Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women From Seeking Mental Health Care?

Nadeem, Erum; Lange, Jane; Edge, Dawn; Fongwa, Marie N.; Belin, Tom; Miranda, Jeanne

doi:10.1176/ps.2007.58.12.1547

Cited by 292 publications

(110 citation statements)

References 40 publications

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“…A closer look at our results, along with those of the other study of the SCMHC (12), reveals some consistency. Specifically, both studies found no association between SCMHC scores and current involvement in any depression treatment.…”

Section: Discussionsupporting

confidence: 88%

“…The SCMHC was found in a previous study to predict desire for depression treatment but not to predict currently being in treatment (12). A closer look at our results, along with those of the other study of the SCMHC (12), reveals some consistency.…”

Section: Discussionmentioning

confidence: 99%

“…The SCMHC was adapted from a measure assessing broader barriers to depression treatment utilization (12,25). The three items of the SCMHC assessed stigma-related barriers to depression treatment (sample item: “embarrassed to talk about personal matters”).…”

Section: Methodsmentioning

confidence: 99%

“…The three items of the SCMHC assessed stigma-related barriers to depression treatment (sample item: “embarrassed to talk about personal matters”). Convergent validity for this measure has been supported in regard to desire for mental health treatment (12). Items were reworded for this study so that they would be specific to depression treatment.…”

Section: Methodsmentioning

confidence: 99%

“…Understanding how stigma affects Latinos and persons from other U.S. racial-ethnic minority groups is a priority for reducing disparities in care (14,15) Latina, black, and immigrant women are more likely to endorse stigma concerns pertaining to depression treatment (12,16,17). Among Latinos, use of antidepressants is likely to be interpreted as a sign of severe depression, being “crazy” or weak, or as a sign of illicit drug use (18).…”

mentioning

confidence: 99%

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Stigma and Depression Treatment Utilization Among Latinos: Utility of Four Stigma Measures

Interian¹,

Ang²,

Gara³

et al. 2010

Psychiatric Services

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Objectives Stigma associated with mental illness is an important yet understudied issue among Latinos. This study examined the psychometric properties of four stigma measures with a sample of Spanish-speaking Latino primary care patients. The study evaluated the scale for Perceived Discrimination Devaluation (PDD), Stigma Concerns About Mental Health Care (SCMHC), the Latino Scale for Antidepressant Stigma (LSAS), and the Social Distance (SD) scale. Methods Participants (N=200) were low-income Latinos who were screened for depression with the Patient Health Questionnaire (PHQ-2) and asked about their depression treatment history, and they completed the four stigma measures at two time points. The four stigma measures were examined for internal consistency, convergent validity, construct validity, and criterion-related validity. Results The factor-analytic results generally provided support for the construct validity of the measures. The four stigma measures also demonstrated internal consistency between two time points. Patients who reported greater social distance from individuals with depression were more likely to have been receiving treatment for emotional care in the past three months (OR=.70, p<.05). Also, Latinos who scored high on the SCMHC (OR=.64, p<.05) and LSAS (OR=.77, p<.05) were less likely to have been taking antidepressant medications. Conclusions The SCMHC, LSAS, and SD scales received support for their reliability and construct validity. Results also showed some support for their criterion-related validity. A more mixed picture emerged for the PDD. Stigma ratings were associated with depression treatment utilization. Stigma ratings changed over time and were associated with treatment experiences.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Stigma and Depression Treatment Utilization Among Latinos: Utility of Four Stigma Measures

Interian¹,

Ang²,

Gara³

et al. 2010

Psychiatric Services

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Racial Differences in Visit Duration of Outpatient Psychiatric Visits

Olfson¹,

Cherry²,

Lewis‐Fernández³

2009

Arch Gen Psychiatry

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Effect of Immediate Referral vs a Brief Problem-solving Intervention for Screen-Detected Peripartum Depression

et al. 2023

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ImportanceThe US Preventive Services Task Force recommends screening adults for depression in settings with programs in place to ensure receipt of appropriate care. Best practices regarding how to ensure such care are unknown, particularly for pregnant and postpartum persons.ObjectiveTo compare the effectiveness of 2 strategies for the initial management of screen-detected peripartum depressive symptoms.Design, Setting, and ParticipantsThis randomized comparative effectiveness trial was performed from February 1, 2018, to June 30, 2020, at the prenatal clinic, postpartum unit, and pediatric clinic within an urban safety-net hospital. Participants included peripartum persons with positive depression screen results. Data were analyzed from July 6, 2020, to September 21, 2022, based on intention to treat.InterventionsEngagement-focused care coordination (EFCC), which used shared decision-making and motivational techniques to refer patients to outside mental health services, and problem-solving education (PSE), a brief cognitive-behavioral program delivered at the screening site.Main Outcomes and MeasuresThe primary outcome consisted of severity of depressive symptoms; secondary outcomes included severity of anxiety symptoms and engagement with care, each measured bimonthly over 12 months. Rates of symptom elevations were modeled using negative binomial regression; rates of symptom trajectories were modeled using treatment × time interactions.ResultsAmong the 230 participants (mean [SD] age, 29.8 [5.8] years), 125 (54.3%) were Black and 101 (43.9%) were Hispanic or Latina. At baseline, 117 participants (50.9%) reported at least moderately severe depressive symptoms (Quick Inventory of Depressive Symptomatology score ≥11), and 56 (24.3%) reported clinically significant anxiety symptoms (Beck Anxiety Inventory score ≥21). Across 6 assessment time points, the mean (SD) number of moderately severe depressive symptom episodes in EFCC was 2.2 (2.2), compared with 2.2 (2.1) in PSE, for an adjusted rate ratio (aRR) of 0.95 (95% CI, 0.77-1.17). The mean (SD) number of anxiety symptom elevations in EFCC was 1.1 (1.8), compared to 1.1 (1.6) in PSE, for an aRR of 0.98 (95% CI, 0.69-1.39). There were significant treatment × time interactions relative to mean depressive symptom scores (−0.34 [95% CI, −0.60 to −0.08]; P = .009 for interaction term), favoring EFCC. There were no differences in engagement with care.Conclusions and RelevanceIn this randomized comparative effectiveness trial, there were no differences in depressive or anxiety symptom burden across comparators; however, the evidence suggested improved depressive symptom trajectory with immediate referral. Further work is necessary to guide approaches to management following depression screening for peripartum persons.Trial RegistrationClinicalTrials.gov Identifier: NCT03221556

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Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women From Seeking Mental Health Care?

Abstract: Stigma-related concerns are most common among immigrant women and may partly account for underutilization of mental health care services by disadvantaged women from ethnic minority groups.

Cited by 292 publications

References 40 publications

Stigma and Depression Treatment Utilization Among Latinos: Utility of Four Stigma Measures

Stigma and Depression Treatment Utilization Among Latinos: Utility of Four Stigma Measures

Racial Differences in Visit Duration of Outpatient Psychiatric Visits

Effect of Immediate Referral vs a Brief Problem-solving Intervention for Screen-Detected Peripartum Depression

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