Toward a cultural adaptation of pharmacotherapy: Latino views of depression and antidepressant therapy

Abstract

Relative to non-Latino Whites, Latinos in the United States with major depressive disorder (MDD) show low engagement in antidepressant therapy, whether engagement is defined as pharmacotherapy access, medication initiation, pill-taking, or treatment retention. One potential reason for this disparity in depression care is the low cultural congruence of pharmacotherapy for this population. To examine Latinos' views of depression and antidepressant therapy, we conducted qualitative interviews with 30 Latino outpatients initiating antidepressants prior to their first treatment visit using the semistructured Treatment Adherence and Retention Questionnaire. These baseline interviews were randomly selected from data collected for a randomized controlled trial testing a novel intervention to enhance engagement by depressed Latino outpatients. Participant narratives were analyzed using open coding and the iterative analytical approach derived from grounded theory. Patient views about depression addressed stigmatizing views held by others in their social circle. Most participants directly refuted these views by providing alternate explanations to depression experiences. Antidepressant therapy narratives also revealed marked stigmatization, but participants tended not to refute these views. Instead, patients expressed concerns about antidepressants and showed marked ambivalence about seeking psychiatric care. Participants, however, did suggest ways in which clinicians and patients might collaborate to address their concerns about antidepressants. Some cultural views, such as concerns about addiction to or dependence on medication, may be negotiable barriers to treatment. Prescribing clinicians should address cultural views and concerns in order to improve Latino engagement in antidepressant therapy.

Integrating Professional and Indigenous Therapies

“…This observation also is consistent with recent research addressed to cultural perspectives of psychiatric medication (Vargas et al, 2015) as well as with calls among psychiatrists to engage in “shared decision making” with clients who are reluctant to take medication. Such calls recommend discussion about the pros and cons of medication in terms of what clients care most about, such as their engagement in “valued social roles and activities,” and their subjective interpretations of side effects (Deegan & Drake, 2006, pp.…”

The Welcome Baby Program: An Implementation and Outcomes Evaluation

“…The possible threats to the validity of this measure under this administration method include clients' discomfort with divulging sensitive mental health information. Indeed, in the Latino population, stigma associated with revealing potential mental health issues has been well-established (e.g., Interian et al, 2010;Interian et al, 2011;Vargas et al, 2015). We examined findings by race/ethnicity, and we did find that Latino participants were less likely to report mild or moderate depressive symptoms compared with other ethnicities.…”

Knowledge and Preferences Regarding Antidepressant Medication Among Depressed Latino Patients in Primary Care

“…This concern has been raised in other studies, and it is associated with less willingness to take medications (Bauer et al, 2013; Fawzi et al, 2012; Vargas et al, 2015). Patients vary widely in their familiarity with any medications, psychotropic or otherwise.…”

“…Despite these risk factors, Latinos in the US are less likely to utilize mental health services than non-Latino Whites (Alegria et al, 2002; Cabassa et al, 2006; Dobalian and Rivers, 2008; SAMHSA, 2015), and they are also less likely to utilize antidepressant medication (Interian et al, 2011). System barriers to mental health treatment for Latinos include cost of care/lack of health insurance coverage, limited time with providers, low knowledge about resources, and lack of linguistic and culturally competent services (Anastasia and Bridges, 2015; Kessler et al, 2001; Rubenstein et al, 1999; Ruiz et al, 2013; SAMSHA, 2015; Shattell et al, 2008; Uebelacker et al, 2012; USDHHS, 2001; Vargas et al, 2015). Latinos are less likely to receive care that meets best practice guidelines (Alexandre et al, 2009; Cabassa et al, 2006; Lagomasino et al, 2005; Quinones et al, 2014), and are more likely to drop out early or discontinue care (La Roche, 2002; Lanouette et al, 2006; Sue, 1998; USDHHS, 1999), highlighting the need to understand characteristics of acceptable and accessible interventions.…”