New User Special Price Expires in

Let's log you in.

Sign in with Facebook


Don't have a StudySoup account? Create one here!


Create a StudySoup account

Be part of our community, it's free to join!

Sign up with Facebook


Create your account
By creating an account you agree to StudySoup's terms and conditions and privacy policy

Already have a StudySoup account? Login here

Week 12 notes

by: Jessica Compton

Week 12 notes SOP 4731

Jessica Compton
GPA 4.0
Global Psychology
Dr. Shannon Quintana

Almost Ready


These notes were just uploaded, and will be ready to view shortly.

Purchase these notes here, or revisit this page.

Either way, we'll remind you when they're ready :)

Preview These Notes for FREE

Get a free preview of these Notes, just enter your email below.

Unlock Preview
Unlock Preview

Preview these materials now for free

Why put in your email? Get access to more of this material and other relevant free materials for your school

View Preview

About this Document

Global Psychology
Dr. Shannon Quintana
Class Notes
25 ?




Popular in Global Psychology

Popular in Department

This 26 page Class Notes was uploaded by Jessica Compton on Tuesday April 7, 2015. The Class Notes belongs to SOP 4731 at Florida International University taught by Dr. Shannon Quintana in Spring2015. Since its upload, it has received 60 views.


Reviews for Week 12 notes


Report this Material


What is Karma?


Karma is the currency of StudySoup.

You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!

Date Created: 04/07/15
J Immigrant Minority Health 2011 13500 509 DOI 10100781090301093896 ORIGINAL PAPER Urban and Rural Immigrant Latino Youths and Adults Knowledge and Beliefs about Mental Health Resources Carolyn Marie Garcia Lauren Gilchrist Gabriela Vazquez Amy Leite Nancy Raymond Published online 11 September 2010 Springer ScienceBusiness Media LLC 2010 Abstract Cultural beliefs and knowledge may in uence helpseeking behaviors Two hundred thirty four immigrant Latino respondents between 12 and 44 years of age completed a questionnaire assessing knowledge of and cultural beliefs regarding mental health resources for adolescents symptoms and helpseeking Knowledge and belief outcomes were also affected by age gender and length of time living in the community I I C M Garcia g School of Nursing University of Minnesota 5140 Weaver Densford Hall 308 Harvard Street SE Minneapolis MN 55455 USA email Garciaumnedu L Gilchrist Deborah E Powell Center for Women s Health Medical School University of Minnesota Minneapolis MN USA G Vazquez Neurology Medical School University of Minnesota Minneapolis MN USA A Leite School of Public Health University of Minnesota Minneapolis MN USA N Raymond Department of Psychiatry and Deborah E Powell Center for Women s Health Medical School University of Minnesota Minneapolis MN USA Springer Future research to inform interventions that increase awareness of accessible mental health services is suggested Keywords Latino Mental health Adolescent Parent Knowledge Cultural beliefs Introduction Immigrant Latino youths mental health status and trajec tory into adulthood in the United States US is concerning 1 The Latino population in the US is rapidly increasing with census data predicting Latinos will comprise 25 of the population in the country by 2050 Further compared to other ethnic groups Latinos are a young population with over 30 under the age of 18 and nearly half under the age of 25 2 The con uence of these issues the predicted US Latino demographic growth and the increasing prevalence of mental health problems in Latino youth is serious Without a signi cant alteration in this trajectory the US will reap the consequences of overlooked or untreated mental health problems among those who will soon make up a large proportion of the workforce and of parents In this paper we provide contextual information on the mental health problems experienced by immigrant Latino youth to inform interpretation of our data that elucidated the mental health knowledge levels and cultural beliefs of rural and urban Latino youth and adults J Immigrant Minority Health 2011 13500 509 501 Background Latino Adolescent Mental Health The US Census estimates that as of July 2007 there were over 154 million Latino youth under the age of 18 and 77 million are estimated to be 10 19 year olds 3 6 A Midwestern survey similarly found that among high school age respondents 9th grade Latinas were signi cantly more likely to report experiencing depressive symptoms than their nonLatino peers 7 8 Suicide attempts a strong indicator of existing mental health problems or symptoms are higher among Latina females with nearly 15 of 9th grade Latina females reporting they have attempted suicide vs 9 white females 4 9 10 Further Latino boys and girls experi ence more problem behaviors such as delinquency multi ple risk taking and substance use compared to nonLatino I 3 0 CD Klt o E r E 5 Individual and Cultural In uences on Perceptions of Mental Health Mental health problems are viewed negatively and with a certain amount of stigma in most cultures ie familism 16 For many immigrant Latino adolescents and their families accultur ative stress and processes have substantial impact on mental wellbeing 17 18 Fear resulting from immigra tionrelated separation and reuni cation patterns or from immigration without legal documentation can contribute to anxiety symptoms hopelessness or depression Leading research recognizes the complexity of accul turative processes which vary by individual and can present intrafamilial challenges when rates of acculturation are different between the youth and their parents 19 When adolescents maneuver between cultures more quickly than their parents this can result in disrupted roles eg ado lescent interprets for parent at a time when normative adolescent developmental processes should include grow ing independence and autonomy Furthermore despite awareness of biochemical explanations for some mental health conditions among many Latinos there are beliefs rooted in traditions that perceive mental health problems as conditions resulting from spiritual or magical causes A mental health problem can also be viewed as a weakness something that the machismo cultural value makes dif cult to accept notably for Latino males In focus groups with Latino fathers and adolescent males Garcia and Lindgren 20 observed a trend toward ignoring or mini mizing mental health problems Barriers to Accessing Mental Health Services 10 21 22 When professional care is sought Latino youth often receive that care from primary care settings 23 Certainly mental health treatment of ado lescents within a primary care setting can be effective It is the disparity experienced by Latino youth in receiving specialist care when it may be indicated that is problematic 24 30 I 31 34 35 37 38 42 Lack of Appropriate Services 39 43 44 Compared to urban areas rural areas generally have less availability and accessibility of mental health specialists 45 However even Spanish speaking providers may lack training or experience working with youth 46 47 Moreover exist ing agencies may not understand adolescent needs or rights such as con dentiality and time to establish trusting relationships 48 49 Theoretical Framework An adaptation of Bronfenbrenner s ecological model pro vides a theoretical foundation to this study 50 We sought further understanding of the family microsystem beliefs speci cally those of Latino adultsparents regarding mental because they serve as gatekeepers to health care systems Andersen s model of health service utilization provides another theoretical foundation to this study 51 The model identi es personal factors that can serve as barriers or Springer 502 J Immigrant Minority Health 2011 13500 509 facilitators to accessing health care In our study we examined adolescent and parental beliefs and knowledge about mental health and access to health care Study Purpose Existing knowledge is sparse regarding individual and familial factors that in uence critical health seeking behaviors and differences between rural and urban Lati nosThus I Methods Design Using a crosssectional study design we assessed levels of knowledge and cultural beliefs among Latino youth and adults living in urban and rural settings of a midwestern state A communitybased participatory research method ology 52 54 was used to develop and pilot the Emo tional Health Survey a 100item bilingual paper pencil instrument The survey was designed to ascertain the mental healthrelated knowledge attitudes and behaviors of Latino youth and adults Participants Due to the communitybased participatory study meth odology the recruitment modes were different between the urban and rural locations The rural sample was recruited by Latino community coinvestigators and research staff employed within a Latinoled grassroots organization Participants were recruited by Promotores de Salud Health Promoters through existing programs offered at the organization s administrative of ces in participants homes and in other accessible community locations Mental health services were not available from this organization The urban sample was recruited by the study investi gator and a research assistant from public charter schools and a community clinic serving the urban Latino com munity None of the urban recruitment sites provided mental health specialist care although each of them had ability to refer to at least two agencies in the metro area that provide bilingual bicultural mental health services for Latinos Springer Data Collection IRB approval was received from the University separately for the urban and rural settings because initially the pro jects were independently undertaken Subsequently IRB approved protocols were slightly different All participants provided written assent or consent For urban participants the IRB approval included a waiver of active parental consent in lieu of parent noti cation Therefore youth less than 18 years of age were required to bring information about the study home and to wait a few days before completing the questionnaire to ensure parents had time to contact the research team if they had questions or reservations All urban participants received a 1000 gift card for survey completion Rural participants com pleted the questionnaire in a variety of community loca tions including school clinic communitybased agencies and in the home No incentives were offered for survey completion based on the preference of the rural coinves tigators Urban participants mostly selfcompleted whereas most rural participants had an interviewer administer the questionnaire All respondents chose to complete the Spanish version of the survey All data from rural and urban settings were collected between January and July of 2006 Measures The questionnaire 55 was developed collaboratively by university and community investigators All the items for the analyses presented in this article were newly developed because measures did not exist to assess knowledge of mental health resources and related beliefs Seven items used to assess knowledge of community resources for mental health concerns There were three items that ascertained respondents knowledge of a place in the community that could help youth with problems like depression or suicidal ideation For each of the two mental health problems presented ie depression and suicidal ideation respondents who stated they knew of a commu nity resource were probed for details about that resource including 1 whether or not the resourceagency required parental permission for youth to access services and 2 if staff told parents when an adolescent had visited Four questions assessed the respondents cultural acceptability of 1 talking about feelings 2 asking for help for problems 3 visiting a mental health professional and 4 identifying someone to talk to about sad feelings Four questions assessed respondents knowledge of and attitudes about mental health and depression Examples of these items include 1 Depression is inherited in some families 2 A person with depression always feels sad and 3 I know the difference between sadness and depression J Immigrant Minority Health 2011 13500 509 Two questions explored whether or not the respondents could identify someone they knew 1 between 12 and 19 years of age who had sought help for a mental health problem and 2 who had attempted suicide For all of the above items respondent options included yes and no Most items also included an I don t know response option Analysis For the purpose of the analysis I don t know responses were coded with the no response for the particular out come variable Descriptive statistics were generated to describe the sample characteristics according to place of residence ie rural or urban Rates of knowledge cultural beliefs and knowledge of symptoms health seeking and attempts were analyzed separately for the urban and rural groups Effect of sample characteristics on outcome vari ables were analyzed using a multivariate marginal model ing through the generalized estimating equation GEE with a logit link function to obtain adjusted odds ratios OR estimates and 95 con dence intervals CI The GEE method allows for accounting of multiple outcomes within a participant To test for difference in the effect of participant characteristics and place of residence urban vs rural we included an interaction effect in the model A P value of 005 was considered signi cant with a two tailed test Analysis was conducted using SAS 92 SAS Institute Inc Cary North Carolina Results Characteristics of Participants The total sample consisted of 234 immigrant Latino adults and youth See Table 1 for select demographics Rural and urban respondents were primarily from Mexico gt85 with the remaining sample representing Honduras El Salvador Ecuador and Guatemala No differences were observed between rural and urban groups for associations of age gender length of time living in the community English speaking and the outcome variables data not shown Rates of knowledge and cultural beliefs for urban and rural respondents were estimated at the mean distribution of age gender number of years lived in the community and Spanish speaking preference see Table 2 3 compared to 18 P lt 0001 Less than 1 in 5 respondents knew of a place in the community that could help with depression Some of the cultural belief measures 503 Table 1 Urban and rural participant characteristics Characteristic Urban Rural n 98 n 136 Age in years 12 17 21 21 19 14 18 24 33 34 25 18 25 44 44 45 92 68 Mean age SD 25 8 SD 28 8 SD Gender Female 58 59 58 43 Male 40 41 78 57 Mean years in community SD 6 4 SD 7 5 SD Spanish speaking at home 67 68 105 77 Time living in the community 31 year 24 24 12 9 2 4 years 19 19 32 24 5 years 50 51 80 59 Not indicated 5 5 12 9 were signi cantly different between the urban and rural H D U 0 D O D D H Y A U U lt U 9 P lt 00001 61 vs 88 P lt 00001 No signi cant difference in the knowledge of symptoms and health seeking was observed between the urban and rural settings Almost a third of participants thought that depression is inherited and 17 know someone who has tried to take his or her life The association of sample respondent characteristics and knowledge and belief outcomes are presented as odds ratios SD 5 O D U 8 0 1 1 A U D D E U y t D U U 4 U v 7 7 OR 56 CI 22 145 P lt 0001 OR 37 CI 13 110 P lt 001 Compared to those who have resided in the community over ve years those who had resided in the community less than a year were signi cantly less likely to know of a place in the community that can help an adolescent OR 01 CI 00 06 P lt 0002 or speci cally a place to bring a suicidal adolescent OR 03 CI 01 09 P lt 001 We found no signi cant association between demographic factors analyzed and participants knowledge of a place for adolescents to go if depressed or if suicidal except for time living in the community However I quotU E D 09 a H 504 J Immigrant Minority Health 2011 13500 509 Table 2 Rates of knowledge of mental health resources cultural beliefs and knowledge of symptoms and health seeking according to urban and rural settings Expected rates Urban Rural P value Knowledge of mental health resources Place in the community for adolescents 18 10 30 3 1 6 00004 Place for adolescent to go if depressed 19 11 31 14 9 23 0488 Place for adolescent to go if suicidal 24 12 43 20 12 29 05825 Cultural beliefs In my culture If someone visits a mental health professional she is crazy 35 24 48 9 5 15 lt0001 It is dif cult to talk about feelings 43 33 53 40 32 49 07386 It is easy to nd someone to talk to about sad feelings 68 55 79 66 58 74 08024 It is okay to ask for help for depression 61 51 70 88 81 93 lt0001 Knowledge symptoms health seeking attempts I know an adolescent who has tried to get help 13 7 22 7 3 12 01125 A person with depression always feels sad 64 50 76 52 42 61 01538 I know the difference between sadness and depression 56 44 66 46 37 55 02017 Depression is inherited 27 18 38 29 22 38 06848 I know an adolescent who has tried to take his or her own life 16 10 26 17 11 25 08677 Major stress always develops into depression 41 28 56 41 32 51 09829 Expected rates at the mean distribution of age gender years lived in the community and Spanish speaking Bold denotes signi cant statistical differences Table 3 Factors associated with knowledge of mental health services Knowledge of mental health services Place in the community for adolescents Place for adolescent to go if suicidal Place for adolescent to go if depressed OR 95CI P value OR 95CI P value OR 95CI P value Urban vs rural 56 22 145 00003 14 07 28 03614 14 05 39 04261 Live in the community years lt1 01 00 06 00022 04 01 11 00898 03 01 09 00198 1 4 11 03 36 09 04 23 04 01 12 5 Ref Ref Ref Age years 12 17 18 06 57 03349 13 05 32 00981 12 05 31 01178 18 24 06 02 21 04 01 11 04 01 11 25 44 Ref Ref Ref Female vs male 37 13 110 00198 18 09 37 00963 15 07 31 02434 Any EnglishSpanish vs only Spanish 20 09 46 01207 13 06 29 04818 20 09 46 06263 Bold denotes signi cant statistical differences compared to speaking only Spanish Signi cant differences were observed for some cultural beliefs Notably urban respondents were over four times more likely to endorse the statement that in my culture seeing a mental health professional is crazy OR 42 CI 19 95 P lt 0001 and much less likely to indicate that in my culture it is okay to seek help for depression OR 02 CI 01 04 P lt 00001 Compared to males females Springer were half as likely as males to report that in my culture it is easy to nd someone to talk to OR 04 CI 02 07 P lt 0003 Compared to older respondents 25 44 year olds younger respondents 12 17 were also less likely to endorse the ease in nding someone to talk with OR 02 CI 01 05 P lt 0002 Few signi cant differences were noted among respon dents on the knowledge of symptoms health seeking and attempts items Compared to those who have resided in the J Immigrant Minority Health 2011 13500 509 505 Table 4 Factors associated with cultural beliefs Cultural beliefs In my culture if someone visits a mental health professional she is crazy In my culture it is dif cult to talk about feelings In my culture it is easy to nd a person to talk to about sad feelings In my culture it is okay to ask for help for depression OR 95CI P value OR 95CI P value OR 95CI P value OR 95CI P value Urban vs rural 42 19 95 00013 10 06 19 08860 15 07 31 02900 02 01 04 lt0001 Live in the community years lt1 07 03 20 07328 09 04 17 09284 10 04 21 09696 12 05 29 04422 1 4 11 03 36 10 05 20 11 04 29 19 07 52 5 Ref Ref Ref Ref Age years 12 17 15 05 43 05139 06 03 13 02981 02 01 05 00024 12 05 29 05524 18 24 19 06 56 07 04 14 05 02 13 19 07 52 25 44 Ref Ref Ref Ref Female vs male 18 08 41 01735 15 09 27 01410 04 02 07 00035 08 04 16 04651 Any English Spanish 08 03 20 06102 11 06 20 08734 08 04 16 05435 10 05 21 09889 vs only Spanish Bold denotes signi cant statistical differences community over 5 years respondents living in the com munity less than a year were less likely to report knowing an adolescent who had sought help for a mental health problem OR 03 CI 01 11 P lt 0003 Speci c to knowledge of symptoms participants aged 12 17 years were signi cantly less likely to endorse the statement that stress always develops into depression OR 02 CI 01 05 P lt 0002 Discussion I This low proportion of persons able to identify a resource is con cerning given the enormity of the mental health needs among Latino youth It is plausible the lack of bilingual or bicultural mental health specialists in rural settings contributes to Latino residents being less likely to identify a mental health resource in their rural communities Our study ndings support extensive existing literature regarding the limitations in current mental health services speci cally limitations of language cultural rel evance and for adolescents developmental appropriate ness 7 8 10 13 The majority of our respondents reported speaking Spanish in their homes and all the adults completed the survey instrument in Spanish An important nding despite no signi cant differences across groups was that Although not predictive our ndings suggest that This is noteworthy because it suggests that Latino youth may not be greatly inhibited by cultural traditions that discourage health seeking for mental health problems outside of the family or spiritual sources of care This nding also supports the growing body of research demonstrating different rates of acculturation between younger and older Latinos I 9 O O 5 U H 59 D D H 2 z Dquot gt D O D H U D 5 U B O O D y 1 O quotb health care access and utilization some of our youth respondents demonstrate personal factors eg willingness to seek care that facilitate healthcare seeking eg social workers nurses physicians youth workers educa H O H U3 V 1 Dquot D lt U3 Dquot O E y 1 Q SD Q lt C cate for policies that require additional services to be provided Schools preparing professionals especially Springer 506 J Immigrant Minority Health 2011 13500 509 Table 5 Factors Associated with Knowledge of Symptoms Health Seeking and Attempts I CD gt ct B 7 0 3E eg Egg H CD 068 3gtQ 2030 quot33913 Ma Q 0 84 28 8390 c6g Sang an 525 we 52 r B Ci quotO a H C 2 CD 82 a 043 H t as a H 8 08 a o a a 5m LH 98 egg 033 Ema cs 4 Hag 00 020339s quot335 3 3433 CD gt cs 33 oy tm is 0395 Vic2m Ha DHUJ Chg ltchc2 E H a 8m CD 030 v OtH quotO 32 at 229 0 MB mquot E o H CL E gt CD was GEE 0 mg quot30 Quad 39 1 5 1 32 Macs Springer P value OR 95CI P value OR 95CI P value OR 95CI P value OR 95CI P value OR 95CI P value OR 95 CI 01192 17 09 32 01082 15 08 25 01760 09 05 16 06781 09 05 19 08715 10 05 20 08896 21 09 50 Live in the community years Urban vs rural 00973 04294 07 03 17 06458 08 04 16 11 05 22 07 03 16 Ref 03919 14 07 28 08 04 16 Ref 00576 15 07 32 05 02 11 Ref 00003 03 01 11 ltl 19 08 48 Ref 10 03 28 Ref 1 4 5 Age Ref 04881 02 01 05 00012 17 07 42 13 05 36 06 02 13 03927 Ref 08397 08 04 17 00898 04 02 09 04497 21 07 6 1 12 17 03 01 10 Ref 06 02 17 Ref 10 05 18 Ref 10 05 20 Ref 11 04 33 Ref 18 24 25 44 Female vs male 01308 06176 16 09 29 08 04 16 04275 04525 08 04 15 01737 08687 07 04 12 03999 01940 03563 08 05 14 02093 13 07 23 07 03 13 01954 00870 06 02 14 11 05 21 13 06 29 15 08 28 24 10 58 Any EnglishSpanish vs only Spanish Bold denotes signi cant statistical differences mental health providers might consider focused recruit ment efforts that contribute to a culturally capable work force able to provide familyfocused mental health services to immigrant Latino youth H D u 3 l l o D D o 7 cultural emphasis on family care for one another is dem onstrated and consistent with our theoretical model which highlights the importance of Microsystems e g family in the health and health care seeking of adolescents Thus interventions are needed that provide mothers and fathers with an accurate understanding of adolescent mental health problems including symptoms and signs of risk that war rant seeking health care Schoolbased outreach and intervention may be an effective mechanism in reaching immigrant Latino youth who are in school as well as their parents Indeed prior research has demonstrated that immigrant Latino parents desire educational opportunities that are based in school as these encourage stronger connectedness to school for these families 20 Strategies to increase knowledge of warning signs including those requiring immediate intervention are warranted However additional communitybased interventions and outreach strategies are needed to reach youth who are not attending school Up to 40 of Latino youth drop out and do not graduate from high school in the US 57 These youth may also be a higher risk for mental health problems Study Limitations The research team was aware of the consequences of varied recruitment and data collection modalities We realized that offering incentives in the urban but not rural locale would create a potential confounder We understood that participants may offer different responses depending on whether they selfcomplete a questionnaire or complete it in an interview format The communitybased methods undertaken in these parallel urban and rural projects inherently meant that methodological differences would exist Further our results should be interpreted within the context of four limitations First the sample size is relatively small resulting in subgroup sizes that were not optimal This possibly explains why we were unable to detect any interaction effects Second there are inherent challenges associated with selfreport data notably reporting biases that may not J Immigrant Minority Health 2011 13500 509 507 accurately re ect levels of knowledge cultural beliefs or futuristic thinking A likely source of reporting bias is that respondents may over endorse awareness of resources In this case our data may suggest an overly optimistic picture of knowledge of mental health resources Third our study used items that had not been previously tested or estab lished as reliable or valid with immigrant Latino respon dents of various ages Serving as a pilot study of these instruments our data are informative and useful but should be interpreted cautiously Finally our sample mirrors the national immigrant Latino community in that it consisted primarily of respondents of Mexican origin Findings should be considered within this context appreciating and recognizing the heterogeneity of the broader US Latino population Our ndings should not be generalized to non immigrant Latinos and should be carefully applied to immigrant Latinos residing outside the Midwest region of the US It is possible that immigrant Latinos choosing to live and work in urban or rural settings within the Midwest have unique characteristics eg acculturation levels migrant patterns length of time in the US that preclude comparisons with immigrant Latinos outside this region New Contributions to the Literature To our knowledge this study is the rst to present urban and rural immigrant Latino youth and adult knowledge and beliefs speci c to mental health resources within their respective communities We accomplished this employing a communitybased participatory methodology through all stages of the study 54 55 58 thereby contributing to a growing body of literature Our study also adds to growing evidence of the value and need for research that examines phenomena of interest separately for immigrant Latinos based on whether they reside in urban or rural parts of the US Implications Future research building on these ndings might employ study designs that allow for matched pairing of family members to further understand the withinfamily beliefs regarding mental health problems and health seeking behavior Insights from such inquiry could support devel opment of assessment tools informing targeted interven tions within families based on their knowledge needs or identi ed barriers to professional helpseeking Because increased knowledge about mental health problems may not alone result in changes in healthseeking behaviors it is necessary that personal familial community and systems level barriers to helpseeking are also recognized and addressed Our study ndings suggest that immigrant Latino par ents and youth generally are not opposed to helpseeking which implies that barriers to care may result from factors external to the family Notable examples of possible external barriers include limited numbers of culturally capable providers training gaps among primary care pro viders in identifying mental health needs of youth and societal values and perceptions about mental health generally In summary our study ndings support the following strategies to address the mental health needs of immigrant Latino youth and their families Familyengaged preventive intervention efforts are needed to alter the mental health trajectory of these youth These will require collaborative efforts that address systemlevel policies communitylevel services and familyindividuallevel beliefs As immigrant Latino communities continue to grow in rural and urban settings throughout the US attention and action toward their mental health needs will contribute to eliminating health disparities and improving immigrant Latino youth mental wellbeing References 1 DouglasHall A Koball H Children of recent immigrants National and regional trends New York NY National Center for Children in Poverty 2004 2 Ramirez RR De la Cruz PG The Hispanic population in the United States Washington DC US Census Bureau 2002 p 20 545 3 US Census Census population estimates Available at http wwwcensusgovpopestnationalasrhNCEST2007asrhhtml Published 2008 Accessed May 8 2008 4 Knopf D Park MI Mulye T The Mental Health of Adolescents A National Pro le 2008 San Francisco CA National Adoles cent Health Information Center 2008 5 MacKay A Duran C Adolescent Health in the United States 2007 Hyattsville MD US Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics 2008 6 YRBSS Youth online online database 2007 Available at httpappsnccdcdcgovyrbssl Published April 9 2008 Acces sed May 8 2008 7 DHHS Mental health culture race and ethnicity A supplement to Mental Health a report of the surgeon general Washington DC Department of Health and Human Services US Public Health Service 2001 8 Garcia C Skay C Sieving R Naughton S Bearinger L Family and racial factors associated with suicide and emotional distress among Latino students I Sch Health 2008789 487 95 9 DuarteVelez YM Bemal G Suicide behavior among Latino and Latino adolescents conceptual and methodological issues Death Stud 2007315425 55 10 O Donnell L O Donnell C Wardlaw DM Stueve A Risk and resiliency factors in uencing suicidality among urban African American and Latino youth Am J Community Psychol 2004331 237 49 Springer 508 J Immigrant Minority Health 2011 13500 509 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 SAMHSA LatinoHispanic Americans fact sheet Available at httpmentalhealthsamhsagovcrefact3asp Published 2008 Accessed May 8 2008 Kao G Vaquera E The salience of racial and ethnic identi cation in friendship choices among Hispanic adolescents Hispanic Journal of Behavioral Sciences 200628123 47 Gamst G Dana RH DerKarabetian A Aragon M Arellano LM Kramer T Effects of Latino acculturation and ethnic identity of mental health outcomes Hispanic Journal of Behavioral Sci ences 2002244479 504 Smokowski PR Bacallao ML Acculturation Intemalizing mental health symptoms and selfesteem cultural experiences of Latino adolescents in North Carolina Child Psychiatry Hum Dev 2007373273 92 CavazosRehg PA Zayas LH Spitznagel EL Legal status emo tional wellbeing and subjective health status of Latino immi grants J Natl Med Assoc 200799101126 31 Marin G Marin BV Research with Hispanic populations New bury Park Sage 1991 Crockett LJ Iturbide MI Torres Stone RA McGinley M Raffaelli M Carlo G Acculturative stress social support and coping relations to psychological adjustment among Mexican American college students Cultur Divers Ethnic Minor Psychol 2007 134 347 5 5 Hovey JD King CA Acculturative stress depression and suicidal ideation among immigrant and secondgeneration Latino adoles cents J Am Acad Child Adolesc Psychiatry 19963591183 92 Martinez CRJ Effects of differential family acculturation on Latino adolescent substance use Fam Relat 2006553306 17 Garcia C Lindgren S Life grows between the rocks Latino adolescents and parents perspectives on mental health stressors Res Nurs Health 2009322148 62 RAND Research highlights mental health care for youth Available at wwwrandorghealth Published 2006 Accessed January 7 2007 Sen B Adolescent propensity for depressed mood and help seeking race and gender differences J Ment Health Policy Econ 20047133 45 Callahan ST Cooper WO Uninsurance and health care access among young adults in the United States Pediatrics 2005 116188 95 Bauman D Conference links deteriorating health of Latinos to poverty University of Connecticut Advance 1999 Fass S Cauthen NK Who are America s poor children Fact sheet no 2 New York National Center for Children in Poverty 2005 Flores G Abreu M Olivar MA Kastner B Access barriers to health care for Latino children Arch Pediatr Adolesc Med 1998152111119 25 LewinEpstein N Determinants of regular source of health care in black Mexican Puerto Rican and nonHispanic white popu lations Med Care 1991296543 57 Miranda LC Latino child poverty in the United States New York National Center for Children in Poverty 1991 National Center for Children in Poverty Children of immigrants a statistical pro le New York National Center for Children in Poverty 2002 Newacheck PW Hung YY Park MJ Brindis CD Irwin CE Jr Disparities in adolescent health and health care does socioeco nomic status matter Health Serv Res 20033851235 52 Ku L Martani S Left out immigrants access to health care and insurance Health Aff 2001201247 56 Manos MM Leyden WA Resendez CI Klein EG Wilson TL Bauer HM A communitybased collaboration to assess and improve medical insurance status and access to health care of Latino children Public Health Rep 20011166575 84 Springer 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 Trevino R Trevino F Medina R Ramirez G Ramirez R Health care access among Mexican Americans with different health insurance coverage J Health Care Poor Underserved 199672 1 12 21 Zambrana R CarterPokras 0 Improving health insurance cov erage for Latino children a review of barriers challenges and state strategies J Natl Med Assoc 2004964508 23 Marcell AV HalpemFelsher BL Adolescents health beliefs are critical in their intentions to seek physician care Prev Med 2005411118 25 Rew L Resnick M Blum RW An exploration of helpseeking behaviors in female Hispanic adolescents Fam Community Health 19972031 15 Rew L Healthrelated helpseeking behaviors in female Mexi canAmerican adolescents J Soc Pediatr Nurs 199724156 62 Alegria M Canino G Lai S Ramirez RR Chavez L Rusch D et al Understanding caregivers helpseeking for Latino chil dren s mental health care use Med Care 2004425447 55 Barr DA Wanat SF Listening to patients cultural and linguistic barriers to health care access Fam Med 2005373199 204 Cauce AM DomenechRodriguez M Paradise M Cochran BN Shea JM Srebnik D et al Cultural and contextual in uences in mental health help seeking a focus on ethnic minority youth J Consult Clin Psychol 200270144 55 Clark L Mexicanorigin mothers experiences using children s health care services West J Nurs Res 2002242159 79 Larkey LK Hecht ML Miller K Alatorre C Hispanic cultural norms for healthseeking behaviors in the face of symptoms Health Educ Behav 200128165 80 Brindis C Park MJ Ozer EM Irwin CE Jr Adolescents access to health services and clinical preventive health care crossing the great divide Pediatr Ann 2002319575 81 Yeo S Language barriers and access to care Annu Rev Nurs Res 20042259 73 Alegria M Canino G Rios R Vera M Calderon J Rusch D et al Inequalities in use of specialty mental health services among Latinos African Americans and nonLatino whites Psychiatr Serv 200253121547 55 Emans SJ Bravender T Knight J Frazer C Luoni M Berkowitz C et al Adolescent medicine training in pediatric residency programs are we doing a good job Pediatrics 19981023 Pt 1 588 95 Hardoff D Schonmann S Training physicians in communication skills with adolescents using teenage actors as simulated patients Med Educ 2001353206 10 BlancoVega CO CastroOlivo SM Merrell KW Socialemo tional needs of Latino immigrant adolescents a sociocultural model for development and implementation of culturally speci c interventions Journal of Latinos and Education 200871 43 61 Morse JM Editorial the contracted relationship ensuring pro tection of anonymity and con dentiality Qual Health Res 199883301 3 Pantin H Schwartz S Sullivan S Coatsworth J Szapoxznik J Preventing substance abuse in Hispanic immigrant adolescents an ecodevelopmental parentcentered approach Hisp J Behav Sci 2003254496 500 Andersen RM Revisiting the behavioral model and access to medical care does it matter J Health Soc Behav 1995361 1 10 Jordan C Gust S Scheman N The trustworthiness of research the paradigm of communitybased research Metropolit Univ 200516137 56 Kim S Flaskerud JH KoniakGrif n D Dixon EL Using com munitypartnered participatory research to address health dis parities in a Latino community J Prof Nurs 2005 214 199 209 J Immigrant Minority Health 2011 13500 509 509 54 Wallerstein NB Duran B Using communitybased participatory 57 PEW Latino teens staying in high school a challenge for all research to address health disparities Health Promot Pract generations Pew Hispanic Center fact sheet Washington DC 200673312 23 Pew Research Center 2004 55 Garcia C Gilchrist L CC Raymond N Naughton S Patino J 58 McQuiston C Parrado EA Martinez AP Uribe L Community Using communitybased participatory research to develop a based participatory research with Latino community members bilingual mental health survey for Latinos PCHP J 2008 22 horizonte Latino J Prof Nurs 2005 214210 5 56 Garcia CM Saewyc EM Perceptions of mental health among recently immigrated Mexican adolescents Issues Ment Health Nurs 200728137 54 Springer Reproduced with permission of the copyright owner Further reproduction prohibited without permission Week 12 Reading Notes Outline of important points in the articles and Chapter 7 in textbook Article I 39 Stressors and Barriers to Using Mental Health Services Among Diverse Groups of F irst Generation Immigrants to the United States Intro This study examined stressors and barriers to using mental health services among firstgeneration immigrants in San Jose California Focus was on 30 immigrants from different regions There are 6 primary stressors that were identified in the study Economic Discrimination Acculturation due to language differences Enculturation Parenting differences Finding suitable employment 6 primary Barriers included Stigma Lack of a perceived norm in country of origin for using mental health services Competing cultural practices Lack of information Language barriers Cost Findings included Some of the most significant concerns of immigrants include stress is associated with acculturation maintaining cultural values and traditions economic struggles and oppression surrounding employment Premigration exposure to political violence is associated with emotional distress among recent migrants regardless of immigration status Many of the new immigrants in the US are refugees or asylum seekers Refugees have shown to be about 10 times more likely to have PTSD compared to agematched general populations in those countries Other postmigration disadvantages associated with mental health issues include inadequate English language skills low socioeconomic status and poor understanding of the new cultural expectations Mental health is understood differently by diverse immigrant populations on account of cultural differences and the availability of mental health services in their countries of origin A lot of times poor crosscultural understanding and a lack of awareness or understanding of services impedes the utilization of metal health services Results of the study The number of groups that gave a statement corresponding to a particular theme among the barriers and stressors we found in the beginning varied from three groups to all six groups reporting it Thus not all groups endorsed every stressor or barrier that was identified in this study Stressor 1 Economic I all 6 groups reported economic distress It included statements about difficulty paying for education inadequate compensation at work and high living costs Stressor 2 Discrimination I all 6 groups reported some type of discrimination since they moved to the US It has occurred in numerous settings including school and workplace Stressor 3 Acculturation Language Differences all 6 groups had issues with differences in language from their country of origin to having to use English in the US Interfered with their ability to obtain medical services find a job and navigate public transportation Stressor 4 Enculturation 4 out of 6 groups endured this stress particularly with the preservation of their native culture and the transmission of traditions and values to the next generation Stressor 5 Parenting Differences 5 out of 6 groups said that parenting in the US was much different than in their native country specifically in regards to physical discipline Stressor 6 Finding Suitable Employment Matching One s Quali cations 5 out of 6 groups found this to be stressful with the inability to assume jobs in the US that re ected their degrees andor their certifications 6 Barrier Themes Barrier 1 Stigma toward Mental Health Services I 4 out of 6 reported stigmas associated w seeking and utilizing mental health services which in turn can lead people to delay seeking treatment or conceal their illnesses to avoid the negative labels that are associated with mental health needs Barrier 2 Lack of a perceived Norm in Country of Origin for Using Mental Health Services I 3 out of 6 reported a lack of presence of mental health care services in their native country Barrier 3 Competing Cultural Practices I 3 out of 6 reported utilizing an alternative practice to the western concept of mental health including performing rituals or using holy water to cure ills Barrier 4 Lack of Information about Mental Health Services I all 6 groups reported that they had little info regarding mental health services offered in the US and that they were unaware of them in general or did not know the process by which to access them Barrier 5 Language I 4 out of 6 said that language was a barrier to receiving mental health care with inability to locate a clinician who speaks their language Barrier 6 Cost I 5 out of 6 groups reported cost as a barrier bc they cannot afford the bills or do not have any insurance Discussion The study s findings suggest that a greater interface between the mental health community and the immigrant communities is desirable In summary the study suggests a conceptual model for understanding sources of stress and barriers to utilizing mental health services that should be considered in designing and promoting these services for diverse groups of recent immigrants tot eh US Although not all of these stressors and barriers will necessarily be applicable to any particular groups of immigrants in a given community they found that these problems were commonly identified by multiple immigrant groups and therefore should be considered The health care staff members who work with immigrants should be informed about exposure to ongoing life stressors that include all these we mentioned before Article 2 Urban and Rural Immigrant Latino Youths and Adults Knowledge and Beliefs about Mental Health Resources Abstract This study looks at how immigrant Latino youth experience mental health problems in the US Multiple analyses have shown that rural respondents were significantly less likely to know of mental health resources than urbanbased immigrant Latinos Findings also suggest that immigrant Latinos appear willing to seek professional help for mental health issues but may not know how to access it or may lack available services Research findings also have supported changes including increased availability of culturally specific mental health services especially in rural areas Intro It mentions that Latino mental health issues have serious health and economic societal implications as Latinos currently compromise over half of the immigrants in the US Latino youth in US report higher rates of MH problems associated w negative outcomes like anxiety depression and suicide than nonLatino white and black youth with females reporting higher than males Some unique potential contributors to these MH issues include acculturation documentation status for those who lack legal immigration papers and familial separation and reunification immigration patters Latino cultures emphasize community and togetherness over individuality and a strong commitment to family Reasons for limited utilization of mental health services for youth include poverty lack of health insurance coverage personal factors like healthseeking behaviors and cultural considerations such as beliefs about the origins of MH problems Not that many linguistically developmentally and culturally appropriate healthcare services are provided in many parts of the US The purpose of the study was to describe immigrant Latino youths and adults knowledge of community resources for an adolescent with a mental health problem such as depression or suicidal ideation and cultural beliefs about health seeking for mental health problems Stats and results Fewer rural respondents know of a place in the community that could help an adolescent w MH issues In both settings fewer than 1 in 4 pp knew of a place or resource for and adolescent contemplating suicide More urban pp said that in my culture seeing a mental health professional is crazy Fewer of the urban pp agreed that in my culture it is okay to seek help for depression Urban respondents were over 5X more likely than rural pp to indicate knowing a place in the community that could help Latino adolescents with MH issues Females were nearly 4X more likely than males to indicate knowing where they could find a MH care place in the community Discussion Fewer than 25 of all respondents indicated knowledge of specific mental health resources for Latino yout This demonstrates the critical need for education to increase awareness win immigrant Latino communities about MH resources Female respondents and those residing in urban regions were 5X more likely to indicate that they could find a community resource that could help Latino youths with a mental health issue Many prefer and seek out services that are available to them in Spanish and ideally are provided by someone with respect for and understanding of their cultural values and beliefs So youth would receive services if culturally appropriate services were available Those in the health and social service professions should aggressively pursue strategies that ensure immigrant Latino communities are aware of available MH services for youth Chapter 7 Notes Health and Culture Culture in uences various aspects of health including beliefs and practices Ex Hospital use maintenance of your health can be different in different cultures eating habits caretaking availability religion etc Shift towards prevention of disease and promotion of health Instead of curing an ailment we try to prevent disease ex Purifying water vaccination promoting exercise testing health Rise in attention to social and behavioral sciences to understand health problems this includes mental health issues WHO Expanded Health is not the absence of illness it is a state of wellbeing Models of health and culture 39Mandala of health39 I Figure 71 pg 135 This model contains four factors that in uence a person s health human biology personal behavior psychosocial environment and physical environment Also in uencing health are the family lifestyle medical care system community biosphere and culture quotSix cultural variablesquot I figure 72 pg 137 1 Environmental control relates to traditional health and illness beliefs folk medicine and traditional healers all of which can have a direct effect on environmental factors 2 Biological variations emphasize physical and genetic differences of people smaller stature of some cultural groups as an example 3 Social organization is the social environment in which people are raised and socialized which includes family backgrounds identification with social group organizations and social barriers like unemployment and poverty at which prevent access to quality healthcare 4 Communication includes language differences verbal and nonverbal behaviors and use of silence within cultural groups 5 Space refers to the personal space and territoriality people hold with variations in the intimate zone personal distance social distance and public distance 6 Time orientation and the view of present past or future varies among cultural groups Cultural Health Beliefs Different cultural groups have diverse believe systems with regard to health and healing in comparison with the western biomedical model of medicine Helman suggests quotthat people attribute causes of almonds to factors within one of four spheresquot People attribute causes of illness to factors within one of four spheres 1 Factors within individuals themselves such as bad habits or negative emotional states ex Don t wash hands don t get enough sleep handling food properly feeling stressed out 2 Factors within the natural environment such as pollution and germs 3 Factors associated with others or the social world such as interpersonal stress medical facilities and actions of others 4 Supernatural factors including God destiny and indigenous beliefs such as witchcraft or voodoo Westerners more likely to attribute the cause of illness to the individual or the natural world individuals from nonindustrialized nations more likely to explain illness as a result of social and supernatural causes Many examples are given that suggests that culture of origin remains an important in uence on health beliefs Found on pages 137 through 138 Many cultures take the ethnomedical approach which seeks to establish internal balance This belief assumes that good deeds are rewarded and bad deeds are punished by some force or deity Approaches to Health and Healing Western biomedical model views disease as originating inside the body due to a specific identifiable medical cause or pathogen psychologically the biomedical model posits that abnormal behavior comes from within the person whether innate or learned There is medication to take you can go to a doctor Osteopathic medicine the musculoskeletal system is the key element of health and medicine is viewed from a wellness perspective physician s work is to correct structural dysfunction in order to return the body to its normal healthy state Approaches to Health and Healing other methods rather than going to the doctor Integrative medicine utilizes the body s own natural healing ability incorporating the individual s health beliefs attitudes and culture into treatment decisions that may include both conventional and complementary and alternative medicine practices ex Acupuncture meditation herbals Traditional Chinese Medicine based on the concept that the human body has interconnected systemschannels meridians that need to stay balanced in order to maintain health balance Ayurvedic Medicine based on the idea that every human contains a unique combination of Doshas the three substances of windspiritair bile and phlegm that must be balanced for health US is starting to take on these things Culture amp Mental Health Psychological disorders are found in all cultures and some disorders like schizophrenia and depression are thought to be universal How their symptoms are shown are different but symptoms are on average the similar Culturally diagnosing abnormal behavior has been somewhat controversial because what is considered abnormal or normal is thought to be culturally determined accepted behavior of culture The Diagnostic and Statistical Manual of the American Psychiatric Association DSM has been the Western standard for classifying abnormal behavior We want to know exactly what you have tied to insurance matters needs to be a diagnosis Culture amp Mental Health 1 Punishment for wrongdoing 2 Being witched by another person someone cursed you ex Voodoo doll 3 An illness passed down through the family According to village elders 1 Confession of wrongdoing repentance 2 Removal of a spirit or the thrown sign through indigenous medicine giving potions beating them etc 3 Prevention of down the line inherited illness Video Health Insurance Termination Focus on the affordable care act Immigrants amp Health Challenges to obtaining health care immigrants are healthier when they come to a country compared to those that are already here because they have immunities from their country of origin that help them here Lack of health insurance amp cost of treatment a simple hospital visit can be very expensive Language and cultural barriers to find a doctor that speaks the language is difficult not all think western doctors are best Lack of transportation amp distance to care they do not have a car to get to the doctor Perceptions of lack of respect the doctor will not respect their cultural beliefs stereotypes Discrimination or racism Complex Western healthcare system you need referral for example CultureBound Syndromes Culturebound syndromes physical and mental illnesses that are unique to particular cultures and are in uenced directly by cultural belief systems and other cultural factors For example the way that eating disorders are viewed varies crossculturally Dhat Mal de ojo ex Being obese here is seen differently in other cultures that might be accepted elsewhere and be viewed as beautiful or rich Recognizing that there are culturebound syndromes and that the expression and formation differs culturally paves the way for practicing culturally sensitive medicine and psychotherapy Video culture and health care when medicine and culture intersect Platinum rule ask others how they want to be treated instead of how you would want to be treated 1 you can t assume what they patient wants 2 we can t transfer our own beliefs in it automatically Culturally Competent TreatmentTherapy Cultural issues have increasingly become incorporated into health care as there has been increased recognition of the intimate tie between cultural beliefs and health beliefs not everyone can be treated in the same way Linguistic competence vs cultural competence just bc you can use the terminology does not mean that you are competent culturally Training in cultural competency is typically categorized by modelsapproaches that address attitudes knowledge and skills chart on pg152 They include 1 Attitudinal approach emphasizes respect sensitivity and awareness of the cultural differences of the patient 2 Knowledge approach emphasizes the multicultural differences of various groups there are problems with stereotypes can create bias in itself 3 Skillsbased behavioral approach communication skills and interviewing techniques that can be generalized across various cultural groups it does not matter what culture you are from you can communicate in way that you understand there are cultural differences Culturally Competent TreatmentTherapy As health care providers often lack time to do a thorough cultural assessment other intermediaries such as cultural brokers and lay health workers allow for more time commitment and training enhanced interaction they do not have time to do a full analysis they are there to realistically help treat you ex In Africa doctors may not have time to address all these issues Cultural brokers patient advocates who act as liaisons bridging linking or mediating between the health care provider and the patient whose cultural backgrounds differ in order to negotiate and facilitate a successful health outcome women in Africa are there to support help navigate translate language Lay health workers LHWpromoters provide public health services to those who have typically been denied equitable and adequate health care in many different cultures and countries they do not have medical degrees but who pays for this it comes down to money Can there be a perfect solution Culturally Competent TreatmentTherapy Psychological therapy based on Western model of the self As globalization continues to increase other international approaches to therapy have been proposed for example HEARTS Listening to History Focusing on Emotions and reactions Asking questions about symptoms Explaining the Reasons for symptoms Teaching relaxation and coping strategies Helping with Selfchange Culturally Competent TreatmentTherapy Other approaches include Folklore therapy use of sayings or folklore Uses proverbs and saying that use folk Wisdom to convey helpful information Ubuntu therapy contains 3 dimensions 1 Psychotheological 2 Intrapsychic 3 Interpersonal humanness Testimonial therapy therapists collect testimonials through collaboration and documentation these are used for education and to advocate for justice as well as to help client see himherself as an empowered spokesperson rather than as a voiceless Victim documenting what is going on used for social change encourage health care systems to look at other options Global Health Disparities Health disparities and commiserate lack of health equity are stark realities faced by families and children globally There has been widening disparities in health and human rights worldwide The big problems in global health have been de ned as 1 HIVAIDS 2 Malnutrition 3 Lack of access to medical care 4 Lack of adequate resources These are things we can fix but in the US common death comes by things that cannot be fixed such as Cancer Video There has been progress with public health and medical care globally through advances in technology and sciences But these health challenges are still faced around the world Global Health Disparities Goals in global health identified by the Bill amp Melinda Gates Foundation and the National Institutes of Health 1 Improve vaccines 2 Create new vaccines 3 Control insect vectors 4 Improve nutrition 5 Limit drug resistance 6 Cure infection 7 Measure health status Video How can healthcare improve worldwide Access to healthcare equal globally for the people that struggle to receive it


Buy Material

Are you sure you want to buy this material for

25 Karma

Buy Material

BOOM! Enjoy Your Free Notes!

We've added these Notes to your profile, click here to view them now.


You're already Subscribed!

Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'

Why people love StudySoup

Jim McGreen Ohio University

"Knowing I can count on the Elite Notetaker in my class allows me to focus on what the professor is saying instead of just scribbling notes the whole time and falling behind."

Allison Fischer University of Alabama

"I signed up to be an Elite Notetaker with 2 of my sorority sisters this semester. We just posted our notes weekly and were each making over $600 per month. I LOVE StudySoup!"

Steve Martinelli UC Los Angeles

"There's no way I would have passed my Organic Chemistry class this semester without the notes and study guides I got from StudySoup."


"Their 'Elite Notetakers' are making over $1,200/month in sales by creating high quality content that helps their classmates in a time of need."

Become an Elite Notetaker and start selling your notes online!

Refund Policy


All subscriptions to StudySoup are paid in full at the time of subscribing. To change your credit card information or to cancel your subscription, go to "Edit Settings". All credit card information will be available there. If you should decide to cancel your subscription, it will continue to be valid until the next payment period, as all payments for the current period were made in advance. For special circumstances, please email


StudySoup has more than 1 million course-specific study resources to help students study smarter. If you’re having trouble finding what you’re looking for, our customer support team can help you find what you need! Feel free to contact them here:

Recurring Subscriptions: If you have canceled your recurring subscription on the day of renewal and have not downloaded any documents, you may request a refund by submitting an email to

Satisfaction Guarantee: If you’re not satisfied with your subscription, you can contact us for further help. Contact must be made within 3 business days of your subscription purchase and your refund request will be subject for review.

Please Note: Refunds can never be provided more than 30 days after the initial purchase date regardless of your activity on the site.