Can a Depression Fotonovela Reduce Stigma Among Latino Adults With Limited English Proficiency?

Objectives. Many Latino adults with limited English proficiency fail to seek help for depression due to stigma, lack of knowledge, and misconceptions about depression treatments.  Culturally- adapted depression literacy tools, such as fotonovelas, can help address these barriers to care. Fotonovelas are popular health education tools that portray a soap opera narrative using a comic -book layout with posed photographs and simple language to engage and educate audiences about health issues. In this study, we examined the impact that a depression fotonovela, “Seceret Feelings,” had in increasing depression knowledge and reducing stigma among Latino adults.

Methods. We recruited a convenience sample of 136 Latinos from three community adult schools in Los Angeles. Participants were randomly assigned to receive either the fotonovela or a depression brochure and assessed before reading the material (pre), immediately after worth (post) and one month later (follow-up).  Knowledge of depression symptoms was assessed through correct identification of DSM-IV depression symptoms. An adapted version of the Depression-Literacy Questionnaire was used to measure depression treatment knowledge.  Several instruments were used to measure stigma: the Latino Scale for Antidepressant Stigma, the Stigma Concerns about Mental Health Care scale, and indicators of dangerousness (e.g., people with depression are dangerous) and social distance (e.g., would you work with someone who received depression treatment?). Means and frequencies were calculated for all variables. Chi-squared tests and mixed design ANOVA were used to test changes within and between the fotonovela and depression brochure over time.

Results. Nearly half of participants were female (48%). Most were born outside the US (84 %), spoke only or mostly Spanish at home (66 %), and had less than a high school education (63 %).  At baseline, there were no significant differences between the fotonovela or depression brochure groups on the depression knowledge and stigma measures.  No significant differences in symptom knowledge were detected within or between groups across time. Both groups reported significant increases in depression treatment knowledge from baseline to post-test and persisted at the 1-month follow-up for both groups. This treatment knowledge gain was significantly larger in the fotonovela compared to the depression brochure group at posttest and follow-up.  Antidepressant stigma decreased significantly in the fotonovela group at posttest, but remained constant in the depression brochure group.  At follow-up, the change in the fotonovela group regressed toward its baseline level.  Mental health care stigma decreased significantly at post-test in the fotonovela group and continued to decrease at follow-up, while no significant changes over time were reported for the depression brochure group. Perceptions of dangerousness decreased for both groups at post-test and was significantly lower for the fotonovela group at follow-up compared to the depression brochure. No significant differences in social distance were detected within or between groups across time.

 Conclusions. Compared to a depression brochure, our fotonovela produced significantly greater gains in treatment knowledge and larger reductions in stigma. “Secret Feelings” appears to be a promising depression literacy tool to increase depression treatment knowledge and reduce stigma among Latino adults with limited English proficiency.