Study and comprehension of barriers to mental health in latino population. Social and cultural factors related to access and retention to mental health services
- Autores: Irene Falgas Bague
- Directores de la Tesis: Diego J. Palao Vidal (dir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2017
- Idioma: español
- Tribunal Calificador de la Tesis: Eduard Vieta i Pascual (presid.), José Antonio Monreal Ortiz (secret.), Mireya Nadal Vicens (voc.)
- Programa de doctorado: Programa de Doctorado en Psiquiatría por la Universidad Autónoma de Barcelona
- Materias:
- Enlaces
- Tesis en acceso abierto en: TDX
- Resumen
Background: Growing Latino population in U.S. and Spain poses important challenges for public health systems in both countries, from limited accessibility of behavioral health services to low quality and lack of continuity of care. There is a paucity of research that identifies the specific barriers and their role on predicting adherence to mental health and substance abuse treatment within Latino populations and investigates whether these variables change depending on the host country. In this research project, we aim to identify barriers to access and retention and the clinical, social and cultural factors related to them. Moreover, we assess how these factors and barriers in care influence treatment retention of a culturally adapted integrative therapy for Latinos with behavioral disorders.
Methods: This research work included a clinical research body, with an observational and an interventional component and a critical review on the topic. Participants were recruited prospectively in the community in three sites; Boston, Madrid and Barcelona. After being screened for mental health and substance abuse symptoms, data on perceived barriers, clinical symptoms, health literacy, discrimination and socio-demographic variables was collected. Eligible participants were randomized for receiving the Integrative Intervention for Dual Problems and Early Action program (IIDEA), a cultural sensitive psychotherapy intervention based on Cognitive Behavioral Therapy (CBT), psychoeducation and mindfulness. Adherence to this intervention was assessed. The observational study that described barriers to retention to treatment among Latinos was first published. A second study assessing the relationship between previously reported barriers to care and adherence to the IIDEA intervention was written and submitted for publication. Finally, a critical review of the literature assessing access and retention to care among Latino immigrants complemented the research project.
Results: Barriers that reflect self-reliance “Wanting to handle the problem on one’s own”, mistrust on behavioral health care systems, “Thinking that treatment would not work”, and “Being unsure of where to go or who to see” were the most frequently reported barriers for Latino immigrants. Differences in reported barriers were found across sites. Two specific barriers were also found to be associated with use of behavioral services. Regarding retention to the IIDEA intervention, Latinos who reported at least one barrier at baseline presented a higher retention to the program compared to those participants who did not report any barrier. Participants that reported more than three barriers showed greater completion of the program compared to those who reported less than three barriers, a difference that was also significant. Mistrust in the behavioral services reported barrier was significantly associated with greater retention in the program. Education and perceived discrimination were found to be predictors for completing the IIDEA program.
Conclusions: This thesis points out the importance of assessing barriers in health care. Efforts to improve behavioral health services must be tailored to immigrants ‘context, with attention to overcoming attitudes of self-reliance, cultural mistrust and outreach to improve access to and retention in care among Latino immigrants.
