Research suggests that experiences of discrimination can threaten the viabilities of families, which may subsequently affect an individual's mental health. Our study tests the hypotheses that (a) everyday discrimination will be indirectly associated with psychological distress through family cultural conflict and lower family cohesion among Latinos and (b) gender will moderate these relations. The sample included Latinos (N = 2,554) from the National Latino and Asian American Study. Path analysis revealed that among the total sample, greater exposure to everyday discrimination was associated with higher levels of family cultural conflict and, in turn, increased psychological distress. Multiple-group path analysis revealed no effect modification by gender. Results underscore the need to consider sociocontextual mechanisms through which discrimination (a) may impinge on the mental health of Latinos and (b) may have implications for the development of mental health interventions that are culturally informed, thus needing to take into consideration family functioning and the role of contextual factors such as discrimination.

This systematic review aimed to synthesize glucose (HbA1c) outcomes of community health worker (CHW)-delivered interventions for Latinos with type 2 diabetes that were tested in randomized controlled trials and to summarize characteristics of the targeted populations and interventions, including the background, training, and supervision of the CHWs. Searches of PubMed and Google Scholar databases and references from selected articles identified 12 studies that met the inclusion criteria. Of these, seven reported statistically significant improvements in HbA1c. Study participants were largely low-income, female, and Spanish-speaking and had uncontrolled diabetes. The CHWs led the interventions alone, in pairs, or as part of a team. Interventions varied considerably in session time, duration, and number. Most met standards for tailored, high-intensity interventions and half were theory-based. Overall, methodological quality was good but there were inconsistencies in the reporting of key information. Future research should report in greater detail CHW background, training, and supervision; examine factors associated with intervention effectiveness; and provide data on cost and cost-effectiveness.

This study examines mental health services in five different regions of the Dominican Republic (DR) from the perspectives of health care providers. The purpose of this research was to (1) examine existing mental health care services; (2) identify barriers to treatment and mental health services delivery; and (3) explore potential strategies to improve mental health services delivery. Thirty-seven health care workers including physicians, nurses, psychologists, governmental administrators, and non-governmental community health workers were part of five focus groups and subsequent follow-up interviews. Transcripts were coded and analysed to obtain the most parsimonious categories of themes. Results indicated that there is insufficient funding allocated to mental health. The unreliable distribution of psychiatric medications precludes care for patients with severe chronic mental illness. Stigmatising attitudes among health care providers influences the quality of care. The prevalence of domestic violence is a significant public health problem contributing to mental illness. In conclusion, our study findings call for a re-examination of priority public health foci, with special attention to mental health and domestic violence in the DR. From a policy perspective, mental health care should be integrated into primary care and coupled with provider and patient education to reduce stigma. A social determinants approach could ameliorate systemic factors contributing to mental illness.

Few studies have examined the attitudes of multidisciplinary health care providers toward mental illness, particularly in Latin America. The present study explored the attitudes of health care providers in the Dominican Republic (DR) toward persons with mental illness. Five Spanish-language focus groups were conducted in different regions of the DR with a purposive sample of 37 multidisciplinary health care providers and administrators. We found that among Dominican health care professionals mental illness was primarily defined as schizophrenia. Stigma was pervasive, but differed based on level of experience with persons with mental illness. People with mental illness were perceived as out of control and unable to conform to societal norms, resulting in fear and a lack of empathy among care providers. General practitioners felt unprepared to manage mental illness and unsupported by families and communities that also held stigmatizing attitudes. Providers considered government investment in mental health services imperative to improve access to treatment. Currently there are few options for intervention or rehabilitation for persons with severe mental illness. Strategies to reduce stigma among nonmental health care providers include governmental prioritization of mental health care, as well as formal training and clinical exposure to persons with mental illness in recovery.

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