“It’s Like Going through an Earthquake”: Anthropological Perspectives on Depression among Latino Immigrants

Abstract

Depression is one of the most prevalent mental illnesses in the community and is responsible for a significant amount of disability. According to epidemiological and primary care studies, Latinos suffer from depression at high rates. This paper examines in depth Latinos’ conceptions of depression and their attitudes towards and expectations of mental health treatment. The aim of this paper is to summarize several qualitative studies examining Latinos’ cultural understandings of mental health in general and depression in particular, as well as to obtain information about the barriers to care that this community experienced. The results are a compilation of findings from four different research projects in New Jersey and New York that examined diverse Latinos’ conceptions of mental health, treatment and barriers to care.

Appendices

APPENDIX A: Focus group guide concerning mental health and mental health services (Studies 1 and 2)

• 1. Para Uds, que es salud emocional o salud mental?

[For you, what is emotional or mental health?]

• Como saben Uds. que una persona es sana mentalmente?

  [How do you know when someone is mentally healthy?]

• Que debe hacer una persona para mantener su salud emocional?

  [What should someone do to maintain their emotional health?]

• 2. Que tipos de problemas (enfermedades) de salud mental hay?

[What types of mental health problems (illensses) are there?]

Como saben Uds. que una persona tiene un problema (una enfermedad) de salud mental?

[How do you know when someone has a mental health problem (illness)?]

• 3. Cuales son las reacciones de gente en la comunidad acerca de personas con problemas de salud mental?

  [How do people in the community react to people with mental health problems?]

• 4. Que debe hacer una persona que padece de un problema de salud mental?

[What should someone do if they suffer from a mental health problem?]

• Que tratamientos conocen Uds. para problemas (enfermedades) de salud mental?

  [What treatments do you know for mental health problems (illnesses)?]

• Cuales de esos tratamientos piensan Uds. son mas efectivos?

  [Which of these treatments do you think are most effective?]

• Que puede hacer la familia de una persona con un problema de salud mental?

  [What can the family of a person with a mental health problem do for them?]

• 5. Que problemas encuentran personas con problemas de salud mental en buscar ayuda?

  [What problems do people with mental health problems encounter in seeking help?]

• Que problemas tiene en identificar servicios apropriadas?

  [What problems do they have in identifying appropriate services?]

• Que problemas tienen en usar estos servicios?

  [What problems do they have in using those services?]

Focus group questions about educational campaign

A nosotros, nos interesa desarollar un programa para educar a la comunidad Latina acerca de la salud mental.

[We would like to develop a program to educate the Latino community about mental health.]

• 1. Que medios de comunicacion serian mejores para ese programa de educacion? (radio, television, periodicos, etc.)

[What forms of communication would work best for the educational program? (radio, television, newspapers, etc.)]

• 2. Utilizaria Ud. un numero 800 para informacion acerca de donde encontrar servicios de salud mental?

[Would you use an 800 number for information about how to find mental health services?]

• 3. Que mensajes deberiamos presentar acerca de salud mental en la comunidad Latina? (Informacion acerca de enfermedades, estigma, recursos o tratamientos, etc.)

  [What messages should we present about mental health in the Latino community? (Information about illnesses, stigma, resources, treatments, etc.)]

Appendix B: Vignette on recognizing depression and attitudes towards treatment (Study 4)

Voy a comenzar por hablarles de un paciente, una mujer que llamaremos Marta, de 38 años, divorciada con 2 hijos de 11 y 13 años. Marta expresa que durante el último año se ha sentido muy triste. Indica que se le hace difícil dormir, tiene poco apetito, llora a menudo, y no puede realizar sus tareas. Ella ha tenido que visitar al médico para dolores de cabeza, estomacales y de los músculos.

[I am going to begin by telling you about a patient, a woman we will call Marta, who is 38 years old, divorced and has two children who are 11 and 13 years old. Marta says that during the past year she has felt very sad. She has had trouble sleeping, had little appetite, cries often and cannot get her tasks done. She has had to visit her doctor for headaches and pains in her stomach and muscles.]

• ¿Qué piensan Uds. que esta pasando con Marta?

  [What do you think is going on with Marta?]

  STOP HERE AND DISCUSS AFTER EACH QUESTION

• ¿Qué tipo de ayuda necesita (Marta)?

  [What type of help does Marta need?]

Los doctores piensan que Marta está deprimida. Al preguntarle si considera que ha necesitado ayuda profesional para algún problema emocional, dice que no.

[The doctors think that Marta is depressed. When they ask her if she thinks she needs professional help for an emotional problem, she says no.]

• ¿Qué esta ocurriendo con Marta que a pesar de lo mal que se siente, no reconoce que tiene un problema emocional?

  [What is happening with Marta, that although she feels really ill, she does not recognize that she has an emotional problem?]

• ¿Por qué personas como Marta se deprimen?

  [Why do people like Marta get depressed?]

• Qué otras razones contribuyen a que personas como Marta se depriman?

  [What are some other reasons why people like Marta might become depressed?]

• Cuándo debe uno buscar ayuda para la depresión?

  [When should one seek help for depression?]

• ¿Qué tipo de ayuda debe buscar Marta para su depresión?

  [What type of help should Marta seek for her depression?]

A pesar de que se siente mal con problemas físicos y psicológicos y que el doctor le ha dicho que esta deprimida, Marta no busca ni ha entrado en tratamiento para la depresión.

[In spite of how badly she feels due to her physical and psychological problems, and that the doctor has told her she is depressed, Marta does not seek nor enter treatment for depression.]

• Qué razones podría tener Marta para no buscar ayuda?

  [What reasons might Marta have for not seeking help?]

Luego de pasar otro año en que los períodos de depresión han ido aumentando, Marta ha pensado en algunas ocasiones en buscar ayuda, pero no lo ha hecho.

[During another year in which her periods of depression have increased, Marta has thought about seeking help on some occasions, but still has not gone.]

• ¿Qué se podría hacer para que alguien como Marta busque la ayuda que necesita?

  [What could be done so that someone like Marta would seek the help she needs?]

Marta decide que desea recibir ayuda profesional pero se ha encontrado con muchos problemas en conseguir tratamiento.

[Marta decides that she would like professional help, but she encounters many barriers in obtaining treatment.]

• ¿Cuáles problemas consideran ustedes que hacen difícil que las personas consiguen tratamiento?

  [What types of problems do you think make it hard for people to access treatment?]

• ¿Qué recomendaciones tienen para resolver estos problemas?

  [What recommendations do you have for solving those problems?]

Si Marta decide buscar ayuda, [If Marta did decide to seek treatment,]

• ¿Cómo reaccionaría su familia? sus amigos?

  [How would her family react? Her friends?]

• ¿Debería Marta contarle a sus compañeros de trabajo que está buscando ayuda por un problema emocional? ¿Por qué?, ¿Por qué no?

  [Should Marta tell her colleagues at work that she is seeking help for an emotional problem? Why should she or shouldn’t she?]

Ya Marta ha decidido buscar ayuda. Ella ha oído hablar de varios tratamientos para la depresión.

[Now Marta has decided to seek help. She has heard of various treatments for depression.]

• ¿De qué tratamientos han oído hablar Uds.?

  [What treatments (for depression) have you heard of?]

Hay varias alternativas para tratar la depresión. ¿Qué cosas positivas (buenas) o negativas (malas) le ven ustedes a cada tratamiento que mencionaba antes?:

[There are various alternatives for treating depression. What positive (good) and negative (bad) things have you heard about each of the treatments you mentioned above:]

REVIEW EACH TREATMENT MENTIONED ABOVE

Qué cosas positivas (buenas) o negativas (malas) le ven ustedes a:

[What positive (good) and negative (bad) things do you see with:]

• ¿tomar pastillas por seis meses?

  [taking pills for six months?]

• ¿reunirse en grupo con un profesional de ayuda una vez semanal por tres meses?

  [going to a weekly therapy group with a professional for three months?]

Marta empezó pero no terminó el tratamiento. [Marta began but did not finish treatment.]

• ¿Porque personas como Marta no terminan sus tratamientos?

  [Why do people like Marta terminate their treatment?]

• ¿Donde prefieren Uds. recibir tratamiento para la depresión?

  [Where would you prefer to receive treatment for your depression?]

• ¿De quienes prefieren Uds. recibir tratamiento?

  [From whom would you prefer to receive treatment?]

• ¿Hay otro comentario que Uds. quieren hacer acerca de este asunto?

  [Is there anything else that you would like to say about this topic?]