Psychotherapy for depression from the point of view of economically disadvantaged individuals in Chile and Colombia

Abstract

Background This article presents a qualitative study, conducted in Chile and Colombia, on mental health care access and experiences with psychotherapy from the perspectives of economically disadvantaged clients. Current epidemiological data show it is important to conduct psychological interventions to address depression in poor populations, given the high prevalence of this disorder in these groups. However, despite efforts made in both countries at the health care policy level, the impact of the available psychological care has been weaker than expected. Aims Based on this observation, this study sought to collect more information for understanding this problem by incorporating patients’ views. Materials & Methods To shed light on this issue, 24 participants from Chile and Colombia were interviewed with respect to their opinions on access to psychotherapeutic care and their experience with it. Semi‐structured interviews conducted were analysed using Grounded Theory procedures. Results The facilitating and impeding factors that low‐income people have regarding access to psychotherapy, in an institutional context, and specific challenges involving changes in their understanding of their problems and their own role in recovery are presented. These changes involve distancing themselves from their original culturally‐shaped understanding of psychological disorders. Discussion The influence of psychotherapy as a force capable of shaping culturally determined meanings in clients from economically disadvantaged areas is problematised. Conclusion The results of this research may encourage clinicians to see the client's uniqueness within a certain social order and a social network as different from that of the therapist.

Patient experiences of psychological therapy for depression: a qualitative metasynthesis

“…This was achieved through a reconceptualisation of the aetiology of their problems, which in many cases involves the convergence of factors belonging to multiple areas [50].…”

“…Specifically in MBCT, the practice of the "body scan" was reported to trigger flashbacks or severe anxiety for some participants with a history of abuse or trauma [27]. In a study of public psychotherapy for economically disadvantaged Chileans and Colombians, it was found that therapy could sometimes feel unfocused and unclear [50]. Two studies, one with Hmong people and one with older white Americans found that therapy was felt to ignore spirituality [49,57].…”

Sintomatologia depresiva y bienestar psicológico en estudiantes universitarios chilenos

“…Dentro de los factores de riesgo reportados en este estudio se encuentran mayor edad, insatisfacción con la carrera y bajo nivel económico propio y de los padres. En este sentido, las variables socioeconómicas anteriormente mencionadas resultan relevantes para comprender las diferencias en la sintomatología depresiva y el bienestar psicológico en estudiantes universitarios 7,9,10 . Un metaanálisis realizado en el año 2016 muestra cifras similares en estudiantes universitarios del área de la salud 11 .…”

Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators

“…Similarly, the Black, Asian and minority ethnic (BAME) label amalgamates a number of distinct cultures and ethnicities with heterogeneous experiences. Much of the • Institutional challenges, such as time/ length of session [32,49] • Inexperienced or unhelpful staff [50] • Lack of provision of home treatment [50] • Lack of service coordination [34] • Limited treatment options [147] • Long waiting lists and availability of treatment [44,147] • Lack of adequate discharge planning [56] • The use of specialist services as the 'default' [57] • Perceived or actual availability of resources [57] • Inappropriate or limited booking systems [66] • Appointments scheduled during working hours [38] • Perceived difficulties in administering treatment [141] • Diversity of treatment options (e.g. outreach, home-based care, help over the phone, street clinics) [147] • Collaborative agency approach [32] Perceived or real discrimination (from staff, family or the community)…”