1498

Cultural Issues, Myths, Misinformation, and Health Care–Seeking Behaviors of Hispanic Patients With ADHD and Their Families

Anthony L. Rostain, MD

Department of Psychiatry and Pediatrics and the Adult Developmental Disorders Section, University of Pennsylvania Perelman School of Medicine, Philadelphia

Racial and ethnic minority Americans compose a significant proportion of the US population, and 16% are of Hispanic or Latino origin.1 The Hispanic population includes people from Mexico (63%), Puerto Rico (9%), and Cuba (4%), as well as other Central and South American countries (24%).1 Many Hispanics are underserved in the mental health system even though their prevalence of mental illnesses is similar to that of the white population.2 Clinicians need to be aware of the disparities in health care for Hispanics, the barriers to receiving mental health care services among Hispanics, and the steps that can be taken to improve care for Hispanics.

Disparities in Health Care for Hispanics

Hispanics face numerous disparities that adversely affect access to mental health care and receiving appropriate treatment.

Economic status. One clear disparity is overall economic status. In the United States, poverty rates in 2012 were 25.6% for the Hispanic population and 9.7% for the white population.3 In rural areas, the 2012 poverty rate was 29.2% for Hispanic people, compared with 13.5% for white people.4

Health insurance. Poor economic status influences another disparity: lack of health insurance coverage. As of 2012, nearly one-third of Hispanics lacked health insurance, putting them in the top category of uninsured Americans compared with white, black, and Asian people (AV 1).5 Without comprehensive health care coverage, including mental health treatment, Hispanic people are less likely to seek care for mental illnesses. Data from the National Center for Children in Poverty revealed that 88% of Latino children have unmet mental health needs.6 This means that only about 1 in 9 children in Hispanic households are receiving the treatment they need.

AV 1. People Without Health Insurance Coverage by Race/Ethnicity, 2012 (00:28)

Data from DeNavas-Walt et al5

Treatment. While 46% of white people with any mental illness received treatment in 2011, only 26% of Hispanic or Latino people did.7 One study8 of past-year major depressive disorder showed that 36% of Hispanic people received any treatment for depression compared with 60% of white people, and fewer Hispanic patients received adequate treatment than white patients (22% versus 33%). While the ADHD prevalence in 2007–2009 was similar for white, black, and Puerto Rican children (about 10%), it was lower in Mexican American children than in the other 3 groups (about 4%),9 and Mexican American adolescents were less likely to report the use of ADHD medications than white and black adolescents (AV 2).10 More research is needed on the disparities in mental health diagnosis and treatment in the Hispanic population, but some barriers to treatment have been identified.

AV 2. Psychotropic Medication Use in US Adolescents by Race/Ethnicity, 2005–2010 (00:33)

Data from Jonas et al10

Barriers to Receiving Mental Health Care Services for Hispanics

Cultural and linguistic barriers to mental health treatment for Hispanics include lack of information about mental health services and communication problems. Among Hispanic people in the United States, about one-fourth do not speak English well or at all.11 In addition to having difficulty describing their symptoms in English, they may not be familiar with certain mental illnesses to recognize there is a problem. For example, depression may be mistaken for nervousness, fatigue, or a physical problem.12

Cultural attitudes may also keep Hispanics from seeking treatment, especially a reluctance to divulge personal problems that they believe should be kept private or within the family.13 Reliance on extended family, community, traditional healers, or religious leaders is common for Hispanic individuals who are undergoing a mental health crisis.12 Another major obstacle is the stigma associated with mental illness.12 Hispanics may also fear or distrust providers and/or doubt the benefits of treatment.2 These cultural issues and attitudes serve as deterrents for Hispanics seeking mental health care.

Another important barrier is the shortage of mental health providers, especially Hispanic professionals who could bridge cultural and language barriers.13 Mental health providers are especially lacking in rural areas.2

More

Steps to Improve Mental Health Care for Hispanics

Clinicians can take steps to address the barriers Hispanic individuals face in obtaining mental health care. Overall, clinicians could increase awareness in the Hispanic community about mental health services and the connection between mental illnesses and chronic medical diseases.12 Along with providing mental health education in the community (such as in schools), mental health clinicians could offer stigma awareness training to key leaders in community organizations and churches as well as primary care providers.2,12

Health care providers need to learn culturally competent strategies for diagnosing and treating Hispanic patients. They must be sensitive and responsive to the language, histories, traditions, beliefs, and values of Hispanic patients.2 Language accessibility could be improved by providing translators or by teaching Spanish to more medical students, nurses, psychologists, and other health care providers. The goal is to ensure quality services for Hispanic patients with culturally appropriate prevention, assessment, and intervention.2 Correcting health disparities requires time and commitment, but clinicians who provide education and improve access to quality mental health care will become part of the solution.

Conclusion

The Hispanic population in the United States is a growing minority group that remains undertreated for mental health conditions such as ADHD and depression. Poor economic status and lack of health insurance limit access to quality care for some Hispanic individuals and contribute to lower treatment rates for these disorders than for the general US population. Language and cultural barriers may keep some Hispanic people from seeking treatment, especially if they believe problems should be kept within the family or they want to avoid the stigma of a mental health condition. The shortage of Hispanic mental health providers and providers in rural areas also limits access to mental health services. Clinicians can address these barriers by providing education on mental health conditions and services and stigma awareness in the Hispanic community. By learning culturally competent strategies, clinicians can better serve their Hispanic patients and build trust within their communities.

Clinical Points

  • Realize that Hispanic patients may not have the insurance coverage or means to cover mental health treatment
  • Spend time with patients to learn their attitudes and beliefs regarding mental health conditions
  • Look for opportunities to educate Hispanic groups on mental health conditions, services, and treatment to improve treatment-seeking behavior

Abbreviation

ADHD = attention-deficit/hyperactivity disorder

References

  1. 1. Ennis SR, Ríos-Vargas M, Albert NG. The Hispanic Population 2010: 2010 Census Briefs. United States Census Bureau; 2011. http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf.
  2. 2. National Alliance on Mental Illness. Achieving the Promise: Transforming Mental Health Care in America: Goal 3: Disparities in Mental Health Services Are Eliminated. http://www.nami.org/Template.cfm?Section=New_Freedom_Commission&Template=/ContentManagement/ContentDisplay.cfm&ContentID=28338. Published July 22, 2003. Accessed October 1, 2014.
  3. 3. United States Census Bureau. Table 3. People in Poverty by Selected Characteristics: 2011 and 2012. http://www.census.gov/hhes/www/poverty/data/incpovhlth/2012/table3.pdf. Published 2012. Accessed October 1, 2014.
  4. 4. US Department of Agriculture. Rural Poverty and Well-being: Poverty Demographics. http://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/poverty-demographics.aspx. Updated September 30, 2013. Accessed October 1, 2014.
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  6. 6. National Center for Children in Poverty. Children’s Mental Health: Facts for Policymakers. New York: NY: Columbia University; November 2006. http://www.nccp.org/publications/pub_687.html.
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  11. 11. Ryan C. Language Use in the United States: 2011: American Community Survey Reports. United States Census Bureau; 2013. https://www.census.gov/prod/2013pubs/acs-22.pdf.
  12. 12. American Psychiatric Association. APA Fact Sheet: Mental Health Disparities: Hispanics/Latinos. http://psych.org/File%20Library/Practice/Diversity/Diversity%20Resources/Fact-Sheet---Latinos.pdf. Published 2014. Accessed October 1, 2014.
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