Meeting the Mental Health Needs of Elderly Latinos Affected by Depression: Implications for Outreach and Service Provision
Brennan, Mark, Vega, Marlena, Garcia, Israel, Abad, Antonio, Friedman, Michael B., Care Management Journals
Latinos are one of the fastest growing segments of the older population and are known to have a high prevalence of depression, as well as a greater likelihood of risk factors for this condition such as poor comorbid physical health, distressed economic circumstances, and social isolation that leads to a de facto homebound status. Thus, long-term care providers are likely to encounter increasing numbers of older Latinos suffering from depression in both community and institutional settings. This article discusses current empirical and conceptual studies on mental health issues facing older Latinos, as well as outreach, clinical practice, and policy recommendations for working with this population.
Keywords: Hispanics; stigma; mental health services; service barriers
Latinos, or persons of Hispanic origin, are one of the fastest growing minority groups in the United States, and will constitute the largest such group in the early part of the twentyfirst century (Pollard, 1993). Latinos are not homogenous, with considerable diversity in national origin, birthplace and immigration patterns, language use, and race (Cantor & Brennan, 2000). The largest Latino group consists of Mexican Americans (48%), followed by Cuban Americans (18%), Puerto Ricans (11%), Central and South Americans (8%), and 15% classified as "other." There will be approximately 8 million older Latinos in the United States by 2050 (Angel & Hogan, 1991). The focus of this article is mental health among the Latino older population, specifically, the identification and treatment of depression and risk factors that may precipitate or exacerbate this condition, such as social isolation and de facto homebound status due to cultural differences, caregiving responsibilities, poor health, and low utilization of mental health services.
Depression as an illness among older adults is highly significant, given its prevalence and its overwhelming association with increased morbidity and mortality (Chew-Graham, Baldwin, & Burns, 2004; U. S. Department of Health and Human Services, 1999). Older persons with mental disorders such as depression use more institutional long-term care (Parker, 2004). Further, depression in long-term home health care clients is likely to be misdiagnosed or undiagnosed, with indications that upwards of 16% of this population may have major depression (Brown, Bruce, et al., 2004; Brown, McAvay et al, 2003; Raue et al., 2003).
Major depressive disorder is defined as one or more episodes characterized by symptoms of depressed mood, loss of interest or pleasure in activities, significant weight loss or gain, sleep disorders, fatigue, psychomotor agitation or retardation, sense of worthlessness, and thoughts of suicide or death, along with other criteria related to duration, and so forth. Although the likelihood of a diagnosis of major depressive disorder decreases with age, older adults are at greater risk for clinically significant depressive symptomatology affecting anywhere from 10% to 20% of communitydwelling older adults, and anywhere from 17% to 35% of this group in primary care settings (U. S. Department of Health and Human Services, 1999).
Prevalence of Depression Among Older Latinos
Whereas some studies have not found racial/ethnic differences in the prevalence of depression (Crystal, Sambamoorthi, Walkup, & Akincingil, 2003), others find Latinos at greater risk. In one national study, Latinos had a 44% increased risk for major depression relative to non-Hispanic Whites (Dunlop, Song, Lyons, Manheim, & Chang, 2003). Elderly Latinos are also more likely to have clinically significant depressive symptoms compared with nonHispanic Whites (i.e., 30% to 44% and 22%, respectively; Falcon & Tucker, 2000). Differences in the prevalence of depression also exist among Latinos based on national origin (Falcon & Tucker, 2000). Puerto Ricans are at greater risk for depression compared to Mexican Americans or Cuban Americans (Guarnaccia, Martinez, &Acosta, 2002). …