Family caregivers' narratives of mental health treatment usage processes by their Latino adult relatives with serious and persistent mental illness

Profiles of Latinx cultural orientation among adolescents: Associations with internalizing symptoms and moderation by ethnic-racial discrimination

INTRODUCTION

The objectives of the current study were the following: (1) to explore multidimensional profiles of Latinx cultural orientation using Spanish language use, familismo, and ethnic-racial identity (ERI) affirmation among Latinx adolescents, (2) to test how Latinx cultural orientation profiles were associated with adolescents' internalizing symptoms (i.e., depressive symptoms and anxiety symptoms), and (3) to test whether associations between profiles and internalizing symptoms were moderated by adolescents' ethnic-racial discrimination experiences.

METHODS

The study was conducted among a sample of 204 Latinx adolescents (52.4% female; Mage = 14.35, SDage = 1.75).

RESULTS

Latent profile analysis indicated four profiles of Latinx cultural orientation: higher affirmation and lower Spanish (HALS), higher Spanish (HS), lower familismo and affirmation (LFA), and higher familismo/lower Spanish and affirmation (HFLSA). Latinx adolescents who reported lower levels on more than one Latinx cultural orientation dimension (e.g. LFA or HFSLA) also reported worse health when compared to adolescents who reported higher levels of more than one Latinx cultural orientation dimension (e.g., HSA). The associations between Latinx cultural orientation profiles and internalizing symptoms were not moderated by adolescents' ethnic-racial discrimination.

CONCLUSION

Findings provide researchers and practitioners with an understanding of the various ways in which Latinx adolescents remain connected to their Latinx culture and implications for their outcomes.

Inequality and barriers in psychosis prevention: A systematic review on clinical high-risk for psychosis studies from developing countries

Background

The clinical high-risk for psychosis (CHR) paradigm is one of the best studied preventive paradigms in psychiatry. However, most studies have been conducted in high-income countries. It is unclear if knowledge from such countries applies to low and middle-income countries (LAMIC), and if there are specific limitations hindering CHR research there. Our aim is to systematically review studies on CHR from LAMIC.

Methods

A multistep PRISMA-compliant literature search was performed in PubMed and Web of Science for articles published until 1/03/2022, conducted in LAMIC, addressing the concept and correlates of CHR. Study characteristics as well as limitations were reported. Corresponding authors of the included studies were invited to answer an online poll. Quality assessment was done with the MMAT.

Results

A total of 109 studies were included in the review: none from low-income countries, 8 from lower middle-income countries, and 101 from upper middle-income countries. The most frequent limitations were small sample size (47.9%), cross-sectional design (27.1%), and follow-up issues (20.8%). Mean quality of included studies was of 4.4. Out of the 43 corresponding authors, 12 (27.9%) completed the online poll. They cited further limitations as few financial resources (66.7%), no involvement of population (58.2%) and cultural barriers (41.7%). Seventy five percent researchers reported that CHR research should be conducted differently in LAMIC compared to high-income countries, due to structural and cultural issues. Stigma was mentioned in three out of five sections of the poll.

Discussion

Results show the discrepancy of available evidence on CHR in LAMIC, given the shortage of resources in such countries. Future directions should aim to increase the knowledge on individuals at CHR in such settings, and to address stigma and cultural factors that may play a role in the pathways toward care in psychosis.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=316816, CRD42022316816.

A qualitative examination of the mental health impact of Covid-19 in marginalized communities in Guatemala: The Covid Care Calls survey

BACKGROUND

The mental health impact of Covid-19 from the perspective of individuals experiencing psychological distress during lockdown period in marginalized, high-risk communities remains underinvestigated.

AIMS

This study aims to identify key factors related to psychological distress resulting from the Covid-19 pandemic across highly vulnerable districts in Guatemala.

METHODS

The Covid Care Calls (CCC) survey was administered to households in 11 districts in Guatemala to gather information about medical, mental health, and psychosocial status during the lockdown period; provide referral for care; and disseminate information on evidence-based protective measures to stem the spread of the virus. The 330 individuals participated the survey. Conventional content analysis was used to analyze survey data.

RESULTS

Most commonly reported mental health issues since the start of the pandemic were anxiety (46%), stress (36%), and exacerbation of pre-Covid-19 mental health conditions (19%). Depression and burnout were equally reported by 12% of participants. Only 2% reported issues with safety in the home. Concerns about catching the virus and economic worries were the most commonly reported sources of psychological distress.

CONCLUSION

Results of this study indicate a high prevalence of anxiety, stress, and increased prior mental health symptoms resulting from the onset of the Covid-19 pandemic in low-income, high-risk communities across Guatemala. Efforts focused on enhancing coping strategies as well as psychoeducation to address stigma and increase help-seeking for depression are particularly important.

Rural Hispanic Perceptions of Mental Health: A Qualitative Study

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.

Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions

Stigma is integral to understanding mental health disparities among racial and ethnic minority groups in the United States. We conducted a systematic review to identify empirical studies on cultural aspects of mental illness stigma (public, structural, affiliative, self) among three racial and ethnic minority groups (Asian Americans, Black Americans, Latinx Americans) from 1990 to 2019, yielding 97 articles. In comparison studies (N = 25), racial and ethnic minority groups often expressed greater public and/or self-stigma than White American groups. In within-group studies (N = 65; Asian American, n = 21; Black American, n = 18; Latinx American; n = 26), which were primarily qualitative (73%), four major cultural themes emerged: 1) service barriers including access and quality (structural stigma); 2) family experiences including concealment for family's sake, fear of being a burden, and stigma extending to family (affiliative stigma); 3) lack of knowledge about mental illness and specific cultural beliefs (public stigma); and 4) negative emotional responses and coping (self-stigma). These findings confirmed stigma has both similar and unique cultural aspects across groups. Despite this, few studies tested stigma reduction interventions (N = 7). These cultural insights can inform contextual change at the health systems and community levels to reduce stigma, and empowerment at the interpersonal and individual levels to resist stigma.

Promoviendo una Alimentación Saludable (PAS) results: Engaging Latino families in eating disorder treatment

Latinos/as are underrepresented in eating disorders clinical trials. This study compared results of a culturally adapted individual cognitive-behavioral treatment (CBT) for binge-spectrum eating disorders that included or excluded a family enhanced module (CBT + FE), in a proof-of-principle pilot study with a sample of Latina adults and one family member per patient. Twenty-five patients (M_age = 37 yrs) and 25 family members (M_age = 40 yrs) were randomized to CBT (n = 13) or CBT+ FE (n = 12). DSM-IV eating disorder diagnoses were: 48% (n = 12) bulimia nervosa, 28% (n = 7) binge-eating disorder, and 24% (n = 6) eating disorder not otherwise specified. Effect sizes favored CBT + FE on adherence and retention, and scores on treatment satisfaction and therapeutic alliance were high, indicating treatment acceptability. In spite of the hypothesis that family outcomes such as support, familism, cohesion, pride, family cultural conflict, burden, and marital satisfaction (in couples) would be superior in CBT + FE, the preliminary data were inconclusive and results were mixed. The hypothesis that eating disorder outcomes including global eating psychopathology, binge eating, and purging would improve in CBT + FE was not supported. There was some evidence that patients in CBT improved more particularly on binge eating, otherwise the groups had no differences. In conclusion, the results suggest that CBT + FE could enhance treatment adherence and retention, although this did not automatically translate to better family and symptom outcomes.

Stigma of mental illness and cultural factors in Pacific Rim region: a systematic review

BACKGROUND

Although cultural factors play a crucial role in experience of stigma, there is scant review on the impact and importance of culture on stigma of mental illness across Pacific Rim Region. This study aims to investigate: 1) the cultural factors related to stigmatizing beliefs about mental illness in Pacific Rim region, and 2) culture-specific measures and interventions on stigma of mental illness.

METHODS

A systematic search of papers was conducted in the MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, Cochrane Library and Google scholar through January 2003 to April 2019.

RESULTS

Forty-one studies in Pacific Rim region which met the inclusion criteria were included in the study. The rate of stigma of mental illness (e.g., public stigma: from 25.4 to 85.2%) was relatively high in Pacific Rim region. Culture factors (e.g., Collectivism, Confucianism, face concern and familism, religion and supernatural beliefs) contributed to people's stigmatizing behaviors and attitudes toward persons with mental illness, their relatives and mental health professionals. Certain measurements were developed and employed to assess different type of cultural factors related to stigma of mental illness.

CONCLUSIONS

Cultural factors play an important role in influencing the rate and performance of stigma of mental illness. Further research on stigma of mental illness and culture-specific interventions to reduce the stigma should be conducted in the Pacific Rim region.

Evaluation of Public Health Messages Promoting Early Detection of Dementia Among Adult Latinos With a Living Older Adult Parental Figure

INTRODUCTION

We aimed to evaluate the resonance of public health messages promoting early detection of dementia in adult Latinos with a living older adult loved one.

METHOD

We conducted a mixed-methods study with focus groups and surveys to evaluate eight messages encouraging Latino adults to accompany their older loved one for cognitive assessment. Qualitative data were transcribed and coded, and thematic analysis was conducted. We used descriptive statistics for quantitative data.

RESULTS

Participants suggested that messages need to be translated into Spanish and images need to be more natural, present balance between positive and serious facial expressions, show more ethnic/racial diversity, and show family members other than the parents. Five major sociocultural themes affected how the messages were received: stigma, gender roles, the importance of the mother figure, guilt, and family togetherness.

CONCLUSION

Public health messages targeting cultural values are needed to effectively encourage early dementia detection in Latinos. Findings can be used to adapt culturally appropriate public health messages encouraging early dementia detection in Latinos.

Cultural competence and metaphor in mental healthcare interactions: A linguistic perspective

OBJECTIVES

The aim of this study is to understand how Spanish-speaking patients conceptualize mental health issues. This study uses a linguistic perspective to focus on how 23 Mexican-origin patients and their doctor talk about mental health during psychiatric interviews conducted in Spanish and how they negotiate cultural barriers.

METHODS

This work analyzes when the doctor and his patients reference metaphors (e.g. feeling "empty," feeling "low"). Metaphors are pervasive in all cultures and languages and reveal important information about people's attitudes and feelings about a range of conditions and circumstances.

RESULTS

This work demonstrates the role of metaphor and linguistic analysis in uncovering culturally based constructions of mental health. The results reveal that the doctor and patients reference different sets of metaphors, which, at times, causes miscommunication.

CONCLUSIONS

Practitioner awareness of how patients use metaphorical expressions in health is crucial for promoting advanced cultural and linguistic competence and ultimately, patient-centered care.

PRACTICE IMPLICATIONS

The main findings have implications for health communication with minority groups such as Spanish-speaking Latinos/as in the United States. Practitioners working with Spanish-speaking patients should be familiar with how Latinos/as conceptualize health and how to avoid or repair confusion caused by cultural barriers.

Parent-adolescent relationships in Hispanic versus Caucasian families: Associations with alcohol and marijuana use onset

Parent-adolescent relationship (PAR) factors such as social support and negative interactions are associated with initiation of alcohol and marijuana use during adolescence. However, few studies have examined whether the relationship between PAR, especially the paternal role, and substance use onset varies by ethnicity. This is important given that ethnic group differences have been related to alcohol and marijuana use, cultural values and parenting. This study examines whether ethnicity moderates the prospective prediction of substance use onset by PAR factors. The sample comprised 124 adolescents who self-identified as Hispanic and 795 adolescents who self-identified as non-Hispanic Whites, and was drawn from an ongoing longitudinal survey on adolescent substance use. Discrete-time survival modeling was used to prospectively predict age at onset of substance use among participants who were substance-naïve at baseline. Interactions between ethnicity and PAR factors indicated that PAR factors had a larger influence on age of alcohol and marijuana onset for Hispanics than for Caucasians. Among Hispanics, greater social support from and greater negative interactions with the father-figure were more predictive of earlier onset of alcohol, and greater social support from the mother-figure was more predictive of later alcohol onset, compared to Caucasians. Similarly, greater negative interactions with the father-figure were more predictive of earlier onset of marijuana use among Hispanics than among Caucasians. These findings suggest the influence of PAR on alcohol and marijuana use onset may be larger for Hispanics than for Caucasians. Incorporating these parenting factors in substance use prevention programs advances public health in a culturally sensitive manner that is relevant to at-risk Hispanic adolescents.

Using a Narrative Film to Increase Knowledge and Interpersonal Communication About Psychosis Among Latinos

Narrative communication is effective in increasing public awareness while generating dialogue about varied health topics. The current study utilized narrative communication in the form of a 15-minute motivational film titled La CLAve to help Latinos recognize symptoms of psychosis and begin a discussion about serious mental illness. The study aimed to explore the participants' response to the film and whether the film led to further dialogue about psychosis. Four focus groups were conducted with 40 Spanish-speaking participants, mostly foreign-born Latinas, with a mean age of 49 years. Results indicate that participants engaged with the film as reflected in their ability to recall the storyline in detail. Reports of psychosis knowledge gains included recognition of key symptoms, such as hallucinations and disorganized speech. Participants attributed symptoms of psychosis, observed in a film character, to social stressors and other previously constructed views of mental illness. Many participants discussed the content of the film within their immediate social networks. Other findings include discussions of key barriers and facilitators to seeking mental health treatment among Latino families, such as denial and family support. Results suggest that narrative films offer a promising strategy to stimulate dialogue about serious mental illness among Latinos.

Stigma experienced by people using mental health services in San Diego County

OBJECTIVE

This paper describes how individuals struggling with severe mental illness experience stigma along multiple dimensions including their experiences of discrimination by others, their unwillingness to disclose information about their mental health, and their internalization or rejection of the negative and positive aspects of having mental health problems.

METHODS

This cross-sectional study employs descriptive analyses and linear regression to assess the relationship between demographics, mental health diagnoses and self-reported stigma among people receiving mental health services in a large and ethnically diverse county public mental health system (n = 1,237) in 2009. We used the King Stigma Scale to measure three factors related to stigma: discrimination, disclosure, and positive aspects of mental illness.

RESULTS

Most people (89.7 %) reported experiencing some discrimination from having mental health problems. Regression analyses revealed that younger people in treatment experienced more stigma related to mental health problems. Women reported experiencing more stigma than men, but men were less likely to endorse the potentially positive aspects of facing mental health challenges than women. Although people with mood disorders reported more discomfort with disclosing mental illness than people with schizophrenia, they did not report experiencing more discrimination than people with schizophrenia.

CONCLUSIONS

Study findings suggest that the multidimensional experiences of stigma differ as a function of age, gender, and diagnosis. Importantly, these findings should inform anti-stigma efforts by describing different potential treatment barriers due to experiences of stigma among people using mental health services, especially among younger people and women who may be more susceptible to stigma.