Ethnicity and Health in America Series:
Mental Health among Latina/o Populations

In recognition of National Hispanic-Latino Heritage Month, OEMA is partnering with the Washington, D.C. Office of Latino Affairs to raise awareness concerning mental health and treatment considerations among Latino populations with special attention given to Hispanic-Latino women. Contextual factors, such as poverty and limited access to resources have been associated with poorer health and mental health vulnerabilities. In general, women of color are more likely than their Caucasian counterparts to experience poverty and limited access to resources, which contribute to the mental health vulnerabilities faced by many Hispanic-Latino women. For instance, discriminatory practices in access to health care and treatment means that the progression of mental health disorders is often more severe among Latinas and other women of color. Thus, it is important to view mental health among Latinas within a larger institutional context of racism, discrimination, political oppression, unemployment and poverty, along with cultural factors such as language barriers, acculturation level, length of stay in the United States and frequently citizenship status.

Following is a collection of articles from psychologists who are experts in the field of mental health among Latino populations. We start with an article by Gallagher-Thompson, Tazeau and colleagues, which highlights some factors that contribute to depression among a specific population of Latinas. Results of this article underscore the necessity of considering contextual/cultural factors in devising culturally relevant and effective treatments for this population. This is followed by a recent article by Santiago-Rivera and colleagues, which explores similar contextual/cultural considerations in order to identify factors that can increase mental health treatment adherence among a population of Latino immigrants who are suffering from depression. Acevedo-Polakovich and colleagues extend the discussion of treatment considerations for Latina/o populations to identify approaches to creating culturally-responsive service organizations, which can facilitate the development and sustainability of effective, culturally responsive practices and practitioners. Finally, Gallardo examines some of the specific ways in which culturally responsive skills are implemented within a therapeutic context (i.e., establishing the initial therapeutic relationship) to emphasize the importance of a culturally-oriented mindset when mental health professionals are working with Latino/a populations. Prefaces by the primary authors are provided before each article.

Latina Mental Health

Elderly Mexican-American women and the intersection of acculturation and depression
Gallagher-Thompson, D., Tazeau, Y.N., Basilio, L., Hansen, H., Polich, T., Menendez, A., & Luz Villa, M. (1997). The relationship of dimensions of acculturation to self-reported depression in older, Mexican-American women.Journal of Clinical Geropsychology, 3(2), 123-137.

Preface by Yvette N. Tazeau, PhD: This is an often cited study which explored depression among elderly Mexican American women article and found that an important aspect of acculturation — language usage — plays a major role in depression for this population. Language usage and the extent of social interactions with mainstream culture were highly predictive: elderly Mexican-American women with less mainstream language usage were more likely to be depressed. (In contrast, identification with traditional cultural values did not predict depression in the sample.) Possibly, these women can feel less lonely and less socially isolated if they can socialize more with English-speaking members of the mainstream culture. The study reminds us that the relationship between self-reported depression and various aspects of acculturation is complex and not always easily explained.

Treatment Considerations for Latina/o Populations

The Treatment of Depression among Latino Immigrants
Santiago-Rivera, A.L., Kanter, J.W., Busch, A.M., Rusch, L.C., Reyes, W., West, P., & Runge, M. (2011). Latino immigrants with depression: An initial examination of treatment issues at a community clinic. Journal of Immigrant and Minority Health,13(4), 772-779.

Preface by Azara Rivera-Santiago, PhD: The underutilization of mental health services among Latino populations has been identified as a major health concern for this population. To address this concern there have been efforts to integrate culturally responsive psychological services into community-based comprehensive health care clinics, with the goal of increasing access to mental health services and keeping Latinos in treatment. This study is an attempt to identify barriers to treatment adherence in a population of Latino immigrants diagnosed with depression. Results of the study suggest providing comprehensive services in which clients can receive psychological treatment and psychopharmacological medications in the same setting may be most effective in retaining Latino clients in treatment for depression. These findings may be particularly useful in helping to guide community-based agencies in developing service delivery alternatives that are particularly relevant for Latino populations.

Increasing Mental Health Service Parities among Latina/o Populations
Acevedo-Polakovich, I. D., Crider, E., Kassab V.A., & Gerhart, J.I. (2011). Increasing Service Parity Through Organizational Cultural Competence. In L. Buki & L.M. Piedra (Eds.). Creating Infrastructures for Latino Mental Health (pp.79-98). New York, NY: Springer.

Preface by I. David Acevedo-Polakovich, PhD: Even when behavioral health conditions are roughly equally prevalent across ethnic groups in the United States, Latinas/os and other U.S. ethnic minority groups have fewer accessible mental health services available to them compared to European Americans. A consequence of these service disparities is that the same conditions lead to greater impairment among ethnic minority groups than they do among European Americans. Our chapter, Increasing Service Parity through Organizational Cultural Competence, included in Lydia Buki and Lizette Piedra’s recent book, Creating Infrastructures for Latino Mental Health, provides guidance on how to understand and address disparities within service organizations.

Disparities arise from a fundamental incompatibility between the ways in which ethnic minority groups and health and human services organizations understand behavioral health. While other scholars have made important strides delineating the characteristics of culturally-responsive practitioners and of culturally-responsive interventions, this chapter describes approaches to creating culturally-responsive service organizations, which are necessary for culturally-responsive practitioners and practices to experience success and sustainability.

The approach to cultural-responsiveness described in our chapter looks to local conditions rather than broad generalizations about ethnic and cultural groups (i.e., stereotypes). This focus allows providers, administrators and policy makers to meaningfully consider important issues often overlooked by generalized approaches, such as the diversity within ethnic communities and the needs of cultural groups whose local relevance is greater than their national representation (whether they be Salvadorans in Washington, D.C. or Chaldeans in Metro Detroit). Our goal is to provide a resource for professionals who wish to ensure that the mental health needs of U.S. Latinas/os and other ethnic minority groups no longer go misunderstood and unmet.

Cultural Considerations when Working with Latina/o Clients
Gallardo, M.E. (2012). Context and culture: The initial clinical interview with the Latina/o client. Journal of Contemporary Psychotherapy, 10.1007/s10879-012-9222-8.

Preface written by Miguel E. Gallardo, PhD: As Latina/o communities continue to grow in the United States, we can no longer assume that to know one means we understand all. Latina/o communities consist of heterogeneous groups in terms of ethnicity, physical appearance, cultural practices, traditions and Spanish language dialects (Comas-Díaz, 2001; Santiago-Rivera, Arredondo, & Gallardo-Cooper, 2002). Latinas/os are a diverse group of multigenerational immigrants from different Spanish-speaking countries as well as long-term residents. We are also very diverse in terms of national origin, level of acculturation, length of residency in the United States, socioeconomic status, and other demographic variables. Before we can begin addressing the needs of Latina/o communities, it is critical that our dialogue reexamine how culturally responsive skills are implemented within a therapeutic context and the notion of culture within the profession. Specifically, a culturally-oriented mindset must take precedence over behavioral skill sets. In fact, attempting to acquire a behavioral skill set, which is most likely based on static cultural characteristics of communities, potentially creates a situation where well-intentioned therapists unintentionally violate ethnocultural clients. Additionally, incorporating client and clinician voices to understand what works and why is essential (Kazdin, 2008).

This article addresses contextual and cultural principles, particularly when establishing the initial therapeutic relationship with Latinas/os, which can be implemented across any therapeutic orientation or clinical interview structure. Reports feature data from a subset of participants (n = 27) that self-identified as bilingual, bicultural, and highly culturally competent from a larger mixed-methods study of 89 Latina/o therapists. The results support the utility of personalismo, respeto, charlar (small talk), language usage, education, and self-disclosure in building respectful relationships, and in conducting the initial interview, with Latina/o clients. These findings are highly consistent with the common factors literature and lend further support to the proposition that the therapeutic relationship serves as the base for therapeutic interventions across all cultures.