Cultural considerations in expanding the mental health workforce to support Latinx family mental health

• In Event: Interventions with Latinx families: the role of family, culture, and policy.

Abstract

Latinx populations face multiple stressors that increase the risk for depression and anxiety symptoms, and these increased risks exist for parent and youth (Alegría et al., 2008; Alegría et al., 2010). These disparities in symptoms are further exacerbated by the lack of access to mental health services (Alegría et al., 2015). Thus, it is critical to address the mental health care crisis by developing and disseminating interventions that are sustainable and attend to the culturally unique risk and protective factors inherent in Latinx families (Ford Paz et al., 2013). Toward this end, this paper describes a community mental health intervention developed to be delivered by community health workers (CHW) for adults in an effort to improve the lives of Latinx families, and considers the role of familism as moderating the impact of treatment. We hypothesized that the intervention effects would be strongest for Latinx adults with greater familism values given the promotive effect of familism (Cahill et al., 2021). In addition to testing familism quantitatively, we also explored how CHWs incorporated Latinx cultural values using semi-structured interviews with a small sub-sample of participants. We hypothesized that participants would report that CHWs attended to issues of culture in the intervention facilitating rapport and intervention effects.
Participants were 604 Latinx adults (M age=41.93; 85.76% female; 17.22% U.S. born; 78.14% low income) who were randomized to a 10-session CHW mental health intervention delivered via phone and tele-health or a case management condition. As seen in Table 1, the intervention was effective at reducing depressive and anxious symptoms 6-months later relative to the case management condition (symptoms assessed with the Hopkins Symptoms Checklist, Derogatis, 2000). Yet, contrary to hypotheses, familism values (Attitudinal Familism Scale, Lugo Steidal & Contreras, 2003) at baseline predicted greater depressive 6-months later. Importantly, exploratory analyses suggested that the although the interaction value was not significant, the effect of familism values on symptoms only held in the case management condition. This is consistent with work that finds that for Latinx individuals facing mental health distress (e.g., Nolle et al., 2012), familism values are not protective and may incur risk.
Thematic content analysis was used to analyze semi-structured interviews for salient themes with 7 female participants (M age = 41.29 years). Overall, participants in the intervention reported having a strong working relationship with their CHW (i.e., feeling supported and comfortable). Participants valued the incorporation of traditional familial values in the sessions while at the appreciating discussing bicultural issues in session. Ethnic and linguistic match with CHWs allowed for open conversations about shame and impacts of conforming to cultural norms (remaining guarded can negatively affect mental health).
CHW delivered interventions can help support Latinx mental health through improving parental symptoms of depression. In the context of depressive and anxious symptoms, familism values may lead to guilt due not to fulfilling obligations (Nolle et al., 2012). However, our qualitative data suggest that addressing these issues in sessions as noted by participants not only improved rapport, but may have helped participants address these cultural complexities.

Authors

• Gabriela Livas Stein, University of North Carolina at Greensboro
  Presenting Author

• Paula Sanchez Hernandez, University of North Carolina at Greensboro

• Andrew Supple, University of North Carolina at Greensboro

• Puja Patel, University of North Carolina at Greensboro

• Claire Poindexter

• Kari Eddington

• Irene Falgas Bague

• Margarita Alegria, Massachusetts General Hospital