Cultural and linguistic considerations in psychodiagnosis with Hispanics: the need for an empirically informed process model

Successful validation of the CAT-MH Scales in a sample of Latin American migrants in the United States and Spain

We examined cultural differences in the item characteristic functions of self-reported of symptoms of depression, anxiety, and mania-hypomania in a Latino population taking Computerized Adaptive Tests for Mental Health (CAT-MH) in Spanish versus a non-Latino sample taking the tests in English. We studied differential item functioning (DIF) of the most common adaptively administered symptom items out of a bank of 1,008 items between Latino (n = 1276) and non-Latino (n = 798) subjects. For depression, we identified 4 items with DIF that were good discriminators for non-Latinos but poor discriminators for Latinos. These items were related to cheerfulness, life satisfaction, concentration, and fatigue. The correlation between the original calibration and a Latino-only new calibration after eliminating these items was r = .990. For anxiety, no items with DIF were identified. The correlation between the original and new calibrations was r = .993. For mania-hypomania, we identified 4 items with differential item functioning that were good discriminators for non-Latinos but poor discriminators for Latinos. These items were related to risk-taking, self-assurance, and sexual activity. The correlation between the original and new calibration was r = .962. Once the identified items were removed, the correlation between the original calibration and a Latino-only calibration was r = .96 or greater. These findings reveal that the CAT-MH can be reliably used to measure depression, anxiety, and mania in Latinos taking these tests in Spanish. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Hispanic Stress Inventory Version 2: Improving the assessment of acculturation stress

This article reports on a 2-phase study to revise the Hispanic Stress Inventory (HSI; Cervantes, Padilla, & Salgado de Snyder, 1991). The necessity for a revised stress-assessment instrument was determined by demographic and political shifts affecting Latin American immigrants and later-generation Hispanics in the United States in the 2 decades since the development of the HSI. The data for the revision of the HSI (termed the HSI2) was collected at 4 sites: Los Angeles, El Paso, Miami, and Boston, and included 941 immigrants and 575 U.S.-born Hispanics and a diverse population of Hispanic subgroups. The immigrant version of the HSI2 includes 10 stress subscales, whereas the U.S.-born version includes 6 stress subscales. Both versions of the HSI2 are shown to possess satisfactory Cronbach's alpha reliabilities and demonstrate expert-based content validity, as well as concurrent validity when correlated with subscales of the Brief Symptom Inventory (Derogatis, 1993) and the Patient Health Questionnaire-9 (Kroenke, Spitzer, & Williams, 2001). The new HSI2 instruments are recommended for use by clinicians and researchers interested in assessing psychosocial stress among diverse Hispanic populations of various ethnic subgroups, age groups, and geographic location. (PsycINFO Database Record

Using Qualitative Methods for Revising Items in the Hispanic Stress Inventory

Despite progress in the development of measures to assess psychosocial stress experiences in the general population, a lack of culturally informed assessment instruments exist to enable clinicians and researchers to detect and accurately diagnosis mental health concerns among Hispanics. The Hispanic Stress Inventory (HSI) was developed specifically for Hispanic adults, however, significant social and geopolitical changes over the past two decades have affected the types and intensity of stress experienced by Hispanics. Immigration related policy changes, for example, affect stress experiences among newer immigrants from Mexico and other Latin American countries in ways that items in the original HSI may no longer capture the full range of today’s stressors. Using expert interviews from Hispanic mental health experts and data gathered in 16 community-based focus groups at two distinct study sites, the goal of the current study was to identify new item content to include in a revised HSI. Using content analysis of all interview data, a total of 155 new stressor items and seven unique stress domains were generated. Content validity analysis using Kappa coefficient reveal high interrater validity for new HSI item content. Findings are described in depth, and recommendations for future research are identified.

Comparing the rates of mental disorders among different linguistic groups in a representative Canadian population

PURPOSE

We aimed to determine whether linguistic group influences reported prevalence rates for a number of common mental disorders.

METHODS

Secondary data analyses of the Canadian Community Health Survey cycle 1.2 (CCHS 1.2) were carried out on representative bilingual French and English, monolingual French and English and other language groups in Canada. Past year prevalence of major depression, anxiety disorders (agoraphobia, social phobia, panic disorder) and alcohol abuse/dependence were ascertained using versions of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) questionnaire. Multivariate data analyses were used to model past year presence of a mental disorder as a function of linguistic group, defined as languages can converse in, and adjusting for socioeconomic, demographic and cultural factors.

RESULTS

Overall, past year rates for the presence of a common mental disorder were 10.7% (9.7-11.7%) for the bilingual English; 9.0% (8.1-9.9%) for the bilingual French; 10.2% (9.8-10.6) for the monolingual English; 8.5% (7.7-9.3%) for the monolingual French; and 8.3% (6.1-10.4%) for the other language group. After adjusting for a number of socio-demographic, economic and cultural factors, the multivariate analyses showed that the linguistic groups were equally likely to report the presence of a past year common mental disorder. This was also true for comparisons between the bilingual participants responding in French and English.

CONCLUSIONS

The differences observed in the reported crude rates for the presence of mental disorders across the different linguistic groups in Canada were explained by socio-demographic, economic, and factors such as immigration, spoke a third language and province of residence, and not explained by language of interview.

Disparities in treatment for substance use disorders and co-occurring disorders for ethnic/racial minority youth

OBJECTIVE

To review the literature on racial and ethnic disparities in behavioral health services and present recent data, focusing on services for substance use disorders (SUD) and comorbid mental health disorders for children and adolescents.

METHOD

A literature review was conducted of behavioral health services for minority youth. Articles were included if specific comparisons in receipt of SUD services for youth were made by race or ethnicity. The review was organized according to a sociocultural framework.

RESULTS

Compared with non-Latino Whites with SUD, Black adolescents with SUD reported receiving less specialty and informal care, and Latinos with SUD reported less informal services. Potential mechanisms of racial and ethnic disparities were identified in federal and economic health care policies and regulations, the operation of the health care system and provider organization, provider level factors, the environmental context, the operation of the community system, and patient level factors. Significant disparity decreases could be achieved by adoption of certain state policies and regulations that increase eligibility in public insurance. There is also a need to study how the organization of treatment services might lead to service disparities, particularly problems in treatment completion. Institutional and family characteristics linked to better quality of care should be explored. Because treatments appear to work well independent of race/ethnicity, translational research to bring evidence-based care in diverse communities can bolster their effectiveness.

CONCLUSIONS

This review suggests promising venues to decrease ethnic and racial disparities in behavioral health services for ethnic and racial minority youth.

One size does not fit all: taking diversity, culture and context seriously

Evidence suggests that the current mental health system is failing in the provision of quality mental health care for diverse children and families. This paper discusses one critical domain missing to improve care: serious attention given to diversity, culture, and context. It discusses what we mean by understanding culture and context at the individual, family, organizational, and societal level. Focusing on key predictors of children's adjustment in natural contexts would increase attention to building community and family capacities that strengthen children's mental health. To conclude, we suggest changes in organizational culture to build natural supports to enhance children's mental health.

Testing language effects in psychiatric epidemiology surveys with randomized experiments: results from the National Latino and Asian American Study

To evaluate the prevalence of mental disorders for persons of non-English-language origin, it is essential to use translated diagnostic interviews. The equivalence of translated surveys is rarely tested formally. In the National Latino and Asian American Study (NLAAS), the authors tested whether a carefully translated mental health survey administered in Spanish produced results equivalent to those obtained by the original English version, using a randomized survey experiment. The NLAAS is a nationally representative survey carried out in the United States in 2002-2003. Bilingual respondents from the Latino section of the NLAAS (n = 332) were randomly assigned to receive either a Spanish- or English-language version of the World Mental Health Survey Composite International Diagnostic Interview. In tests of differences in lifetime and 12-month prevalences of 11 diagnoses and four higher-order aggregate disorder categories, in only one case was there an apparent difference between randomized language groups: Lifetime reports of generalized anxiety disorder were more prevalent in the bilingual group assigned to English than in the group interviewed in Spanish. Detailed follow-up analyses did not implicate any specific question in the generalized anxiety disorder protocol. Translation and back-translation of surveys does not guarantee that response probabilities are exactly equivalent. Randomized survey experiments should be incorporated into cross-cultural psychiatric surveys when possible.

Perspectives on disparities in depression care

Depression is a major public health problem and a leading cause of disability worldwide. Compounding the high rates of morbidity and mortality and treatment challenges associated with depression are the tremendous disparities in quality of mental health care that exist between the majority of the population and those of racial and ethnic minorities. Although more study data are available on depression care for African Americans than for other groups, racial and ethnic minorities overall are less likely than whites to receive an accurate diagnosis, to receive care according to evidence-based guidelines, and to receive an antidepressant upon diagnosis. Multiple factors contribute to these disparities, among them socioeconomic and cultural issues and prejudices among patients and health care providers. Closing the gap that exists between what depression care is and what depression care could be begins with clinicians' recognizing the relevance of culture to care. Opportunities exist within the broader context of medical education, including continuing medical education (CME), to prepare health care professionals to address the myriad issues related to managing depression.

Clinical algorithms as a tool for psychotherapy with Latino clients

Clinical algorithms have the advantage of being able to integrate clinical, cultural, and environmental factors into a unified method of planning and implementing treatment. A model for practice is proposed that uses 3 algorithms as guides for conducting psychotherapy with Latino clients, the uses of which are illustrated in a single, ongoing case vignette. The algorithm format has the additional advantage of easily adapting itself for data gathering for research purposes.

Use of the MMPI-2 in American Indians: I. Comparability of the MMPI-2 Between Two Tribes and With the MMPI-2 Normative Group

The comparability of the MMPI-2 in American Indians with the MMPI-2 normative group was investigated in a sample of 535 Southwestern and 297 Plains American Indian tribal members with contrasting sociocultural and historical origins. Both American Indian tribal groups had clinically significant higher T scores (> 5 T points) on 5 validity and clinical scales, 6 content scales, and 2 supplementary scales than did the MMPI-2 normative group. There were no significant differences between the 2 tribal groups on any of the MMPI-2 clinical, content, or supplementary scales. Matching members of both tribes with persons in the MMPI-2 normative group on the basis of age, gender, and education reduced the magnitude of the differences between the 2 groups on all of these scales, although the differences in T scores still exceeded 5 T points. It appears likely that the MMPI-2 differences of these 2 American Indian groups from the normative group may reflect their adverse historical, social, and economic conditions.