Latinos are the largest minority in the United States, constituting roughly 54 million and making up 17% of the U.S. population. Latinos are also the fastest growing minority: the U.S. Census Bureau estimates that by the year 2030, the population may grow to nearly one fourth of the population . The Latino population is made up primarily by Mexicans (66.1%), Central and South Americans (14.5%), Puerto Ricans (9%), Cubans (4%), and other Hispanics/Latinos (6.4%).
The most debilitating health issue within the Latino community is depression. The most common depression among Latinos is major depression, which commonly starts early in life, usually before the age of 25 and leads to decreased productivity, poverty, as well as increased morbidity. Many never receive treatment for this illness, mainly due to the poor access to appropriate mental health care. Around 17.7% of Latinos suffer from depression during their lifetimes. Latinos generally experience depression in the form of bodily aches such as headaches and stomach pains, while other symptoms can include:
- Changes in sleeping and/or dietary patterns
- Cognitive problems, such as difficulty concentrating or remembering
These symptoms persist despite medical attention. The Latino community is less likely to receive care for depression in comparison to other minorities,: less than 1 in 11 seek help from mental health specialist and among immigrants, this is reduced to 1 in 20 . Among the latinos who do access mental health care, only 30% return for follow up visits.
Mental Health Status, Services, & Disparities
The main factors that affect Hispanic & Latino health care access and quality include:
- Lack of insurance: The rate for uninsured Hispanic & Latino individuals is as high as 33%, compared to 16% of all Americans. Due to these high rates of uninsurance, they are at greater risk for lacking basic access to healthcare. It has also been found that citizenship and immigration statusaffect health access and availability: an astounding 58% of non-citizen Latinos/Hispanics are uninsured.
- Lack of Latino personnel: According to NAMI, a survey conducted among 596 licensed psychologist APA members found that only 1% identified themselves as Latino. The Center of Medical Health Services also reported about 20 Latino mental health professionals for every 100,000 Latino individuals.
- Inadequate sources of treatment: Latinos are more likely to seek treatment of mental illness outside of mental health settings such as churches or general health care practitioners. A major problem in finding appropriate health care is not knowing where to seek treatment: because it is common that Latino culture views mental health symptoms as physical illnesses, they generally seek treatment in the general health sector.
- Immigration & Acculturation: It has been found that U.S. born Latinos have higher rates of mental illness than recent Latino immigrants. For example, Mexicans Puerto Ricans who have resided their countries of origin experienced lower rates of mental disorders than those living in the United States for less than 12 years. (CITE 9) Central and South Americans, however, bear an exception and have higher rates of mental illnesses, such as Post Traumatic Stress Disorder (PTSD) , in their countries of origin due to exposure to trauma and war.
The Mexican American Prevalence and Services Survey (MAPSS) reports that the most common barriers to receipt of mental health care services were:
- Lack of knowledge of where to seek treatment
- Lack of proximity to treatment centers
- Transportation problems
- Lack of available Spanish speaking providers who are culturally and linguistically trained to meet the needs of Latinos
Attitudes about mental illness and mental health services can affect the use of services, as well:
- For example, among some Latinos, depression may be mistaken for nervousness, tiredness or a physical ailment, and may be viewed as something temporary.
- Latinos’ reluctance to utilize mental health services can be described by the saying: “No se lava la ropa en casa ajena” (One must not wash their dirty clothes in someone else’s home). In other words, problems are handled within the family and should not be discussed or revealed outside of the home.
- Among Hispanics with a mental disorder, fewer than 1 in 11 contact a mental health specialist, while fewer than 1 in 5 contact general health care providers. Even fewer Hispanic immigrants seek these mental health services.
- While Latinos use mental health services less than the general population, rates of mental health service use among Latinos have increased
- Many Hispanics/ Latinos rely on their extended family,community, traditional healers, and/or churches for help during a mental health crisis.
- Estimates of the use of alternative and complementary therapies
- Several studies have found that bilingual patients are evaluated differently when interviewed in English as opposed to Spanish and that Hispanics are more frequently undertreated.
How Can We Fix This?
- Providers should understand that Latino narratives include different past experiences, including trauma, injury, and social isolation. They should foster empowerment in an effort to awaken a social consciousness within Latinos.
- Application of a culturally sensitive psychotherapeutic model.
- Programs and models that include a life course approach will enable practitioners and organizations to understand the effects of resource disparities, racism, and other hardships that impact the mental health of Latinos.
Health care training
- Train health providers to better understand and identify Latino specific symptoms.
- Providers should be trained to understand the stigma related to mental health problems among the Latino community.
- Develop instrumentation specific for Latinos.
- Develop a sense of “confianza” (confidence, trust) between the health provider and Latino patient.
- Utilization of an outreach program to educate Latinos on mental health issues.
- Providers and outreach can be linked in order to provide a better experience regarding health care.
- Outreach can also assist in health care appointments.
- serving as translators rather than the patient’s child or other family members
- can also possibly alleviate the transportation barrier as outreach is closely linked to the patient's’ community.
- Mental health hotlines must have Spanish speaking staff and bilingual messaging.
- More close-knit work with Spanish language media to spread outreach and education as much as possible.
- Develop treatment programs, such as rehabs, to have culturally relevant treatment programs as well as staff designed for Latinos and their needs.
- Mental health diagnostic scales should be adapted to meet the needs of Latinos.
- "United States". United States Census Bureau. United States Census Bureau.US Census. (2008) Income, Poverty, and Health Insurance Coverage in the United States: 2007. www.census.gov/prod/2008pubs/p60-235.pdf
- US Census. (2003) Summary Tables on Language Use and English Ability: 2000. www.census.gov/population/www/cen2000/briefs/phc- t20/index.html
- Alegria M, et al. (2007) Prevalence of psychiatric disorders across Latino subgroups I the United States
- Hough, R.L., J.A. Landsverk, and M. Karno. (1987). Utilization of health and mental health services by Los Angeles Mexican-American and non-Latino whites. Archives of General Psychiatry, 44, pp: 702-709.
- Schoenbaum, M., J. Miranda, and C. Sherbourne, N. Duan, K. Wells. (2004). Cost effectiveness of interventions for depressed Latinos. Journal of Mental Health Policy Economics, 7: pp. 69-76.
- U.S. Bureau of the Census. (March 2003). The Hispanic Population: Census 2003 Brief. U.S. Department of Health and Human Services. Office of the Surgeon General. Substance Abuse and Mental Health Services Administration (2001). Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General. (SMA)-013613. <http://SAMSHA.gov>
- Acculturation can be defined as the process of adapting to a new culture as a result of changes in cultural attitudes, values, and behaviors that come from being in contact with two or more distinct cultures (Barlow, Taylor & Lambert, 2000).
- U.S. Department of Health and Human Services. Office of the Surgeon General (2001). Mental Health Care for Hispanic Americans. In Mental health: culture, race, and ethnicity. A supplement to mental health: A report of the Surgeon General. SAMHSA