How Do Hispanics Experience Depression?

People from different cultures express symptoms of depression in various ways. In addition to changes in their mood, Hispanics tend to experience depression as bodily aches and pains (like stomachaches, backaches or headaches) that persist despite medical treatment. Depression is often described by Hispanics as feeling nervous or tired. Other symptoms of depression include changes in sleeping or eating patterns, restlessness or irritability, and difficulty concentrating or remembering.

Use of Mental Health Services

Among Hispanic Americans with a mental disorder, fewer than 1 in 11 contact mental health specialists, while fewer than 1 in 5 contact general health care providers. Among Hispanic immigrants with mental disorders, fewer than 1 in 20 use services from mental health specialists, while fewer than 1 in 10 use services from general health care providers.

One national study found that only 24% of Hispanics with depression and anxiety received appropriate care, compared to 34% of whites. Another study found that Latinos who visited a general medical doctor were less than half as likely as whites to receive either a diagnosis of depression or antidepressant medicine.

Precise estimates of the use of complementary therapies by Hispanic Americans do not exist. One study found that only 4% of its Mexican American sample consulted a curandero, herbalista, or other folk medicine practitioner within the past year, while percentages from other studies have ranged from 7 to 44%. The use of folk remedies is more common than consultation with a folk healer, and these remedies are generally used to complement mainstream care.

Availability of Mental Health Services

In 1990, about 40% of Hispanics either did not speak English at all or did not speak it well. While the percentage of Spanish-speaking mental health professionals is not known, only about 1% of licensed psychologists who are also members of the American Psychological Association identify themselves as Hispanic. Moreover, there are only 29 Hispanic mental health professionals for every 100,000 Hispanics in the United States, compared to 173 non-Hispanic white providers per 100,000.

Another big problem is access to professional help. Nationally, 37 percent of Hispanics are uninsured, compared to 16% for all Americans. This high number is driven mostly by Hispanics' lack of employer-based coverage - only 43% compared to 73% for non-Hispanic whites. Medicaid and other public coverage reaches 18% of Hispanics.

Need for Mental Health Care

Generally speaking, the rate of mental disorders among Hispanic Americans living in the community is similar to that of non-Hispanic white Americans. However,

• Adult Mexican immigrants have lower rates of mental disorders than Mexican Americans born in the United States, and adult Puerto Ricans living on the island tend to have lower rates of depressions than Puerto Ricans living on the mainland.

• Studies have found that Latino youth experience proportionately more anxiety-related and delinquency problem behaviors, depression, and drug use than do non-Hispanic white youth.

• Regarding older Hispanic Americans, one study found over 26% of its sample were depressed, but depression was related to physical health; only 5.5% of those without physical health problems said they were depressed.

• Culture-bound syndromes seen in Hispanic Americans include susto (fright), nervios (nerves), mal de ojo (evil eye), and ataque de nervios. Symptoms of an ataque may include screaming uncontrollably, crying, trembling, verbal or physical aggression, dissociative experiences, seizure-like or fainting episodes, and suicidal gestures.

• In 1997, Latinos had a suicide rate of about 6% compared to 13% for non-Hispanic whites. However, in a national survey of high school students, Hispanic adolescents reported more suicidal ideation and attempts proportionally than non-Hispanic whites and blacks.

High-Need Populations

Hispanics are relatively under-represented among people who are homeless or children in foster care. However, they are present in high numbers in other high-need populations.

• People who are incarcerated. 9% of Hispanic Americans, compared to 3% of non-Hispanic white Americans, are incarcerated. Latino men are nearly four times as likely as white men to be imprisoned at some point during their lifetimes.

• Vietnam War Veterans. Latinos who served in Vietnam were at higher risk for war-related post-traumatic stress disorder than were black and non-Hispanic white veterans.

• Refugees. Many refugees from Central America experienced considerable civil war-related trauma in their homelands. Studies have found rates of post-traumatic stress disorder among Central America refugee patients ranging from 33 to 60%.

• Individuals with Alcohol and Drug Problems. In general, Hispanic Americans have rates of alcohol use similar to non-Hispanic whites. However, Hispanic women/Latinas have unusually low rates of alcohol and other drug use, while Latino men have relatively high rates. Rates of substance abuse are higher among U.S.-born Mexican Americans compared to Mexican-born immigrants. Specifically, substance abuse rates are twice as high for U.S.- born Mexican American men than for Mexican-born men, but seven times higher for U.S.-born Mexican American women than for Mexican-born women.

Appropriateness and Outcomes of Mental Health Services

Few studies on the response of Latinos to mental health care are available. Several studies have found that bilingual patients are evaluated differently when interviewed in English as opposed to Spanish. One small study found that Hispanic Americans with bipolar disorder are more likely to be misdiagnosed with schizophrenia than are non-Hispanic white Americans.

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