Yelena Bugbee Westberg, Shalimar Bulaclac, Julie Radford

Submitted to Dr. RobertsonCalifornia State University, Fullerton

508: Vulnerable PopulationsSeptember 27, 2010

Examine mental illness statistics in mood disorders in the US with the emphasis on newly immigrated Latinos

Analyze depression in the Hispanic cultureExamine the Hispanic culture, and related

diagnoses Compare the differences in adult and adolescent

depressionDiscuss current community interventions to assist

the vulnerable Latino population

Mental illnesses are medical conditions that affect thinking, feeling, speaking and ability to function on a daily basis

The term refers to a broad range of mental health conditions including: schizophrenia, anxiety disorders, major depression, obsessive compulsive disorder, eating disorders, borderline personality disorder, addictive disorder, post-traumatic stress disorder, and bipolar disorder

1 in 17 Americans live with a serious mental illness

Mental illness affects the very young, the very old, the rich and poor, and across all religious and ethnic lines.

NAMI (2010) states “mental illness is not a result of personal weakness, lack of character, or poor upbringing” and usually strike during adolescence.

National Alliance on Mental Illness (NAMI), 2010

Monetary Nontreatment : more than $100 billion/ yr

Personal and quality of life Leads to substance abuse, suicide, preventable

disability, unemployment, and homelessness Decreased QOL, shorter life

While all mental disorders create vulnerability, the most prevalent, and easily treatable of all mental illness is depression

Depression through history Hippocrates The Bible Original Latin

“I continue to be amazed about a mental health condition that is common, pervasive, costly,

debilitating, painful, stigmatizing, and puzzling, but at the same time highly treatable and challenging to us all regardless of where we live, and whether we are clients, family members, friends, providers, researchers,

policy makers or administrators” -Agular-Gaxiola, 2008

Depression affects a large majority of the population and is a MAJOR public health concern

Depression has increased from 3.3% to 7.1% of the general population

Childhood prevalence linked to maternal depression

Incidence continues to rise 2020: 2nd biggest disease after cardiovascular

Compton, Consway, Stinson, & Grant, 2006; Weissman, 2005; Murray & Lopez, 1996; Vega, 2010

Fewer days of steady workDecreased academic successLower incomePoorer working conditionsOnly 20-25% seek help

Coryell, Endicott, & Keller, 1990; Aguilar-Gaxiola, 2008

In 2001, the Surgeon General reported that major health disparities existed between various races in the US specifically named Latino immigrants

Latino immigrants are more likely to suffer from mental illness, especially depression and anxiety Less likely to seek help when compared to whites

USDHHS, 2001; Bayard-Burfield, 2001; Ritsner, 2001; Wittig, 2008

“Latino”: A Catch All Name accounts for over 20 different countries of origin Spanish language is the only uniting thread

between all LatinosMajor ethnic groups include: Mexican (64%),

Puerto Rican (9%), Cuban (3.4%), Dominicans (2.8%), with Central and South American’s comprising 5.5-7.6% of the US Latino population

Aguilar-Gaxiola, 2008

Inequalities and poverty in their homelandUS has:

Close proximity Better education Better economic conditions

Aguilar-Gaxiola, 2008

Largest growing population in the US make up 14.8% of the total population

Estimated that by 2050, the Latino population will comprise 24.4% (102.6 million) of the US population

US Census Bureau, 2006; US Census Bureau, 2004

Estimated at 28% to 44% of the US Latino population The second greatest prevalence for any race in the

US

Saiz-Santiago 2003

Chronic health conditions Low economic status/ financial hardship/ manual

labor Immigration issues / legal problems Lack of insurance AcculturizationDiscrimination Limited number of bilingual speaking health

providers

Shattell, 2009

Somatization Familismo - familyMachismo vs marianismo – gender roles Simpatica - agreeableRespeto- respect for elders and those in authorityVerguenza- shame Fatalismo – external locus of control Personalismo- personalized Religiositiy- religion

Alegria, 2007b; Anez, et al., 2005 ; Gloria & Peregoy, 1996 ; Vega, 2010

Many Latinos live in povertyShortage of mental health programsLanguage barrier and unknown healthcare

infrastructure Belief in alternative health systems Inability to pay for medication and

noncompliance with taking them

Aguilar-Gaxiola, 2008 ; Alegria et al, 2007a; Kochlar, 2005; Vega, 2010

IntroductionPrevalence

Depression is higher in Latinos than any other ethnic background

Hispanic females have the highest rate of suicide

African American males the lowest rate of suicide

Hispanic adolescents are the least likely to receive mental health treatment

Acquiring a new languageNew peer relationshipsNew cultural norms

Hardships from living in povertyLack of legal immigration status Inadequate housingLack of health insuranceLack of public assistance

Sadness Irritability Withdrawn from friends Loss of interest Change in eating or sleeping habits Restlessness and agitation Fatigue or lack of energy Difficulty concentrating Thoughts of death or suicide

Irritability in teens Adult sadness

Teens express physical ailmentsTeens express a sensitivity to criticismWithdraw from people but not completely

Problems at school Delinquency Substance abuse Pregnancy Eating disorders Internet overuse Self injury especially cutting Reckless behavior Violence Suicide

Early detectionMultidisciplinary approach

Respect autonomy of teen Adequate family assessment Social support Assess school environment Community

Recognize changes in behavior

Latino youths experience more stressors than Caucasian youths Peer Stressors Family stressors Immigration stressors Environmental stressors

Boys vs. Girls

Mental health is assessed in the context of family, friends, and life circumstances

Health includes physical, mental, social, and emotional attributes

Positive thinking is important

http://www.youtube.com/watch?v=AaJatVpZrRk&feature=related

A systematic review of depression treatments in primary care for Latino adults A collaborative care model is more effective than usual

care EB treatments in primary care were effective and cost-

effective

Cabassa & Hansen, 2007

Solutions to improve treatment rates among Hispanics, and decrease the racial disparities in treatment of depression

Have more culturally and linguistically appropriate educational materials

More accessible mental health-care treatment Multiple intervention choices Informal support systems by ethnicity

Complementary and alternative medicine (CAM) use Extensive use of CAM in depressed, underserved

Hispanic patients for treatment of symptoms of depression as a substitute to conventional care

Mental Health Care Preferences Among Low-income and Minority Women: Preference of active mental health treatment (i.e.

individual counseling, group counseling) over medication treatment.

Faith Support from friends and family

A community-based participatory research (CBPR) approach can be used to identify and create ways to address factors affecting mental health services access and use at individual, organizational, and community levels Issues revealed and proposed solution for themIssues revealed and proposed solution for them

Somatization Trust Language barriers

Shattell, Hamilton, Starr, Jenkins, & Hinderliter, 2008

Assessment Key symptoms of depression include:

Sad or irritable mood Anhedonia

Signs of depression specific to children in school Some differences in the signs and symptoms of

depression between youth and adults Screening

Prevention and early intervention Optimal prevention strategies for managing depression in

adolescents• Cognitive restructuring• Problem solving• Stress management• Accessing social support

The most effective is to target at-risk cohorts and utilize expert clinicians to deliver treatments

Latest evidence-based treatments for children and adolescents with depression Cognitive-behavioral therapy Interpersonal psychotherapy Psychopharmacological treatment Psychodynamic therapy and family therapy

Adaptations made in the Beardslee Preventive Intervention Program for Depression for use with predominantly low income, Latino families Clinical implications from the adaptationClinical implications from the adaptation

Importance of the Family Meeting Recognition of Potential Difficulties in the Family

Conversation Understanding Depression and Resilience

Mental Health Services: The Depression and Bipolar Support Alliance (DBSA) of OC

A referral and education center for patients and their families affected by mood disorders (depression and bipolar disorder)

http://www.dbsaoc.org/ Mental Health Association of OC

Confidential mental health screening ATM (Access to Money Reimbursement Program) Rehabilitative services to mentally ill homeless individuals http://www.mhaorangeny.com/

NAMI (National Alliance for the Mentally Ill) Support groups http://www.namioc.org/

Multifactorial causes for racial health disparities

Improvement efforts need to be multisystem Improvements in the access to and the

treatment of depression in vulnerable populations, will result in:

Better quality of life Prevent the economic repercussions of depression Narrowing of the health disparity gap

http://www.youtube.com/watch?v=0fRZ38AtOVQ

Abela, J. & Hankin, B. (2008). Handbook of depression in children and adolescents. New York: The Guildford Press.

Aguilar-Gaxiola, S. A., & Gullotta, T. P. (eds.). (2008). Depression in Latinos. New York, New York: Springer Science. doi: 10.1007/978-0-378-78512-7_1

Alegria, M., Mulvancy-Day, N., Torres, M., Polo, A., Cao, Z., & Camino, G. (2007a). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97(1), 68-75. doi: 10.2105/AJPH.2006.087205

Alegria, M., Sribney, W., Woo, M., Torres, M., & Guarnaccin, P. (2007b). Looking beyond nativity: The relation of age of immigration, length of residence, and birth cohorts to the risk of onset of psychiatric disorders for Latinos. Research in Human Development, 4(1 and 2), 19-47. doi: 0.1080/15427600701480980

Anderson, E. T., & McFarlane, J. M. (2008). Community as partner: Theory and practice in nursing (5th ed). Philadelphia: Lippincott Williams & Wilkins.

Anez, L. M., Paris, M., Bedregal, L. E., Davidson, L., & Grilo, C. M. (2005). Application of cultural constraints in the care of first generation Latino clients in a community mental health setting. Journal of Psychiatric Practice, 11(4), 221-230. Retrieved from http://journals.lww.com/practicalpsychiatry/Abstract/2005/07000/Application_of_Cultural_Constructs_in_the_Care_of.2.asp

Bamber, D., Stokes, C., & Stephen, A. (2007). The role of diet in the prevention and management of adolescent depression. Nutrition Bulletin, 3290-99. Retrieved from CINAHL Plus with Full Text database.

Briggs, S. (2009). Risks and opportunities in adolescence: Understanding adolescent mental health difficulties. Journal of Social Work Practice, 23(1), 49-64. Retrieved from CINAHL Plus with Full Text database.

Carr, A. (2008). Depression in young people: Description, assessment and evidence-based treatment. Developmental Neurorehabilitation, 11(1), 3-15. Retrieved from CINAHL Plus with Full Text database.

Cespedes, Y.M. & Huey, S. J. (2008). Depression in Latino Adolescents: A cultural discrepancy perspective . Cultural Diversity Ethnic Minority Psychology, 14(2), 168-172. doi: 10.1037/1099-9809.14.2.168

Compton, W. M., Consway, K. P., Stinson, F. S., & Grant B. F. (2006). Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002. American Journal of Psychiatry, 163(12), 2141-2147. doi: 10.1176/appi.ajp.163.12.2141

Cook, M., Peterson, J., & Sheldon, C. (2009). Adolescent depression: An update and guide to clinical decision making. Psychiatry, 6(9), 17-31.

Coryell, W., Endicott, J., & Keller, M. B. (1990). Outcome of patients with chronic affective disorder: A five-year follow-up. American Journal of Psychiatry, 147, 1627-1633. Retrieved from http://ajp.psychiatryonline.org/cgi/content/abstract/147/12/1627

Cosgrave, E., Yung, A., Killackey, E., Buckby, J., Godfrey, K., Stanford, C., et al. (2008). Met and unmet need in youth mental health. Journal of Mental Health, 17(6), 618-628. Retrieved from CINAHL Plus with Full Text database.

Cuijpers, P., van Straten, A., Smits, N., & Smit, F. (2006). Screening and early psychological intervention for depression in schools: systematic review and meta-analysis. European Child & Adolescent Psychiatry, 15(5), 300-307. Retrieved from CINAHL Plus with Full Text database

D'Angelo, E., Llerena-Quinn, R., Shapiro, R., Colon, F., Rodriguez, P., Gallagher, K., et al. (2009). Adaptation of the preventive intervention program for depression for use with predominantly low-income Latino families. Family Process, 48(2), 269-291. Retrieved from CINAHL Plus with Full Text database.

Donaldson, C., Malugeon, J, Malugeon, L, & Powell, L. (2010, Fall). Quarterly newsletter of the Depression and Bipolar Support Alliance Orange County. The Rollercoaster Times.

Dreby, J. (2006). Honor and virtue: Mexican parenting in the transnational context. Gender and Society, 20(1), 32-59. doi: 10.1177/0891243205282660

Garcia, C. (2010). Conceptualization and measurement of coping during adolescence: A review of the literature. Journal of Nursing Scholarship, 42(2), 166-185. doi:10.1111/j.1547-5069.2009.01327.x.

Garcia, C. & Lindgren, S. (2009). “Life grows between the rocks”: Latino adolescents’ and parents’ perspectives on mental health stressors. Research in Nursing & Health, 32, 148-162.

Garcia, C., & Saewyc, E. (2007). Perceptions of mental health among recently immigrated Mexican adolescents. Issues in Mental Health Nursing, 28, 37-54.

Gloria, A. M., Peregoy, J. J. (1996). Counseling Latino alcohol and other substance abuse users/ abusers. Journal of Substance Abuse Treatment, 13(2), 119-126. Retrieved from http://www.journalofsubstanceabusetreatment.com/article/0740-5472(96)00035-9

Goodman, D., & Happell, B. (2006). The efficacy of family intervention in adolescent mental health. International Journal of Psychiatric Nursing Research, 12(1), 1-9. Retrieved from CINAHL Plus with Full Text database.

Hamrin, V., & Pachler, M. (2005). Child & adolescent depression: Review of the latest evidence-based treatments. Journal of Psychosocial Nursing & Mental Health Services, 43(1), 54-65. Retrieved from CINAHL Plus with Full Text database.

King, T., & Wheeler, M. (2009). Medical management of vulnerable and underserved patients: Principles, practice, and populations. NewYork, NY: McGraw Hill.

Kinnunen, P., Laukkanen, E., Kiviniemi, V., & Kylmä, J. (2010). Associations between the coping self in adolescence and mental health in early adulthood. Journal of Child & Adolescent Psychiatric Nursing, 23(2), 111-117. doi:10.1111/j.1744-6171.2010.00230.x.

Kosoko-Lasaki, S., Cook, C., & Obrien, R. (2009). Cultural proficiency in addressing health disparities. Sudbury, Massachusetts: Jones & Bartlett.

Lenz, K., Coderre, K., Watanabe, M. (2009). Overview of depression and its management in children and adolescents. Formulary, 44, 172-180.

Lundy, K.S., and Janes, S. (2009). Community health nursing: Caring for the public’s health (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.

Lutz, W., & Warren, B. (2007). The state of nursing science -- cultural and lifespan issues in depression: part II: focus on children and adolescents. Issues in Mental Health Nursing, 28(7), 749-764. Retrieved from CINAHL Plus with Full Text database.

MacPhee, A., & Andrews, J. (2006). Risk factors for depression in early adolescence. Adolescence, 41(163), 435-466. Retrieved from CINAHL Plus with Full Text database.

Mayoclinic.com. (2010). Mental illness: Definition. Minnesota: Author. Retrieved from http://www.mayoclinic.com/health/mental-illness/DS01104

Melnyk, B., Jacobson, D., Kelly, S., O'Haver, J., Small, L., & Mays, M. (2009). Improving the mental health, healthy lifestyle choices, and physical health of Hispanic adolescents: A randomized controlled pilot study. Journal of School Health, 79(12), 575-584. doi:10.1111/j.1746-1561.2009.00451.x.

Meredith, L., Stein, B., Paddock, S., Jaycox, L., Quinn, V., Chandra, A., Burnam, A. (2009). Perceived barriers to treatment for adolescent depression. Medical care, 47(6), 677-685.

Michael, Y., Farquhar, S., Wiggins, N., & Green, M. (2008). Findings from a community-based participatory prevention research intervention designed to increase social capital in Latino and African American communities. Journal of Immigrant & Minority Health, 10(3), 281-289. Retrieved from CINAHL Plus with Full Text database.

Murray, C. J., & Lopez, A. D. (Eds.). (1996). The global burden of disease: A comprehensive assessment of mortality and disability form diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press.

National Alliance of Mental Illness. (2010). What is a mental illness: Illness facts. Arlington, VA: Author. Retrieved from http://www.nami.org/Content/NavigationMenu /Inform_Yourself/About_Mental_Illness/About_Mental_Illness.htm

Ponixovsky, A., & Modai, I. (2001). Gender differences in psychosocial risk factors for psychological distress among immigrants. Compr Psychiatry, 42, 151-160.

Saez-Santiago, E. & Bernal, G. (2003). Depression in ethnic minorities' Latinos and Latinas, African Americans, Asian Americans, and Native Americans. In G. Bernal, J. Trimble, A. K. Burlews, F. T. I., Leong (Eds). Handbook of racial and ethnic minority psychology (pp. 401-428). Thousand Oaks, CA: Sage Publications.

Shattell, M. M., Stokes, N., Hamilton, D., Foster, J., Petrini, R. H., Johnson, K., Hinderliter, N., Witherspoon, C., Hinshaw, R. K., Faulkner, C. (2009). Depression in Latinas residing in emerging Latino immigrant communities in the United States. Hispanic Health Care International, 7(4), 190-202. doi: 10.1891/1540&U8211;4153.7.4.190

Simon, D., Loh, A., Wills, C., & Härter, M. (2007). Depressed patients' perceptions of depression treatment decision-making. Health Expectations, 10(1), 62-74. Retrieved from CINAHL Plus with Full Text database.

Teen Depression. (2005). Teen Depression: Help for troubled teens. Retrieved September 15, 2010 from www.teendepression.org

U.S. Census Bureau. (2004). US interim projections by age, sex, race, and Hispanic origin. Retrieved from http://www.census.gov/prod/2007pubs/acs-03.pdf

U.S. Census Bureau. (2006). Nation’s population one-third minority. Retrieved from http://www.census.gov/newsroom/releases/archives/population/cb06-72.html

U.S. Department of Health and Human Services. (2001). Mental health, culture, race and ethnicity: A supplement to mental health: A report of the surgeon general. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/cre/sma-01-3613.pdf

U.S. Preventative Services Task Forces: Screening and treatment for major depressive disorder in children and adolescents: US Preventative Services Task force Recommendation Statement. Pediatrics, 123(4), 1223-1228.

Vega, W. A., Rodriguez, M. A., & Ang, A. (2010). Addressing stigma of depression in Latino primary care patients. General Hospital Psychiatry, 32(2), 182-191. doi: 10.1016/j.genhosppsych.2009.10.008

Weissman, M. M., Wickramaratne, P., Normura, Y., Warner, V., Verdeli, H., Pilowsky, D J., et al. (2005). Families at high and low risk for depression: A 3-generation study. Archives of General Psychiatry, 62(1), 29-36. Retrieved from http://archpsyc.ama-assn.org/cgi/reprint/62/1/29

Witig, U., Lindert, J., Merbach, M., & Brahler, E. (2008). Mental health of patients from different cultures in Germany. European Psychiatry, 23, 28-35.

World Health Organization. (2001). The World Health Organization report 2001. Mental health: New understanding, new hope. Geneva: Author.

http://tv.fooyoh.com/fooyohtv_videos_viral/6741375