Purpose: Latino immigrants' underutilization of mental health services has been mostly attributed to traditional access barriers (e.g., lack of health insurance, dearth of bilingual providers). Little is known about the role that cognitive processes play in Latino immigrants' decisions to seek depression care. The purpose of this study is to address this gap in the literature by examining the role played by three cognitive processes – illness perceptions, attitudes toward depression care and the subjective norms related to seeking professional mental health care – in Latino immigrants' intentions to seek informal (e.g., family member, friend, priest, minister) and formal (e.g., social worker, primary health care doctor, psychiatrist) sources of care for depression. A conceptual model that draws from the theory of reasoned action and the self-regulatory model of illness cognitions guides this study.

Methods: A convenience sample of 95 Latino immigrant patients, 18 years of age or older, attending a primary health care clinic in St. Louis, Missouri was recruited. Patients were presented a vignette depicting an individual meeting DSM-IV criterion for major depression. Through structured face-to-face interviews, they were asked about their intentions to seek informal and formal sources of care if confronted with the situation presented in the vignette. Patients were also queried about their perceptions of depression, attitudes toward depression care, subjective norms, and correlates of service use, including demographics variables, levels of acculturation, current depressive symptoms, general health status, lifetime use of services for a mental health problem, and their perceived barriers for accessing mental health care.

Findings: Fifty-five percent of patients identified the situation in the vignette as depression. Hierarchical multiple regression models revealed that illness perceptions were not uniquely associated to Latino immigrant patients' intentions to seek informal and formal sources of depression care. However, attitudes toward depression care and subjective norms were uniquely associated with intentions to seek informal and formal sources of care after controlling for correlates of service use. As patients attitudes toward the effectiveness of depression treatments (e.g., counseling, antidepressants) increased, their reliance on informal sources of care decreased. A positive relationship was found between patients' trust of their primary health care provider's skills and their reliance on formal sources of care. Moreover, patients' intentions to seek informal and formal sources of care were positively influenced by their subjective norms. That is, the advice, information, and pressure that patients receive from individuals close to them (e.g., spouse/partner, family members) played an important role in their help-seeking decisions for depression.

Implications: The development of culturally congruent and effective depression treatments for Latinos and other racial and ethnic minority groups must be informed by sound research that examines how sociocultural factors influence their health behaviors and search for care. This study contributes fundamental knowledge to this important public health goal by examining the unique contributions that three cognitive processes play on Latino immigrants' decision to seek informal and formal sources care for depression. Areas of future research that build upon the findings of this study are delineated.