Perspectives of Support and Recovery Among Latino Adults with Schizophrenia: Acceptance of Marginalization and Inequities in Daily Life Experiences

Background and Purpose:

Latino immigrants experiencing schizophrenia face barriers to engagement in psychosocial rehabilitation services (PRS).  Barriers include cultural values incongruent with an independence-oriented recovery model, limited English proficiency coupled with limited bilingual services, and immigration status that may preclude insurance access. This exploratory study examined the recovery perspectives of Latinos receiving services at a community wellness and recovery program.

Methods:

Eleven in-depth, semi-structured interviews using a recently developed PSR assessment tool were conducted with Latino clients (seven females, 29-62 years old) diagnosed with schizophrenia; most had received PRS at this urban west-coast agency for more than one year (72%). Participants were predominately unmarried (82%), Spanish-speaking first-generation immigrants (82%), and from diverse Latino subgroups (e.g. Salvadorian [36%], Mexican [18%]). The interview tool assessed core recovery principles (e.g., social support, spirituality, stigma/stressors, self-empowerment, and strengths/resilience). Data was collected via audiotaped interviews, transcribed verbatim and translated into English. Transcripts were coded independently by two qualitatively trained bilingual Latina researchers, who then compared codes and categories until consensus was achieved and themes were developed using a grounded theory approach.

Findings:

Findings reflected recovery perspective themes related to familismo (family-focused priorities) and fatalism (acceptance). Low English proficiency and avoidance coping were identified as barriers to recovery while spirituality was considered a primary source of support. The majority of the participants described a sense of hope motivated by concern for the well-being of immediate family members, especially children. Further, while many participants reported infrequent contact with distant family members in their native countries, they expressed feeling supported by these relatives. Regarding personal recovery goals, many participants appeared to accept the reality of their day-to-day experiences and were not actively seeking employment, new relationships or major life changes.  One participant described her situation as, “It is what it is.” Many participants reported low English proficiency was a barrier impeding them from opportunities to increase their social support systems or obtain employment. Avoidance coping facilitated maintaining current relationships, even when the relationships were not supportive. For example, two women expressed discomfort with the male-dominant (machismo) attitudes of partners, yet chose to walk away to avoid showing displeasure when upset. Prayer, reminding themselves to accept God’s will, and religious books or music were described as supportive and important in their daily lives.

Conclusions and Implications:

When assessing recovery goals and perspectives of Latino immigrants, it is important to expand the dialogue to include the well-being of family members important to the consumer, explore their daily life inequities and determine perceived barriers and supports. Acceptance of marginalized status may be related to faith, acceptance of God’s wishes, perceived hopelessness, especially regarding English language acquisition, female gender roles, and avoidance tactics to maintain relationships. Providers may apply what is learned from use of a recovery assessment tool to assist Latino consumers with developing and working to meet realistic, culturally congruent recovery goals. It is essential to gently address avoidance coping as it may compound barriers and further increase marginalization among a vulnerable subgroup of consumers within PRS settings.