According to the 2020 National Survey on Drug Use and Health (NSDUH), nearly eight million (18.4 percent) Hispanic/Latino adults reported having a mental illness. Among those with a mental illness, 1.9 million (24.4 percent) had a serious mental illness, or a mental illness that impacted their ability to function. Though the prevalence of a major depressive episode (MDE) was lower in Hispanic/Latino youth, a larger proportion of those with MDE reported suicidal ideation compared to non-Hispanic White youth. In 2020, 18.7 percent non-Hispanic White and 15.7 percent Hispanic/Latino youth reported MDE. In non-Hispanic White youth with MDE, the proportion of those with suicidal ideation decreased from 71.6 percent in 2019 to 69.4 percent in 2020. In contrast, the proportion increased for Hispanic/Latino youth – 67.1 percent in 2019 to 72.1 percent in 2020.
In addition to disparities in prevalence, it is important to consider disparities in treatment. For MDE, non-Hispanic White youth received treatment at rates 12-13 percentage points higher than Hispanic/Latino youth. In the 2019 NSDUH, nearly half of non-Hispanic White youth with MDE did not receive treatment compared to 63.2 percent Hispanic/Latino youth. This remained relatively unchanged in 2020 with 49.1 percent non-Hispanic White youth and 37.0 percent Hispanic/Latino youth. Additionally, in 2019, 18 percent of Hispanic/Latino females aged 12 to 17 with MDE had severe impairment (PDF | 4.2 MB), a sharp increase from 11.5 percent in 2016.
Treatment gaps for Hispanic/Latino youth with MDE worsened for those with suicidal ideation. Serious treatment gaps exist for Hispanic/Latino youth with MDE. In 2020, 57.3 percent of non-Hispanic White youth with MDE and suicidal ideation received treatment. However, only 39.6 percent of Hispanic/Latino youth received treatment, a gap of nearly 18 percentage points.
Evidence-based practices and treatments (EBPs and EBTs) are considered the gold standard of behavioral healthcare service delivery. EBPs/EBTs have gone through rigorous evaluation and clinical trials and are replicable. Utilizing EBPs/EBTs supports countless individuals in accessing lifesaving behavioral health services. However, gaps in equitable service for diverse and hard to reach communities persist.
Many EBPs/EBTs rely on a Western medical model which may not reflect perceptions of health across diverse cultures. Culturally adapted EBPs/EBTs for Hispanic/Latino populations tend to add cultural elements like personalismo and familismo to existing mainstream treatment modalities. In contrast, culturally defined interventions are developed and delivered with culture integrated in specific and intentional ways. Culturally defined treatment concepts utilize the therapeutic value inherently embedded within Hispanic/Latino cultural practices.
Latinos often rely on cultural context to understand and address their health needs. This may include assessing progress in psychotherapy by the improvement in relationship instead of internal or individual growth. Understanding relational or collectivistic needs within Latino culture is important for effective and equitable behavioral health care.
Many Latinos use cuento, or storytelling, to answer questions in a narrative form. Storytelling preserves a collective memory and shares historical knowledge. Through cuento, Latinos can find healing through the intersections of their culture and personal stories. Storytelling allows people to learn about, share, and better understand each other’s culture. When leveraged correctly, storytelling is beneficial to behavioral health wellbeing, treatment, and recovery. Digital storytelling, or the use of images to describe experience, has been effective for several diverse communities, including peers in recovery, Indigenous youth, and immigrant/refugee community members. In Latinas, fotonovelas, or images of soap opera narratives, have been effective as a health education tool to reduce stigma related to accessing treatment. For more culturally appropriate strategies, providers should consider integrating storytelling into all aspects of care for Latinos.
Methods
A clinical tool to encourage storytelling is the Cultural Formulation Interview (CFI). The CFI evolved from years of research focusing on culture and its relationship to behavioral health. The tool is intended to garner nuanced information based on an individual’s experiences and understanding of their culture. Clinicians can also use the informant CFI (I-CFI) to gain cultural insight from those close to the patient. There are additional CFIs for even more unique experiences based on subcultures such as older or younger patients. Most health assessments ask generalized, close-ended questions. In contrast, the CFI blends general and probing questions allowing the provider and patient to explore deeper issues.
It is important to understand the positive impact of culturally responsive tools, like CFI, on achieving behavioral health equity for Latinos. However, this understanding is only the first step. Behavioral health practitioners serving Latinos must take meaningful, actionable steps toward providing culturally, and linguistically tailored care. Beyond a one-time assessment, the use of tools, such as CFI, should be a requirement for all patients throughout the entire care continuum of service delivery. Ensuring these culturally responsive changes are sustained will require a sense of urgency and broad support from behavioral health leadership and policymakers.
Population of Focus: Hispanic and Latinx
Links to Resources:
- Learn more about cuento
- Learn about cultural formulation interviews
- Read about cultural adaptations to evidence-based interventions
- Read about mental health recovery narratives
Date: 2022