Ann-Marie Yamada

Unmet Needs for Mental Health Services for Latino Older Adults: Perspectives from Consumers, Family Members, Advocates, and Service Providers

This study qualitatively assessed the need for mental health services among Latino older adults in San Diego, California. The primary mental health issue was depression. Primary organizational barriers to accessing services were language and cultural barriers secondary to a lack of translators, dearth of information on available services, and scarcity of providers representative of the Latino community. Other challenges included a lack of transportation and housing, and the need for socialization and social support. Latino older adults experienced their unmet needs in ways associated with their cultural background and minority status. Age- and culturally-appropriate services are needed to overcome these barriers.

Ethnic differences in social network help-seeking strategies among Latino and Euro-American dementia caregivers

This research explores the help-seeking behavior of Euro-American and Latino caregivers who provide homecare assistance to an older adult with dementia. A community sample of 89 caregiver-care recipient pairs (39 Latino and 50 Euro-American) was interviewed. Descriptive, bivariate, and multivariate analyses were conducted to examine ethnic differences in use of an informal social network for help with caregiving tasks. Caregiver experiences that may impact help-seeking behaviors such as perceived availability of support network, satisfaction with support received and caregiver distress were also considered. Latino caregivers reported less help-seeking than did the Euro-American caregivers. Overall, ethnicity accounted for 16% of the variation in help-seeking behaviors. Ethnicity accounted for a significant portion of the variation in most of the help-seeking characteristics examined even after adjusting for socioeconomic variables. In the multivariate model, the effects of ethnicity on help-seeking persisted, while the effects of other likely predictors did not. The size of social network may not be synonymous with the seeking of support by caregivers. Likewise, higher levels of distress among Latino caregivers did not result in increased help-seeking behaviors. There remains a need to identity what other factors may contribute to the cultural variability in caregivers’ use of informal support.

Addressing mental health disparities through clinical competence not just cultural competence: The need for assessment of sociocultural issues in the delivery of evidence-based psychosocial rehabilitation services

Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness.

Fotonovelas: A Health Literacy Tool for Educating Latino Older Adults About Dementia

Abstract The purpose of this study was to examine the feasibility and impact of a guided educational intervention centering around dementia-oriented fotonovelas on a community sample of Spanish-speaking Latino older adults with a relatively low level of prior exposure to, or knowledge of Alzheimers disease and related disorders. Two fotonovelas, or “photo novels,” were developed and subsequently tested with 111 Spanish-speaking older adults who completed a survey following group administration of a fotonovela. After a discussion to reinforce the educational content, participants were given a second fotonovela to take home. A second assessment was conducted approximately three weeks later. The results suggest that many of the participants increased their overall knowledge of Alzheimers disease and most reported satisfaction with the educational materials. Implications for use of fotonovelas as an acceptable and cost-effective means of providing health education to an underserved population are discussed.

Culturally Based Intervention Development: The Case of Latino Families Dealing With Schizophrenia

Objectives: This article describes the process of developing a culturally based family intervention for Spanish-speaking Latino families with a relative diagnosed with schizophrenia. Method: Our iterative intervention development process was guided by a cultural exchange framework and based on findings from an ethnographic study. We piloted this multifamily group 16-session intervention with 59 Latino families in a randomized control trial. Data were collected on family- and client-level outcomes, and poststudy focus groups were conducted with intervention participants. Results: Preliminary evidence indicates that the intervention is effective by increasing illness knowledge and reducing family burden. Conclusions: This work can provide a model for how to integrate cultural factors into psychosocial services and enhance interventions in real-world settings for culturally diverse populations.

Intrinsic Motivation as a Mediator of Relationships Between Symptoms and Functioning Among Individuals With Schizophrenia Spectrum Disorders in a Diverse Urban Community

This study investigated intrinsic motivation as a mediator of the relationship between clinical symptoms and functioning. The mediation model was tested with a sample of 166 adults with schizophrenia spectrum disorders attending psychosocial rehabilitation programs in a diverse urban community. Ethnic minority status was examined as a moderator of the mediation model. Motivation was measured using items reflecting intrapsychic drive. Symptoms were assessed with the expanded Brief Psychiatric Rating Scale and functioning with the Role Functioning Scale. Motivation was a significant mediator of the relationship between functioning and all symptom scores; fully mediating the relationship between functioning and negative, disorganized, and global symptoms, and partially mediating the relationship between positive symptoms and functioning. Motivation scores between ethnic minority and nonminority individuals differed significantly (p < 0.05), but no moderation effect was indicated. The strong mediation effect schizophrenia of motivation on the symptoms-functioning relationship supports future work to translate findings into effective recovery-oriented services.

Community Mental Health Allies: Referral Behavior Among Asian American Immigrant Christian Clergy

Asian American Christian faith leaders support and provide an array of services within their communities. However, little is known about their response to congregants’ mental health concerns. This study examined correlates of mental health referral behavior among 103 Asian American Christian clergy in California who completed an anonymous mail survey. Using multiple regression analyses, we found that clergy’s prior mental health education, knowledge of mental illness, education level, time spent providing individual counseling and referral to general practitioners were positively associated with making mental health referrals. Outreach efforts (including mental health education, and mental health referral information) to facilitate clergy’s support of congregants with mental health needs are discussed.

Tri-ethnic variations of co-morbid substance and alcohol use disorders in schizophrenia

OBJECTIVES This study examined the differential prevalence of substance and alcohol use disorders among European Americans, African Americans, and Latinos with schizophrenia (n = 6424) who received public mental health services in San Diego County during fiscal year 2002-2003. METHODS Data were obtained from the public mental health database used by the San Diego County Mental Health System. Chi-Square analyses and stepwise logistic regression analyses were used to examine differences regarding the prevalence of substance and alcohol use among clients with schizophrenia and schizoaffective disorder, and to analyze the sociodemographic variables associated with this co-morbidity. RESULTS Significant differences in the prevalence of diagnosed co-morbidity were found across the ethnic groups. Rates of co-morbid diagnosis among African Americans (25%) were significantly higher than those among European Americans (22%) and Latinos (19%). Logistic regression results revealed ethnicity was a significant predictor of co-morbid substance and alcohol use, as was being homeless and male. Among Latinos, language preference was also a significant predictor. Latinos who denoted English as their primary language were 1.7 times more likely to be diagnosed with co-morbid substance or alcohol use disorders than Latinos who denoted Spanish. CONCLUSIONS Among people with schizophrenia, there were significant differences in prevalence rates and predictors of diagnosed co-morbid substance and alcohol use disorders. Future research is needed to examine the relationship among language preference, level of acculturation, and subsequent diagnosing barriers for Latinos. Among African Americans, the reasons behind increased co-morbidity rates need to be examined, and homelessness should be carefully addressed among all three ethnic groups.

Hope and Burden among Latino Families of Adults with Schizophrenia

This study examined hope and family burden among Latino families of individuals with schizophrenia. The sample consisted of 54 family members, one family member per outpatient adult recruited from public mental health programs in a diverse urban community. Hierarchical linear regression analyses were used to test the hypothesis that the family members increased hope for the patients future would be associated with decreased family burden beyond effects explained by the patients length of illness and severity of symptoms. Results supported the study hypothesis. Family hope for the patients future was associated with four of five types of family burden. Findings point to the prominent role of hope as a source of resilience for Latino families dealing with severe mental illness of a loved one.

Longitudinal Invariance of the Satisfaction With Life Scale for Individuals With Schizophrenia

Objectives: This study examined the longitudinal structural stability of a subjective quality of life measure in an ethnically diverse sample of 331 adults with schizophrenia. Methods: Participants completed the Satisfaction With Life (SWL) scale at entry to community-based mental health services and again at 6 and 12 months. Five types of measurement invariance were tested using a series of multiple-group confirmatory factor analyses. Results: All five types of longitudinal invariance were supported. Conclusions: These findings offer strong support for the validity of the SWL scale as a tool for research or for clinical purposes to assess the effectiveness of interventions over time. Implications for use of the SWL scale in evidence-based social work practice are discussed.