Older Mexican Americans : perceptions of mental distress and pathways to mental health service utilization

Gonzalez, John Michael, 1964-
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The literature has documented the contention that economic, cultural, and structural barriers have led to lower utilization of mental health services by Latinos when compared to other ethnic groups. With the growth of older Hispanics, the number of people affected by the barriers to health care will grow. Despite barriers, a small number of older Latinos access mental health services. A gap exists in the literature to explain how some older Latinos access mental health treatment. Using qualitative exploration, this dissertation answers the central question what factors influence help-seeking behavior and mental health service utilization of older Mexican Americans. The researcher used a purposive sample and interviewed 20 older Mexican Americans, who completed outpatient mental health services located in Texas. Green’s (1999) Adapted help-seeking behavior model guided the ethnographic content analysis. Respondents experienced a multiplicity of stressors and behavioral signs of mental distress. Among labels used for the problem were depression or depresion, anxiety, nervios or ansiosa, also soledad, tristeza and coraje. The meaning of the language respondents used was important; often times had multiple meanings. Factors that influenced respondents’ help-seeking behavior and mental health service use included family with the daughter being most instrumental. Community factors doctors, nurses, social workers, support groups, and housing authority. An overarching theme was the significant relationships with the interaction of these factors. The relationships were characterized as close, family like. The physician was central to the respondents. Agency staff and the group members helped with utilizing services, resolving their problem, and continuing treatment. Other themes included challenges such as lack of education of mental illness and mental health services, language preference, costs of medication, and stigma of mental illness. Recommendations include expanding the workforce of bilingual/bicultural providers and Spanish-speaking providers; community education of mental illness and reduce the cultural distance between older Hispanics and health care providers. Future research should focus on exploring the relationship with the primary care physician, and the language that research and treatment programs use, attitudinal barriers to the treatment of depression among ethnic minorities, effective culturally competent interventions and improving treatment adherence with older Latinos.