Depression in Latinos (eBook)

Sergio Aguilar-Gaxiola is Professor of Clinical Internal Medicine in the Department of Internal Medicine, School of Medicine, University of California, Davis. He is also Founding Director of the newly developed Center for Reducing Health Disparities at UC Davis Health System. Dr. Aguilar-Gaxiola is the on-site Principal Investigator of the Mexican American Prevalence and Services Survey (MAPSS), the largest mental health study conducted in the U.S. on Mexican Americans. He is a member of the National Advisory Mental Health Council (NAMHC), National Institute of Mental Health (NIMH). He holds several World Health Organization (WHO) advisory board and consulting positions, and is the Coordinator for Latin America and the Caribbean of the WHO World Mental Health (WMH) Consortium. He is also Chair Elect of the Board of Directors of the National Mental Health Association (NMHA) and a member of the NMHA’s Executive Board of Directors. He is actively involved in several key areas of national and international mental health. His extensive research includes cross-national comparative epidemiologic research on patterns and correlates of mental disorders and substance abuse in general population samples, and the development of culturally and linguistically sensitive mental health diagnostic instruments and the delivery of culturally and linguistically appropriate treatments. He is a licensed clinical-community psychologist who formally trained in cognitive-behavioral therapy for depressive and anxiety disorders with over two decades of experience providing psychotherapy services to Spanish-speaking consumers and their families.

Depression in Latinos 2
Foreword 7
Contents 11
Contributors 13
Introduction 18
Part 1: Sociodemographic, Epidemiological, Linguistic, and Cultural Factors in Depression in Latinos 21
The Context of Depression in Latinos in the United States 22
Personal Journey: Sergio Aguilar-Gaxiola 22
Introduction 22
The Latino Population in the United States 25
Mexicans 27
Puerto Ricans 27
Cubans 27
Dominicans 28
Central and South Americans 28
Cultural Issues, Values, and Constructs 28
The Importance of Culture in Mental Illness 28
Idioms of Distress 30
Cultural Constructs 31
Culture Bound Syndromes 32
General Characteristics of the Latino Population 33
Religion 34
Depression in Latinos 35
Prevalence 35
Risk and Protective Factors for Depression 37
Risk Factors 37
Protective Factors 38
Comorbid Conditions 38
Disability, Morbidity, and Mortality in the Elderly 39
Health Care Beliefs and Behaviors, and Health Services Utilization 39
Beliefs and Behaviors 39
Health Service Utilization 40
Conclusions 41
References 41
Latino Population Demographics, Risk Factors, and Depression: A Case Study of the Mexican American Prevalence and Services Survey 48
Personal Journey: William A. Vega 48
Personal Journey: William M. Sribney 49
Introduction 49
Population Structure of U.S. Latinos 50
Major Depression in Different Latino Populations 53
Description of the MAPSS Methodology 56
Characteristics of the MAPSS Study Population 56
Lifetime Major Depressive Episodes Compared to Anxiety and Substance Disorders 59
Immigrant Age at Arrival and Major Depression 60
Assimilation and Depression 62
The Impact of Disrupted Marital Status 63
Parental Risk Factors, Social Assimilation, and Depression 65
Conclusions 67
References 69
Descriptive Epidemiology of Depression in Latin America and Hispanics in the United States 72
Personal Journey: Guilherme Borges 72
Introduction 73
Methods 75
Samples 75
Measures 77
Diagnostic 77
Prevalence 77
Disorder Severity 77
Role Impairment 78
Treatment Sectors 78
Analyses 79
Results 79
Discussion 85
Conclusion 87
References 87
Comorbidity: Depression and Substance Abuse 91
Personal Journey: María Elena Medina-Mora 91
Introduction 91
Definitions and Theory 93
Tobacco Smoking and Depression 93
Cocaine Abuse and Depression 94
Alcohol and Depression 95
Substance Abuse and Depression: The Context 95
Sociocultural Issues 95
Extent of Substance Abuse and Mental Health Disorders 97
Alcohol Abuse 98
Abuse of Other Substances 101
Mental Disorders 102
Comorbidity 103
Treatment of Comorbid Disorders 104
Conclusion 105
References 105
Cultural Considerations in the Diagnosis and Classification of Depression: The Hispanic Perspective 110
Personal Journey: Renato D. Alarcón 110
Introduction 112
Sociocultural Characteristics of Hispanic Populations 114
Cultural Dimensions in the Diagnosis of Depression among Hispanics 116
DSM-IV-TR Cultural Formulation and the Hispanic Depressed Patient 119
Suggestions for Diagnosis and Classification of Depression among Hispanics 121
General 121
Specific 122
A Research Agenda 124
Conclusions 126
References 127
Part 2: Prevention, Screening, Assessment, and Diagnosis of Depression 131
Prevention of Depression in Latinos 132
Personal Journey: John Pérez 132
Personal Journey: Ricardo Muñoz 133
Introduction 134
Levels of Prevention 135
Randomized, Controlled Prevention Trials Focusing on Depressive Symptoms 136
Randomized, Controlled Trials Designed to Prevent Major Depressive Episodes 137
Enhancing Cultural Competency in Depression Prevention Interventions 140
Risk Factors for Depression 142
Socioeconomic Status 142
Residence in the United States 143
Enhancing Protective Factors 144
Social Support/Family Network 144
Religion and Spirituality 145
Multilevel, Multidisciplinary Approach 145
Use of Innovative Delivery Methods 146
Conclusions 149
References 149
Assessment of Depression Symptoms: Self-report Paper-and-Pencil and Computerized Questionnaires 156
Personal Journey: Gerardo M. González 156
Detection of Depression 157
Obstacles to Depression Assessment and Services for Latinos 157
Conventional Methods of Depression Screening 158
The Beck Depression Inventory-II (BDI-II ) 158
The Center for Epidemiological Studies-Depression Scale (CES-D) 158
The Children’s Depression Inventory (CDI) 160
Reynolds Child and Adolescent Depression Scales 160
Geriatric Depression Scale (GDS) 161
Limitations of Conventional Screening 161
Computerized Assessment of Depression 161
Telephone-Assisted Computerized Screening 164
The Voice-Interactive Depression Assessment System (VIDAS) 166
Future Directions in Depression Screening Methods 169
Computerized Assessment with Latino Children 169
Comorbidity 169
The Internet 170
Practical Implications of Depression Screening for Latinos 170
Conclusion 171
References 171
Diagnosis of Depression Among Latino Children and Adults 177
Personal Journey: Antonio J. Polo 177
Personal Journey: Steven R. López 178
Introduction 179
Classification and Diagnostic Criteria for Depressive Disorders 179
Major Depressive Disorder 179
Criteria for Major Depressive Episode (DSM-IV-TR APA, 2000)
Dysthymic Disorder 181
Criteria for Dysthymic Disorder (APA, 2000) 181
Diagnostic Instruments for Depressive Disorders 184
Diagnostic Instruments for Adults 185
Diagnostic Instruments for Children and Adolescents 187
Psychometric Properties of Depression Diagnostic Instruments 189
Test-Retest Reliability Findings 189
Concurrent Validity Findings 193
Translation and ‘‘Real World’’ Considerations 195
Summary 197
References 197
Part 3: Treatment of Depression 201
Psychosocial Treatments for Depression with Adult Latinos 202
Personal Journey: Guillermo Bernal 202
Introduction 203
Historical Conceptualization of Depression 203
Ethnic Differences in the Concept of Depression 204
Epidemiology 204
Psychosocial Treatment for Depression 205
Cognitive Behavior Therapy 205
Treatment of Depression 206
Working with Cognitions 207
Pleasant Activities 207
Contact with People 208
Cultural Adaptations of CBT 208
Effectiveness of CBT with Latinos 209
Interpersonal Psychotherapy 210
Interpersonal Problem Areas 211
Grief 212
Interpersonal Disputes 212
Role Transitions 212
Interpersonal Deficits 212
Effectiveness of IPT with Latinos 213
Visions for the Future and Recommendations 213
References 215
Pharmacological Treatment of Depression in Hispanic Americans 218
Personal Journey: Alex J. Kopelowicz 218
Introduction 219
Efficacy of Antidepressant Treatment in Hispanic Americans 220
Efficacy of Pharmacologic Versus Psychotherapy Treatment for Depressed Hispanics 221
Preference and Acceptability of Antidepressant Treatment Among Hispanics 222
Pharmacogenetics of Drug Metabolizing Enzymes 224
Drug Metabolizing Enzymes 224
CYP2D6 225
CYP2C19 225
CYP1A2 226
CYP3A4 226
Environmental Factors 227
Traditional and Alternative Healing Methods 227
Dietary Effects 228
Placebo Effects 229
Compliance 229
Coexisting Conditions 230
Discussion and Recommendations 231
References 232
Community-Based Interventions for Depression 237
Personal Journey: Jeanne Miranda 237
Introduction 237
Treatment of Depression in Latinos 238
Treatment of Depression in Medical Settings 240
Community-Based Interventions to Improve Access to Appropriate Care 241
Vision of the Future and Recommendations 244
References 244
Part 4: Gender and Life-Cycle Issues 249
Women and Depression: The Influence of Gender in Major Depressive Disorder 250
Personal Journey: María Asunción Lara 250
Gender Differences in Depression 250
Experience of Depression in Latinas 251
Explaining Gender Differences in Depression Rates 252
Biological Explanations 252
Genetic Factors 252
Reproductive Hormones 253
Pregnancy and the Postpartum Period 253
Psychosocial Explanations 254
Risk Factors for Depression in Women 255
Childhood and Adverse Conditions 255
Life Events and Social Support 256
Domestic Violence 257
Women’s Status in Societies and Gender Roles 258
Marital Status and Childcare 258
The Cost of Caring for Others 259
Paid Work 260
Poverty 260
Migration and Nativity 261
Assessment, Treatment and Prevention of Depression in Women 262
Assessment 262
Treatment 262
Preventing Depression 262
Use of Mental Health Services by Latinas 263
Recommendations 264
References 265
Depression in Latino Children and Adolescents: Prevalence, Prevention, and Treatment 273
Personal Journey: Guillermo Bernal and Jeannette Rosselló 273
Introduction and Epidemiology of Depression 273
Prevention of Depression 275
Treatment of Depression in Latino Youth 276
Vision for the Future and Recommendations 279
References 282
Epidemiology, Assessment, and Treatment of Depression in Older Latinos 286
Personal Journey: Ladson Hinton 286
Personal Journey: Pat Areán 286
Demography of Aging in Latinos 287
Epidemiology: Prevalence, Correlates, and Consequences 288
Prevalence of Depression in Community Settings 288
Prevalence of Depression in Primary-Care Settings 289
Risk Factors Associated with Depression 290
Patterns of Treatment for Depression 293
Assessing Depression in Older Latinos 294
Validity of MDD Criteria in Elderly 295
Psychosocial Interventions 297
Pharmacological Treatment Approaches 298
Depression and Dementia 300
Depression and the Family 301
Depression and Substance Abuse 301
Adherence and Access to Care 302
Cultural and Linguistic Considerations 302
Depression and End-of-Life Care 302
Summary 303
References 303
Epilogue 308
About the Editors 309
About the Authors 311
Index 317