Barriers to care and psychopathology among Bolivian migrants living in São Paulo, Brazil

Abstract

The objective of this study was to investigate barriers to appropriate mental health care in a sample of Bolivian migrants living in São Paulo and to examine the association between barriers of care and the presence of symptoms of non-psychotic psychiatric disorders in this population. Considering that treatment usually reduces symptoms, it could be hypothesized that individuals reporting more barriers to care also will report more symptoms. The sample comprised 104 individuals born in Bolivia, with Bolivian nationality and living in São Paulo for at least 30 days prior to enrolling in the study, between 18 and 80 years of age and able to read and write in Spanish or Portuguese. The symptoms of mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20) and barriers to appropriate mental health care were evaluated using the Barriers to Assessing Care Evaluation (BACE). A multiple linear regression analysis was performed to determine the predictive effect of the BACE total score (independent variable) in the SRQ-20 score (dependent variable), including in the model, and the variables that were significantly correlated with the BACE total score or SRQ-20. Our results indicate that more than a half of the sample of Bolivian migrants living in Sao Paulo, Brazil, especially females, presented significant non-psychotic psychopathology. Individuals reporting more barriers to care, especially instrumental and attitudinal barriers, also have a higher risk of psychiatric symptoms, independently of sex, age and family income. Our results suggest that actions to increase availability of mental health services, especially culturally sensitive services, could reduce barriers to care and improve mental health among migrants.

Barriers to Mental Health Service Use among Palestinian-Arab Women in Israel: Psychological Distress as Moderator

“…Despite these alarming findings, to date the effect of psychological distress on the use of mental health services and its relationship with the barriers to such use in this population have not been investigated. This is despite the fact that previous studies have shown psychological distress to be significantly associated with mental health service use and with perceived barriers to service use among women and minorities [25][26][27].…”

“…We also think that the sociocultural changes taking place in Arab society in Israel improve mental health literacy, and attitudes to mental illness, its treatment, and stigma [35], factors that may also explain the low perceived barriers among Arab women in our sample. Finally, the low levels of psychological distress among the participants may also explain this finding: Bustamante et al [26], for example, found that mental health symptoms and perceived need for mental health treatment are positively related with perceived barriers to mental health service utilization.…”

“…Following previous practice [26,49], three subindices were generated for each scale type by averaging the relevant items, with higher scores indicating a more significant barrier (0-1 indicated a weak barrier; 1-2 a medium barrier; and 2-3 a severe barrier). The scale was translated into Arabic using the back-and-forth method [47,48].…”

Mental Health Underutilization by Palestinian-Arabs in Israel: Stigma-Related, Attitudinal, and Instrumental Barriers

“…Studies attempting to explain the mental health service underutilization among minorities worldwide show that minority groups report more barriers than do majority groups, with some of these barriers being unique to their status as minorities and to their socioeconomic and cultural background (Fante-Coleman & Jackson-Best, 2020; Planey et al, 2019; Scheppers et al, 2006). These barriers include self-and social stigma; concerns about confidentiality and trust; cultural beliefs against treatment and preference for informal sources of help; cost and transportation problems; lack of cultural and linguistic adaptation of services; and experiences of group-based discrimination (Cheng et al, 2018; Fante-Coleman & Jackson-Best, 2020; Jorm, 2012; Maura & de Mamani, 2017; Planey et al, 2019; Scheppers et al, 2006; Ugarte Bustamante et al, 2020).…”

Mental health care for refugees and the need for cultural competence training in mental health professionals

“…Local and regional studies have reported adverse mental health outcomes in immigrants. 3,4 Other studies have described psychiatric treatment experiences with refugees and the development of specialized assistance programs. 5,6 However, there is still a lack of data about mental health issues in this population.…”