Understanding Utilization of Mental Health Services Among Latinos

Background/Purpose:Many Latinos experience inequalities in attaining socioeconomic status, education, and access to health and mental health services. In effort to better understand Latinos’ underutilization of mental health service use, this study examines the association of family cultural conflict and use of a mental health service among Latinos according to whether they have experienced a Major Depressive Episode (MDE) in their lifetime. Particularly among Latinos, familism represents one of the most important culture-specific values (i.e., having a strong identification, attachment, and loyalty with immediate and extended family). For many families, tension arises among family members who have different cultural and generational goals and values. Andersen’s behavioral model is used to explain the use of mental health services which includes three components: 1) predisposing factors (e.g., demographics); 2) enabling resources (e.g., affordability of mental health care services); and 3) need (e.g., evaluated/actual need of mental health care). Informing the knowledge base about the effect of family cultural conflict and having a MDE on mental health service use/utilization (MHSU) will provide a better understanding of the determinants of utilization when outreaching and providing services to Latinos.

Methods: The National Latino and Asian American Study is a nationally representative household survey carried out in the U.S. in 2002-2003 that focuses on mental health disorders and MHSU. Secondary data analysis was conducted using data from the NLAAS, restricted to Latinos (N=2,554). Respondents  Puerto Ricans, Cubans, Mexicans, and all other Latinos. Logistic regression using the Karlson/Holm/Breen (KHB) method suggests there is a significant association between family cultural conflict and MHSU, which is mediated by having a MDE. Furthermore, nested logistic regression models were used to test the behavioral model using a stepwise approach.The five-item subscale from the Hispanic Stress Inventory assessing the respondent’s cultural and intergenerational conflict with family over values and goals was used to operationalize family cultural conflict. Mental health service utilization is defined as receiving care/aid (including medication) from any service provider for problems with emotions, nerves, or substance use/dependence and the NLAAS operationalized utilization dichotomously. The NLAAS collected data with the Composite International Diagnostic Interview, which generates diagnoses based on the DSM-IV-TR criteria, which classifies a MDE as a depressive disorder under mood disorders; diagnosis requires a change of mood accompanied by psychophysiological changes lasting a minimum of two weeks.

Results: Results indicate that only 9% of these respondents, including 29% of those meeting criteria for a MDE, report having used at least one mental health service in the past year. For Latinos with a MDE, as family cultural conflict increases the likelihood of using services decreases.

Conclusions and Implications: Family cultural conflict and having a MDE both affect the likelihood of Latinos using mental health services. The findings highlight the need for research to expand work on the influence of culture and values among Latinos’ MHSU. Mental health professionals should explore family cultural conflict 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.