Eval Program Plann 1999;22:313–322

    Article  Google Scholar 

  39. Lau A, Takeuchi DT: Cultural factors in help-seeking for child behavior problems: Value orientation, affective responding, and severity appraisal among Chinese-American parents. J Community Psychol 2001;29(6):675–692

    Article  Google Scholar 

  40. Cooper LA, Brown C, Vu HT, Palenchar DR, Gonzales JJ, Ford DE, Powe NR: Primary care patient’s opinions regarding the importance of various aspects of care for depression. Gen Hosp Psychiatry 2000;22:163–173

    Article  PubMed  CAS  Google Scholar 

  41. Marin GS, Gamba RJ: A new measurement of acculturation for Hispanics: The bidimensional acculturation scale for Hispanics (BAS). Hisp J Behav Sci 1996;18(3):297–316

    Google Scholar 

  42. Radloff LS: The CES-D Scale: A self report depression scale for research in the general population. Appl Psychol Meas 1977;1(3):385–401

    Google Scholar 

  43. Guarnaccia PJ, Angel R, Worobey JL: The factor structure of the CES-D in the Hispanic Health and Nutrition Examination survey: The influence of ethnicity, gender and language. Soc Sci Med 1989;29(1):85–94

    Article  PubMed  CAS  Google Scholar 

  44. Mulrow CD, Williams JW, Gerety MB, Ramirez G, Montiel OM, Kerber C: Case-finding instruments for depression in primary care settings. Ann Intern Med 1995;122(12):913–921

    PubMed  CAS  Google Scholar 

  45. Fayers PM, Sprangers MA: Understanding self-rated health. Lancet 2002;359(9302):187–188

    Article  PubMed  Google Scholar 

  46. Franzini L, Fernandez-Esquer ME: Socioeconomic, cultural and personal influences on health outcomes in low income Mexican-origin individuals in Texas. Soc Sci Med 2004;59:1629–1646

    Article  PubMed  Google Scholar 

  47. Strauss A, Corbin J: Basics of qualitative research: Grounded theory procedure and techniques. Newbury Park, CA: Sage Publications; 1990

    Google Scholar 

  48. Padgett DK: Qualitative methods in social work research: Challenges and rewards. Thousand Oaks, CA: Sage; 1998

    Google Scholar 

  49. Qualitative Solutions and Research [QSR]: NVivo 2.0.: Using NVivo in qualitative research [Computer software and manual]. Melbourne, Australia: QSR International; 2002

    Google Scholar 

  50. Dalla LR, Christensen A: Latino immigrants describe residence in rural midwestern meatpacking communities: A longitudinal assessment of social and economic change. Hisp J Behav Sci 2005;27(1):23–42

    Article  Google Scholar 

  51. Patel V: Explanatory models of mental illness in sub-Saharan Africa. Soc Sci Med 1995;40(9):1291–1298

    Article  PubMed  CAS  Google Scholar 

  52. Lauber C, Falcato L, Nordt C, Rössler W: Lay beliefs about causes of depression. Acta Psychiatr Scand 2003;108(418):96–99

    Article  Google Scholar 

  53. Matschinger H, Angermeyer MC: Lay beliefs about the cause of mental disorders: a new methodology. Soc Psychiatry Psychiatric Epidemiol 1996;31:309–315

    Article  CAS  Google Scholar 

  54. Lugo-Steidel A, Contreras JM: A new familism scale for use with Latino populations. Hisp J Behav Sci 2003;25(3):312–330

    Article  Google Scholar 

  55. Zayas LH, Lester RJ, Cabassa LJ, Fortuna LR: Why do many Latina teens attempt suicide? A conceptual model. Am J Orthopsychiatry 2005;75(2):275–228

    Article  PubMed  Google Scholar 

  56. Magaña S: Puerto Rican families caring for an adult with mental retardation: Role of familism. Am J Ment Retard 1999;104(05):466–482

    Article  PubMed  Google Scholar 

  57. Gil AG, Wagner EF, Vega WA: Acculturation, familism & alcohol use among Latino adolescent males: Longitudinal relation. J Community Psychol 2000;28(4):443–458

    Article  Google Scholar 

  58. Fisher CB, Hoagwood K, Boyce C, Duster T, Frank DA, Grisso T, et al: Research ethics for mental health science involving ethnic minority children and youths. Am Psychol 2002;57(12):1024–1040

    Article  PubMed  Google Scholar 

  59. Angermeyer MC, Matschinger H: Public attitude towards psychiatric treatment. Acta Psychiatr Scand 1996;94:326–336

    PubMed  CAS  Google Scholar 

  60. Urdaneta ML, Saldana DH, Winkler A: Mexican-American perceptions of severe mental illness. Hum Organizations 1995;54(1):70–77

    Google Scholar 

  61. Vega WA, Kolody B, Aguilar-Gaxiola S: Help seeking for mental health problems among Mexican Americans. J Immigr Health 2001;3(3):133–40

    Article  PubMed  CAS  Google Scholar 

  62. Meyer JA: Improving men’s health: Developing a long-term strategy. Am J Public Health 2003;93(5):709–711

    Article  PubMed  Google Scholar 

  63. Mitchell L, Romans S: Spiritual beliefs in bipolar affective disorder: Their relevance for illness management. J Affect Disord 2003;75:247–257

    Article  PubMed  Google Scholar 

  64. Kirmayer LJ: Cultural variations in the clinical presentation of depression and anxiety: Implications for diagnosis and treatment. J Clin Psychiatry 2001;62(13):22–28

    PubMed  Google Scholar 

  65. American Psychiatric Association: Diagnostic and statistical manual of mental disorders: Text revision (4 ed.). Washington, DC: American Psychiatric Association, 2000

    Google Scholar 

  66. Lewis-Fernández R, Diaz N: The cultural formulation: A method for assessing cultural factors affecting the clinical encounter. Psychiatr Q 2002;73(4):271–295

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by a dissertation grant from the National Institute of Mental Health (1R36MH072172-01). The authors would like to express their gratitude to Dr. Thomas Kernan and his staff at Grace Hill South for welcoming us into their clinic and providing us with a recruitment site for this study. An earlier version of this paper was presented at the Critical Research Issues in Latino Mental Health: Mental Disorders among Latinos: Biological and Psychological Influences on Diagnosis and Treatment, November 8, 2005, Princeton, NJ. The authors are grateful for the comments of Enola K. Proctor, Arlene R. Stiffmann, Wendy Auslander, Edward Spitznagel, Peter Guarnaccia, Bin Xie and Vanessa Noriega on earlier drafts of this paper.

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Authors and Affiliations

  1. School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, USA, 90089-0411,, USA

    Leopoldo J. Cabassa

  2. Department of Anthropology, Washington University, St. Louis, MO, USA

    Rebecca Lester

  3. George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA

    Luis H. Zayas

Authors
  1. Leopoldo J. Cabassa
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  2. Rebecca Lester
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  3. Luis H. Zayas
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Corresponding author

Correspondence to Leopoldo J. Cabassa.

Appendix A. Vignette

Appendix A. Vignette

Vignette was adapted from the Mental Health Module of the 1996 General Social Survey [33].

Laura

Instructions: Now, I’m going to describe a person—let’s call her Laura. As you listen to what is happening to Laura, I want you to imagine yourself going through the same situation. Please listen as carefully as you can and try to put yourself in her situation. Later, I’ll ask you some questions about what you think and feel about Laura.

For the last two weeks Laura has been feeling down. She wakes up in the morning with a flat, heavy feeling that sticks with her all day long. She isn’t enjoying things the way she normally would. In fact, nothing seems to give her pleasure. Even when good things happen, they don’t seem to make Laura happy. She pushes on through her days, but it is really hard. The smallest tasks are difficult to accomplish. She finds it hard to concentrate on anything. She feels out of energy and out of steam. And even though Laura feels tired, when night comes she can’t get to sleep. Laura feels pretty worthless, and very discouraged. Laura’s family has noticed that she hasn’t been herself for about the last month, and that she has pulled away from them. Laura does not feel like talking.

Roberto

Instructions: Now, I’m going to describe a person—let’s call him Roberto. As you listen to what is happening to Roberto, I want you to imagine yourself going through the same situation. Please listen as carefully as you can and try to put yourself in his situation. Later, I’ll ask you some questions about what you think and feel about Roberto.

For the last two weeks Roberto has been feeling down. He wakes up in the morning with a flat, heavy feeling that sticks with him all day long. He isn’t enjoying things the way he normally would. In fact, nothing seems to give him pleasure. Even when good things happen, they don’t seem to make Roberto happy. He pushes on through his days, but it is really hard. The smallest tasks are difficult to accomplish. He finds it hard to concentrate on anything. He feels out of energy and out of steam. And even though Roberto feels tired, when night comes he can’t get to sleep. Roberto feels pretty worthless, and very discouraged. Roberto’s family has noticed that he hasn’t been himself for about the last month, and that he has pulled away from them. Roberto does not feel like talking.

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Cabassa, L.J., Lester, R. & Zayas, L.H. “It’s Like Being in a Labyrinth:” Hispanic Immigrants’ Perceptions of Depression and Attitudes Toward Treatments. J Immigrant Health 9, 1–16 (2007). https://doi.org/10.1007/s10903-006-9010-1

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