Mental Health Service for Latino/as
Abstract
The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Mental health is thus vital for the well-being of a population. Latinos form a unique component of the more extensive American residents. Their historical background separates them from most other minority ethnic groups. However, .research has shown that the proportion of Latinos with mental health problems is no different from that of the non-Hispanic white population. Nonetheless, equal arrays of studies have demonstrated how the Hispanic population is disadvantaged in the uptake and consumption of mental health services. Part of the reason why the Latino populations poorly utilize mental health services could be embedded in their socio-cultural and religious dynamics. Furthermore, the Latino population’s assimilation into American society could have an impact on their health-seeking behaviors. This study aims to determine how the socio-cultural factors and acculturation influence the utilization of mental health services amongst the Latinas. Identification of a problem and its root cause is the initial step towards addressing it. The study would thus help practitioners and policymakers to understand the basis of the reduced utilization of mental health services and effectively solve the conundrum. The study will be a quantitative one, and the study population shall be the Latino population in various states in the US. Latinos will be defined as persons who can trace their origins to Mexico, Puerto Rica, Salvador, Guatemala, Cuba, or the Dominican Republic. Data collected will be entered in excel then exported to SPSS for analysis. Chi-square will be used to test the association between variables.
Mental Health Services for Latinos
Introduction
Background Information
The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Over the past few decades, mental health has received the attention and recognition that it sourly lacked in the past. Improvements and rapid evolutions in the medical field have made the diagnosis and management of psychiatric conditions, more robust and patient-oriented. Generally, the advances have increased the penetration of knowledge in mental wellness. While the stigma associated with these conditions is still existent hitherto, it is, to a great extent, less than what was experienced in prior ages. It is feasible to openly converse on matters of mental health, a phenomenon that would be unimaginable not so long ago. This openness has made it possible to collect critical data that shape and dictate various policies and changes in the field of psychiatric medicine.
The United States of America is a dynamic nation with people from different cultural, historical, social, and economic backgrounds. Whereas the vast majority of the American populace is white, people of color constitute a vital thread in society’s fabric. Together, they form the ethnic minority of the country and include predominantly African Americans and Latinos. The challenges that face these minorities are universally documented. Indeed, their general well-being form critical elements of American history. One of the most vital components of such an account is the state of health they find themselves in, including, but not limited to, mental health. In this aspect, the Hispanic populations form an attention-grabbing focus.
Statement of the problem
Research has shown that the proportion of Latinos with mental health problems is no different from that of the non-Hispanic white population. Similarly, equal arrays of studies have demonstrated how the Hispanic population is disadvantaged in the uptake and consumption of mental health services. For instance, only eleven percent of Mexican Americans seek professional help in dealing with psychiatric problems, compared to twenty -two percent of the white population (DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2001). Furthermore, the proportion of Latin Americans seeking psychiatric help from mental health specialists is also alarmingly low. A 2017 research showed that an average of 1 out of 10 Latinos with a mental disorder seek mental health services from general healthcare providers, while 1 out of 20 receives similar services from a mental health specialist (Rastogi et al. 2012). The absolute number of Hispanic-speaking Americans has been increasing over the years. It is projected to constitute roughly thirty percent of the entire population by 2060 (Mental Health America, n.d.) If the weak trend in health-seeking behavior is transferred to posterity, a significant proportion will thus be in a deplorable state of mental health and, the ripple effects would be felt far and wide.
Part of the reason why the Latino populations poorly utilize mental health services could be embedded in their socio-cultural and religious dynamics. Unlike the greater American community, the Latinos tend to operate within the confines of tightly bound familial structures (DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2001). Whereas this has been inculcated by their shared historical origins and societal struggles, it could hold the key for critical reasons as to why their health-seeking behavior is sharply distinguished from that of the white population. Their deep religious affiliations have also been touted as a possible explanation of their behavior (Caplan, 2019, p. 7). Elucidating how and why these factors influence their perception of mental health, thus health-seeking behavior is vital in maintaining their well-being.
Furthermore, the Latino population’s assimilation into American society could have an impact on their health-seeking behaviors. The Latino population is unique in that the combinations of factors leading to their settlement in the USA would ordinarily predispose them to develop psychiatric diseases. However, studies have been in congruence with the fact that this population does have a lower prevalence of mental health issues (Cabassa, Zayas, & Hansen, 2006, p. 321). Whereas the prevalence of mental illness fails to vary between Hispanics and white Americans, overwhelming data reveals a difference in the prevalence between those born in the USA and those born in the Latin nations like Mexico. Also, there is a direct correlation between the number of years spent in the USA and the development of these diseases (DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2001). These statistics point to the possibility of acculturation being an etiological cause of mental illnesses. Thus, it is imperative to evaluate if this causation has any links to the population’s health-seeking behaviors.
Research Purpose
General-purpose
To determine how the socio-cultural factors and acculturation influence utilization of mental health services amongst the Latinas
Specific purpose
To determine how family unit, gender roles religious activities and acculturation affect the utilization of mental health services amongst the Latinas
Justification of the study
Identification of a problem and its root cause is the initial step towards addressing it. The study will help practitioners and policymakers to understand the basis of the reduced utilization of mental health services and thus effectively solve the conundrum. Additionally, problem identification will lead to a more focused approach to deconstructing the myths and misconceptions that may be culture or religious-bound, thus helping the target population comprehend mental health better. Also, the study could go a long way in shaping the social, economic, and environmental factors, both physical and built, to mitigate their effects on the development of psychiatric diseases amongst the Latinos. Considering that the population of the focus group is projected to constitute a significant proportion of the American populace in the foreseeable future, the study will play a critical role in ensuring the nation stays healthy and ready to focus on activities that would have profound benefits to its economy
Research questions
- How does the family unit influence utilization of mental health services amongst the Latinos?
- What is the impact of religious beliefs on the utilization of mental health services amongst the Latinos?
- What role does gender play in the utilization of mental health services amongst the Latinos?
- What role does acculturation play in influencing the utilization of mental health services amongst the Latinos?
Hypothesis
Cultural values and acculturation influence mental health service utilization among Latin-Americans
Conceptual framework
| Acculturation |
Literature review
Cultural values and mental health
Historical context
The Hispanic speaking proportions of the USA have varied historical origins. By far, the largest of the group originally came from Mexico. The Mexicans constitute approximately sixty-five percent of the Latinos in America. Persons of Puerto Rican origin make up slightly more than nine percent of the group. In contrast, people from Salvador, Cuba, Dominica, and Guatemala all comprise less than four percent of the total population (Mental Health America, n.d.). Circumstances surrounding their immigration to America vary, yet all seem to converge along themes of political instability and search for greener pastures. In essence, members of these communities are firmly bound by their historical origins. Not only that, but they also share the Spanish language and tend to have similar cultural setups in one way or the other. Furthermore, the process of migrating from their countries of origin is also typical for the group. However, with time, the original immigrants have grown in number, and the numbers of those born in the USA supersedes that of the original immigrants (DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2001). Still, the Hispanics would more aptly consider themselves a big family.
The family unit
The concept of family trickles down to the primary units. Unlike the white population, Hispanics tend to have stronger attachments to their families. These units represent not only their biological similarities but also a representation of a social group with similar struggles and the shared immigration experience. As such, the Latinos rarely go past these units. It is rare to find Latinos living in isolation (DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2001). This seemingly strong sense of belonging to a family unit, whether nuclear or extended, has been termed familismo.
Among the Latinos, especially adolescents and young adults, familismo plays a fundamental role in the running of day to day activities. The family units play critical roles in the perception and management of mental health within the population (Corona et al. 2017, p. 64). In their discussion, they argued that parental support limited the impact of cultural stressors on Latino students’ mental health. For instance, the students experiencing restrained parental support and a rise in acculturative stresses were more likely to develop symptoms related to stress and depression (Kapke & Gerdes, 2016, p. 332). Maintaining family orientation and a sense of connectedness was deemed vital to the wellness of this community.
Some scholars have divided the concept of familismo into three components for deeper understanding. They include familism support, familism referent, and familism obligations. Familism obligation involves the provision of tangible assistance to the family member. Familism support is the longing to keep close relationships, whereas familism referent is conducting oneself in a manner that is coherent to the expectations of the family (Corona et al. 2017, p. 64). Even though some of these components are beneficial, others are destructive. For instance, Kapke & Gerdes argued that supportive and referent values were useful as they led to low levels of depression. However, obligatory values were detrimental. With the adolescents maturing and taking up responsibilities, a relationship between the added responsibility and obligatory familism ideals increased psychological illnesses. Therefore, in a way, familismo could contribute to the development of mental illness.
However, familismo could also hinder the uptake of mental health services. The strong sense of responsibility towards family members prohibits the Hispanics from engaging in communications that touch on their members’ mental health (DeFreitas, Crone, DeLeon, & Ajayi, 2018, p. 11). Whereas they view this as a form of protection to the ill, the practice generates stigma around mental health. Directly, it also seems to influence their health-seeking behavior, as it would prohibit them from speaking to health care workers whom they consider outsiders in the family setup. Furthermore, older adults have a sense of responsibility in taking care of those below them. Studies have shown that these adults become ashamed of their mental health conditions, for they interpret the situation as having failed their respective families (DeFreitas, Crone, DeLeon, & Ajayi, 2018, p. 11). Besides, research has shown that the Hispanic population prefers being treated by fellow Latinos. The study above found that Latinos may fail to take up mental health services due to the belief that clinicians do not understand their backgrounds hence the origins of their conditions. Similarly, the study found that compared to the white population, less than half of Hispanics would attend subsequent sessions once attended to by a non-Hispanic health care provider. Besides, Latinos are majorly bilingual, speaking both English and Spanish or monolingual in speaking Spanish alone. A language barrier can thus crop up in an attempt to utilize mental health services. Only 1% of psychologists identify themselves as being of Hispanic origin. It, therefore, becomes quite evident that some aspects of the family set up in the Latinos could influence their understanding of psychiatric conditions and determine their propensity to seek professional help.
Religious beliefs
Religion has widely been regarded as a protective factor against mental illnesses among young Latinos (Corona et al. 2017). In essence, the community believes religious fidelity safeguards against mental disorders. Previous studies also show the critical role religiosity plays among Latina adolescents by promoting their psychological well-being. While focusing on depression and suicidal attempts, the scholars observed that those who were deemed to be more religious suffered fewer symptoms in general.
However, emerging research proves religion could be a significant undoing in the fight against mental illnesses. Many Hispanics believe psychiatric conditions are a consequence of inadequate faith in a supreme being (Caplan, 2019, p. 6). Under these circumstances, the net effect would be stigmatization of the affected, who would, in turn, shy away from seeking help for fear of being reattributed. Other beliefs like mental illnesses being a result of possession by evil spirits or punishment for parents’ wrongdoing would have similar ripple effects. Furthermore, the very notion of prayer alone being sufficient in managing mental illnesses would make patients hesitate in seeking professional help and lead to more suffering. Therefore, religion could be a double-edged sword. Whereas it has been touted as protective, some of the beliefs could do more harm than good to mentally ill patients.
Traditional gender roles
Gender roles could influence health-seeking behavior. The Latino culture accentuates virginity, male subservience, self-sacrifice, and motherhood. The culture dictates that males have to demonstrate their authority over females, be the head of their families as well as breadwinners (Corona et al. 2017). Despite higher levels of religiosity and familismo linked to reduced mental disorders, scholars have shown that higher endorsement of traditional gender role feelings among Latino adolescents translates to increased mental health problems (Corona et al. 2017). The study observed that adhering firmly to gender roles is associated with rising cases of depressive issues among college students. However, the roles could have bidirectional effects. Emerging data demonstrate that males are less likely to utilize mental health services compared to females. Yet, it has not been established why this could be so. Nonetheless, the strong definitions of gender roles amongst the Latinos warrant its consideration as a causative mechanism.
Acculturation
As stated earlier, the historical background of the Hispanic population makes them a unique entity. The realization that differences exist between rates of mental illnesses in Latinos born in the USA and those born in their original countries point to the effect of acculturation. Also, the length of stay in the states has shown a direct correlation. Hispanics who have stayed in the USA for more than thirteen years have significantly increased cases of mental illnesses than those who stayed for less than the said time. Data on the effect of acculturation on health-seeking behavior is unavailable. However, given the challenges and limitations that minority ethnic groups have faced over the years, it would be noteworthy to examine any correlation.
Empirical review
Various scholars have delved into the topic, with each taking a different but related approach. Mendoza, Masuda & Swartout, in their 2015 assessment, covered the concepts of assistance-seeking attitudes, self-concealment, and stigmatization associated with Mental health services. In terms of help-seeking positions, Mendoza et al. observed that females were more likely to seek counseling than men. However, the factors influencing this predisposition were not explored. The same study further argued that self-concealment was inversely related to help-seeking attitudes. As illustrated above, family units and religious beliefs work in complex ways towards forming stigma within the Hispanic population. However, there is no data to indicate the exactness of this statement. Furthermore, acculturation has been touted as an etiological agent in the development of psychiatric disorders (DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2001). The effect of this assimilation in the broader context of Latinos’ health-seeking behaviors has not yet been explored. Therefore, this study aims to fill the knowledge gap. The study would provide a solid foundation upon which further research and government policies can be hinged by getting how family, religion, and acculturation interact to limit the utilization of mental health services. This would go a long way in guaranteeing universal health care as demanded by the World Health Organization but highlighting the probable barriers to proper health-seeking behaviors. In a particular way, it would have played its part in leveling the field for a significant proportion of the ethnic minority.
Methodology
Research design
The research will be a quantitative one as it would analyze the relationship between abstract concepts where cultural factors and acculturation will be linked to the utilization of mental health services. It will also be a cross-sectional study as it would analyze a single case and its relation to several variables from which a relationship would be derived. This method is suitable as it enables data collection without direct researcher observation. It would thus be possible to deduce, if any, the effect of family, religion, gender, and acculturation on the health-seeking behaviors of the Latinos.
Study population
The study population shall be the Latino population in various states in the US. Latinos will be defined as persons who can trace their origins to Mexico, Puerto Rica, Salvador, Guatemala, Cuba, or the Dominican Republic. The inclusion criteria will be any Latino who would consent to be involved in the study and can either read or effectively communicate by speech. The exclusion criteria will be any Non-Hispanic individuals and Hispanic individuals who don’t consent to the survey or cannot communicate due to one reason or the other.
Sampling size determination
Cochran formula of 1963 will be used after adjustment using the finite formula to determine the sample size
Sampling technique
Convenient sampling would be used. This will enable individuals who are easily accessible to participate in the study. The sample size shall be a representation of the whole Hispanic-speaking community as subjects will be randomly picked. However, the study will be limited as it would not factor in aspects of socioeconomic and geographical differences in evaluating their relationship to the dependent and independent variables. These aspects shall, therefore, not be accounted for. The independent variable shall be the failure to utilize mental health services, while dependent variables shall be the cultural and acculturation effects.
Study site
The study shall be performed in public places such as the streets, malls, restaurants, and parks where subjects can quickly be interviewed.
Anticipated problems in sampling
Some subjects may identify themselves as belonging to the Latino population but fail to recognize their ancestral countries of origin. For purposes of clarification, such subjects will not be considered in the study.
Data collection
Data collection tools
A self-made questionnaire will be used to collect data. There will be two forms, one written in English and another in Spanish. Upon establishing the language, a subject is comfortable with; the appropriate questionnaire will be issued. The questionnaire will have both open-ended and closed questions. The first part will establish patient details like age, sex, residence, and country of origin. The other sections will be divided into four parts, representative of the family set up, religion, gender, and acculturation factors. Those who will not be able to read will be orally asked the questions on the questionnaire by the interviewer. Both processes are expected to take a maximum of ten minutes.
Data collection procedure
Interviewers will approach a person of color and introduce themselves and the study. They would then request for consent to ask questions concerning the survey. The first step would be to identify whether the subject is Latino or not. If the answer is positive, the interviewer will request to know the language the subject is comfortable with. Afterward, the subject’s ability to read and write will be determined from where either a questionnaire will be administered, or interviewer would help in reading the questions. Once done, the interviewer will thank the subject and close the interview.
Data analysis
Data collected will be entered in excel then exported to SPSS for analysis. Chi-square will be used to test the association between variables. The independent variable, failure to utilize mental health services and dependent variables, cultural and acculturation effects will be analyzed to determine any possible associations. The mean of subjects with similar response traits will be assessed and reported. The range of subject’s ages in relation to their response traits will also be determined.
Protection of human subjects
The aim of the research will be communicated to subjects, and thereafter, informed, voluntary consent will be sought. A consent form will be available for subjects to append before the initialization of data collection. Data collected will be anonymous as no personal identifiers like names and personal identification numbers will be requested for from the subjects
Implications
The data collected by this study will illuminate how family, religion, gender roles, and acculturation interact to impact the utilization of mental health services amongst the Latinos. This data will be critical in shaping government policies on ensuring universal health care. It will also act as a foundation upon which future research may be hinged. Finally, the study will be vital in educating the target community on myths and misconceptions about mental illnesses.
Limitations
The study will be limited by the willingness of participants to participate. Convenient sampling used may also introduce a selection bias.
References
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