Toward a cultural adaptation of pharmacotherapy: Latino views of depression and antidepressant therapy.
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.
University of Southern California.
Sylvanna M
SM
Vargas
Columbia University School of Social WorkNew York State Psychiatric Institute.
Leopoldo J
LJ
Cabassa
University of Central Florida.
Andel
A
Nicasio
Columbia University Medical Center.
Ana Alicia
AA
De La Cruz
New York State Psychiatric Institute.
Elizabeth
E
Jackson
New York State Psychiatric Institute.
Melissa
M
Rosario
Rutgers University.
Peter J
PJ
Guarnaccia
Columbia University Medical CenterNew York State Psychiatric Institute rlewis@nyspi.columbia.edu.
Roberto
R
Lewis-Fernández
D000223:Adaptation, Psychological; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000208:ethnology*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence / Q000208:ethnology* / Q000523:psychology*; D008875:Middle Aged; D036301:Qualitative Research; D013240:Stereotyping; D014481:United States / Q000208:ethnology
D000928:Antidepressive Agents
Latino; antidepressant pharmacotherapy; cultural adaptation; engagement; stigma