Does Experiencing a Major Depressive Episode Affect the Relationship Between Family Cultural Conflict and Mental Health Service Use Among Latinos?

Background and Purpose:

Recently, Latinos were identified as high-risk for mental health problems due to race-related stress. These mental health problems include depression, which is one of the most common mental health problems in the US. Although multiple stressors can contribute to depression, empirical research has shown a link between depression and family cultural conflict (FCC) among Latinos. Particularly among Latinos, FCC refers to “family conflict due to the tension of adhering to cultural norms promoting strong family ties” (collectivistic versus individualistic values), placing them at risk for FCC, and thus depression. This is a matter of great concern since Latinos underutilize mental health services. While the relationship between FCC and depression seems apparent and depressive symptoms and mental health service utilization (MHSU), little if any research examining the relationship between FCC and MHSU exists. Thus, this study seeks to fill this gain in the literature by examining the relationship between FCC among Latinos and their MHSU and whether experiencing a Major Depressive Episode (MDE) moderates this relationship. A greater understanding of the role of culture and values on Latinos’ MHSU use can help social workers/service providers and researchers better serve this population.

Methods:

Secondary data analysis restricted to Latinos (N=2,554) was conducted using the National Latino and Asian American Study (NLAAS), a nationally representative household survey carried out in the US in 2002-2003 on mental disorders and MHSU. NLAAS used a stratified area probability sampling design, the survey populations included non-institutionalized Latino and Asians adults (>18 years old), stratified based on self-reported ancestry/national origin. Professional lay interviewers conducted face-to-face interviews and used the Composite International Diagnostic Interview (WMH-CIDI), which generated a MDE diagnoses based on the DSM-IV criteria. A subscale from the Hispanic Stress Inventory (HSI) was used to operationalize FCC, and MHSU was operationalized dichotomously using a list of service providers to report if services were used.

Results:

Results indicate that the effect of FCC on MHSU depends on experience of a MDE (p<0.05), producing a disordinal interaction: Latinos experiencing higher levels of FCC are more likely use mental health services compared to those experiencing lower levels of FCC. However, the results suggest that Latinos who had increased FCC and experienced a MDE were less likely to use mental health services compared to those who did not experience a MDE. There is a dearth research related to these specific findings; hence, there is a need for studies to explore possible explanations, especially since the results demonstrate that those with depressive symptoms are most in need for mental health care.

Conclusions and Implications:

These findings offer clear evidence that FCC and having a MDE both affect the likelihood of Latinos using mental health services. Mental health professionals should explore FCC when providing services, as family is a strong Latino value and may not be shared by every family member, possibly increasing the risk of having a MDE. Furthermore, the findings highlight the need for research to expand work on the influence of culture and values among Latinos’ MHSU.