Vida Alegre: Modifying Depression Treatment for Immigrants in New Growth Communities

Background and Purpose: Recent settlement patterns compound existing mental health disparities for Latino immigrants. As immigrants move into small towns and rural areas of the South and Midwest, “new growth” communities with small but rapidly growing Hispanic populations have emerged. These communities lack the service infrastructure to meet the needs of Latino immigrants. Therefore, evidence-based treatments—many developed and tested in urban settings—require adaptations to overcome the service constraints inherent in rural and small metropolis contexts. This pilot study tests the efficacy of a modified Cognitive Behavioral Group Therapy (CBGT) to treat depression among Spanish-speaking immigrants in a “new growth” community. The original CBGT manual-Spanish version (Muñoz, Aguilar-Gaxiola, & Guzmán, 2000)—developed in San Francisco and tested in integrated health care settings— was altered to suit a “new growth” community service context. Structurally, the study used a university-training model and employed bilingual MSW and PhD students as co-therapists to compensate for the lack of bilingual-mental health providers in the community. Undergraduate Spanish language students provided labor-intensive support services. Procedurally, the original manual was changed to emphasize how the experience of migration affects the thoughts, activities, and interpersonal relationships of recent immigrants.

Method: A pre- and post-test design was used to compare the effects of the modified CBGT on depression for Spanish-speaking mothers (n=9) at baseline and after 10 weeks. Participants were recruited from health and social service agencies in Champaign County—one of the10 Midwest counties with the fastest growth in the Latino population (Fry, 2008). Each woman was screened using the Major Depressive Episode Screener (Muñoz, 1998). Spanish-speaking mothers who were 18 years or over, and who were presently depressed or had a past history of depression, were enrolled in a 10-week CBT group after signing the IRB-approved consent and completing a demographic questionnaire. They completed the Center for Epidemiological Studies–Depression Scale (CES-D) at the start of the intervention and again upon completion. Weekly hour-long CBGT sessions were led by two student-therapists using the modified manual. Treatment fidelity was monitored through weekly supervision, submission of group notes, and completing behavioral checklists. Data analyses included descriptive statistics and nonparametric test for 2 related samples.

Results: At baseline, the average CES-D score was 23.33 and ranged from 12 to 39. At post-test, average CES-D score was 8.89 and ranged was from 0 to 20. Since two observations were 2 standard deviations from the average, a nonparametric test was conducted. Statistic of Wilcoxon Signed Ranks Test showed the pre- and post-test scores are significantly different (z=-2.549, p<.05). Based on an average number of 8 sessions attended, the results indicate that the participants showed a significant decrease in their depression scores. Conclusions and Implications: Although based on a small sample, the results are promising for communities that lack bilingual mental health services. Many service agencies struggle to find bilingual providers and most cannot provide support services in Spanish that facilitate treatment adherence. Therefore, a larger trial is needed to replicate these positive findings in other communities with the under-served immigrant populations.