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Barriers and Facilitators of Treatment for Depression in a Latino Community: A Focus Group Study

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Abstract

We conducted focus groups with Latinos enrolled in a Medicaid health plan in order to ask about the barriers to and facilitators of depression treatment in general as well as barriers to participation in depression telephone care management. Telephone care management has been designed for and tested in primary care settings as a way of assisting physicians with caring for their depressed patients. It consists of regular brief contacts between the care manager and the patient; the care manager educates, tracks, and monitors patients with depression, coordinates care between the patient and primary care physician, and may provide short-term psychotherapy. We conducted qualitative analyses of four focus groups (n = 30 participants) composed of Latinos who endorsed having been depressed themselves or having had a close friend or family member with depression, stress, nervios, or worries. Within the area of barriers and facilitators of receiving care for depression, we identified the following themes: vulnerability, social connection and engagement, language, culture, insurance/money, stigma, disengagement, information, and family. Participants discussed attitudes toward: importance of seeking help for depression, specific types of treatments, healthcare providers, continuity and coordination of care, and phone calls. Improved understanding of barriers and facilitators of depression treatment in general and depression care management in particular for Latinos enrolled in Medicaid should lead to interventions better able to meet the needs of this particular group.

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Acknowledgments

This project was funded by a grant from Robert Wood Johnson to Neighborhood Health Plan of RI (PI: Marootian).

Author information

Authors and Affiliations

  1. Alpert Medical School of Brown University and Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, USA

    Lisa A. Uebelacker, Jennifer Primack & Ivan W. Miller

  2. Neighborhood Health Plan of RI, 299 Promenade St, Providence, RI, 02098, USA

    Beth A. Marootian

  3. Division of Biology and Medicine, Alpert Medical School of Brown University, 830 Chalkstone Ave., Bldg. 32, Providence, RI, 02908, USA

    Paul A. Pirraglia

  4. New England Alliance for Children’s Health of Community Catalyst, 30 Winter St., 10th Floor, Boston, MA, 02108, USA

    Patrick M. Tigue

  5. Plaza Psychology and Psychiatry, 68 Cumberland St, Ste. 102, Woonsocket, RI, 02895, USA

    Ryan Haggarty

  6. MAP-Behavioral Health Services, Inc/Progreso Latino, Inc., 66 Burnett St., Providence, RI, 02907, USA

    Lavinia Velazquez

  7. School of Public Health and Health Sciences, Arnold House, 3rd Floor, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA

    Jennifer J. Bowdoin

  8. Department of Psychology, Michigan State University, East Lansing, MI, 48824-1116, USA

    Zornitsa Kalibatseva

Authors
  1. Lisa A. Uebelacker
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  2. Beth A. Marootian
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  3. Paul A. Pirraglia
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  4. Jennifer Primack
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  5. Patrick M. Tigue
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  6. Ryan Haggarty
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  7. Lavinia Velazquez
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  8. Jennifer J. Bowdoin
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  9. Zornitsa Kalibatseva
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  10. Ivan W. Miller
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Corresponding author

Correspondence to Lisa A. Uebelacker.

Appendix: Focus Group Leader Guide

Appendix: Focus Group Leader Guide

Today we want to talk about the problem of depression, stress, nervios, or worries. We say someone is “depressed” when they feel sad or down, and they do not enjoy doing things. People with depression may have trouble sleeping or sleep too much, may have trouble eating or eating too much, may have trouble thinking or concentrating, and may not have any energy. They might cry a lot, or they might not. They may have trouble getting things done around the house or at work. They might worry a lot and feel stressed a lot.

Hoy queremos hablar del problema de la depresión, estrés, nervios, y preocupaciones. Decimos que alguien está “deprimido” cuando se siente triste o decaído, y no disfruta en hacer cosas. Personas con depresión a veces tienen dificultad durmiendo o duermen demasiado, tienen dificultad comiendo o comen demasiado, les cuesta trabajo enfocarse o concentrarse, y quizás no tienen nada de energía. Pueden llorar mucho o no. Pueden tener dificultad en hacer cosas por la casa o en el trabajo. También se pueden preocupar mucho o sentir mucho estrés.

  1. 1.

    Have you known anyone with this problem? (Don’t need to tell us who). What was the experience like for them? What did you notice?

    Ha conocido a alguien con este problema? (no nos tiene que decir quién). Cómo era la experiencia para ellos? Qué notaron?

  2. 2.

    What do you think is the best thing to do when you have this problem? Who/where do you go to first?

    Que es lo mejor que uno puede hacer si tiene este problema?

    Con quién se ve/adonde va primero?

    1. a.

      What are some reasons people do not get help for this problem if they are in need?

      Que son unas razones porque la gente no recibe ayuda si lo necesita?

  3. 3.

    What does your family/country/culture say to do? [cultural aspects]

    Qué les dice su familia/cultura que haga?

    1. a.

      How to overcome barriers if cultural/familial issues arise preventing treatment?

      Cómo uno supera estas cosas cuando por ejemplo (insert what has come up)?

  4. 4.

    Did they get help from a doctor or therapist? Why or why not?

    Recibieron tratamiento de un doctor o terapeuta? Por qué?/Por qué no?

  5. 5.

    Did they take medication for depression? Why or why not? Would you ever recommend someone take medication for their depression? Why or why not?

    Recibieron medicamento para la depresión? Por qué/Por qué no? Recomendarían a alguien que tomara medicamento para la depresión? Por qué?/Por qué no?

  6. 6.

    What would make it easier to get treatment for depression? Is there anything that doctors could do? That your health plan could do?

    Qué se podria hacer para facilitar adquirir tratamiento para la depresión?

Recent Community Events

  1. 1.

    We know that there have been several events recently, including the shopkeeper who asked two Spanish-speaking men for their social security card, and the governor’s order asking state employees and police to check immigration status. What impact have these events had on your mood or your behavior? What about the people around you?

    Sabemos que recientemente han habido varios eventos, incluyendo el dueño de una tienda quien le pidió ha dos hombres que hablaban español por sus tarjetas de seguro social (social security), y el orden del gobernador que pide que empleados del estado y policiá que tienen que verificar estado migratoria. Cómo les ha afectado su estado de ánimo o cómo se ha comportado estos eventos? Y qué tal las personas en su vida? De su comunidad?

  2. 2.

    Do these events make it less likely that you would seek treatment from a doctor or a clinic? If so, why?

    Estos eventos bajan la probabilidad de que vaya a un doctor o clínica? Sí, por qué?

  3. 3.

    Do these events make it harder to trust your health plan?

    Estos eventos le hacen más difícil confiar (tener confianza) con [name of the health plan]?

    1. a.

      What could we do? How can we implement [group members suggestions]?

      Qué podemos hacer para aumentar la confianza?

Telephones

  1. 1.

    We found that cell phones frequently were turned off. We had a lot of trouble reaching people. Any ideas for how to deal with this problem?

    Encontramos que teléfonos celulares frequentemente están apagados o desconectados. Tuvimos muchos problemas localizando a la gente. Tienen ideas en cómo podemos solucionar este problema?

  2. 2.

    We are wondering if the use of phones is a problem for members. In particular, we are concerned about:

    Estamos pensando si el uso de teléfonos es un problema para miembros. En particular estamos preocupados en:

    1. a.

      Using people’s minutes

      Usar los minutos de la gente

    2. b.

      People being worried about telephone scams

      La gente esta preocupada de trampas/trucos usados por teléfono para robar dinero.

    3. c.

      People being worried about INS

      La gente está preocupada de la migración

Are there other problems with using phones? Is there any way that we can deal with these concerns?

Hay algunos otros problemas con usar teléfonos? Hay algo que nosotros podemos hacer para arreglar estas situaciones/ideas?

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Uebelacker, L.A., Marootian, B.A., Pirraglia, P.A. et al. Barriers and Facilitators of Treatment for Depression in a Latino Community: A Focus Group Study. Community Ment Health J 48, 114–126 (2012). https://doi.org/10.1007/s10597-011-9388-7

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  • DOI: https://doi.org/10.1007/s10597-011-9388-7

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