Toward a cultural adaptation of pharmacotherapy: Latino views of depression and antidepressant therapy

    Authors

    S. M. Vargas; L. J. Cabassa; A. Nicasio; A. A. De La Cruz; E. Jackson; M. Rosario; P. J. Guarnaccia;R. Lewis-Fernandez

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    Abbreviated Journal Title

    Transcult. Psychiatry

    Keywords

    antidepressant pharmacotherapy; cultural adaptation; engagement; Latino; stigma; IMPROVE TREATMENT ADHERENCE; ASTERISK-D REPORT; MENTAL-ILLNESS; MOTIVATIONAL PHARMACOTHERAPY; HISPANIC ETHNICITY; MEXICAN-AMERICANS; UNITED-STATES; STIGMA; DISORDERS; CARE; Anthropology; Psychiatry

    Abstract

    Relative to non-Latino Whites, Latinos in the United States with major depressive disorder (MDD) show low engagement in antidepressant therapy, whether engagement is defined as pharmacotherapy access, medication initiation, pill-taking, or treatment retention. One potential reason for this disparity in depression care is the low cultural congruence of pharmacotherapy for this population. To examine Latinos' views of depression and antidepressant therapy, we conducted qualitative interviews with 30 Latino outpatients initiating antidepressants prior to their first treatment visit using the semistructured Treatment Adherence and Retention Questionnaire. These baseline interviews were randomly selected from data collected for a randomized controlled trial testing a novel intervention to enhance engagement by depressed Latino outpatients. Participant narratives were analyzed using open coding and the iterative analytical approach derived from grounded theory. Patient views about depression addressed stigmatizing views held by others in their social circle. Most participants directly refuted these views by providing alternate explanations to depression experiences. Antidepressant therapy narratives also revealed marked stigmatization, but participants tended not to refute these views. Instead, patients expressed concerns about antidepressants and showed marked ambivalence about seeking psychiatric care. Participants, however, did suggest ways in which clinicians and patients might collaborate to address their concerns about antidepressants. Some cultural views, such as concerns about addiction to or dependence on medication, may be negotiable barriers to treatment. Prescribing clinicians should address cultural views and concerns in order to improve Latino engagement in antidepressant therapy.

    Journal Title

    Transcultural Psychiatry

    Volume

    52

    Issue/Number

    2

    Publication Date

    1-1-2015

    Document Type

    Article

    Language

    English

    First Page

    244

    Last Page

    273

    WOS Identifier

    WOS:000351957800006

    ISSN

    1363-4615

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