Latino Older Adult Mental Health Needs Assessment 4.14.10

Latino older adult mental health needs assessment Cynthia Zubritsky, PhD 1 , Karen Fortuna, MSW 1 , and the Philadelphia Prevention Partnership/Latino Golden Age Committee 1 Center for Mental Health Policy and Services Research, University of Pennsylvania Background Table 2: Latino OA Barriers to Mental Health Services (N=60) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],The unique needs of Latino OAs for mental health services were language barriers, mistrust in mental health providers, physician’s understanding of their culture, transportation, health insurance, immigration status, stigma, and family disapproval. These barriers can be addressed through a variety of policy and program changes to ensure the development of culturally-appropriate services. Focus group data from Latino OAs about mental health needs provided an understanding of their preferences and the systems, organizational, cultural, and attitudinal barriers to services directs us to possible solutions to address their unmet mental health needs. Table 1: Sociodemographics of the Total Sample Population (N=121) Over half of the participants (N=121, n=64) reported that someone has told them that they have a mental illness (53%). Fifty-three percent (N=64, n=34) of the participants reported a lifetime clinical mental health diagnosis of anxiety or depression. Over half of the participants reported that that their mental health treatment works (69%); however, of these individuals, fifty-two percent of the participants with a mental health condition do not trust their mental health provider (p=.026). Formal MH Services Utilization The majority of the participants with a mental health condition reported that they use formal mental health services from their primary care physician (94%), medication (89%), group therapy (81%), self-help groups (81%), and social work services (77%). Non-traditional MH Services Utilization Many of the participants with a mental health condition also reported that they used non-traditional mental health services, which included: meditation (84%); spiritual and religious supports (83%); herbs (78%) and exercise (73%). Fewer participants reported the use of friends’ assistance (58%), art therapy (58%), and acupuncture (36%). Satisfaction Satisfaction with both formal and non-traditional services use was high and included satisfaction with: 1) primary care physicians (84%); 2) medication (81%); 3) religion/spirituality (76%); 4) meditation (75%); and 5) group therapy (74%). Barriers Significant barriers to medication adherence were reported as: physician’s understanding of the Latino culture (66%) (p=.014); language difficulties (64%); lack or inadequate health insurance (64%); transportation issues (47%); family approval (47%); and cost (39%). Latino OAs reported many barriers in accessing mental health services, which included: language (p=.010), physician's understanding of their culture (p=.037) (see Table 2). References Cabassa, L., Zayas, L., & Hansen, M. C. (2006). Latino adults’ access to mental health care: A review of epidemiological studies. Administration and Policy in Mental Health and Mental Health Services Research, 33 (3), 316–330. Ell, K. (2006). Depression care for the elderly: Reducing barriers to evidence based practice. Home Health Care Service Quarterly, 25 (1–2), 115–148. Ortiz, I. & Romero, L. (2008). Cultural implications for assessment and treatment of depression in hispanic elderly individuals. Annals of Long-Term Care: Clinical Care and Aging, 16 (8), 45-48. Rosental-Gelman, C. (2002). The elder Latino population in Holyoke, MA: A qualitative study of unmet needs and community strengths. Journal of Gerontological Social Work, 39 , 89–114. Tennstedt, S. L., Chang, B., & Delgado, M. (1998). Patterns of long-term care: A comparison of puerto rican, african-american, and non-latino white elders. Journal of Gerontological Social Work , 30 (1/2), 179-199. Tolin, D., Robison, J., Gaztambide, S., et al. (2007). Atques de nervios and psychiatric disorders in older Puerto Rican primary care patients. Journal of Cross-Cultural , 38, 659. Avilable at: http://www.census.gov/prod/2003pubs/p20-546.pdf Results Policy Implications Background Latino older adults (OA) are one of the fastest growing population of OAs in the U.S. This increase in the general population of Latino OAs, will impact the the proportion of health car Needs, including the need for mental health services. The current mental health system is not designed to provide specialty mental health services for OA in general, or Latino OAs specifically. Mental health providers need to better understand their needs and the needs of their families and caregivers. Objectives To investigate the mental health needs of Latino OAs through examining the: (1) effectiveness of existing services; (2) quality of care; (3) access to care/barriers to treatment; (4) service utilization; and (5) medication adherence. Methods Guided self-report survey led by Spanish speaking facilitator. Results Participants expressed high satisfaction with a variety of existing formal and non-traditional mental health services. Participants identified significant barriers to obtaining mental health services. Conclusions These findings provide clinicians and researchers direction for the development of new, more effective interventions and provide administrators and policy makers with a clear direction to reduce access barriers to mental health systems. In 2001, 35.3 million individuals identified themselves as Latino Americans, and it is anticipated that this number will increase to 97 million by 2050 (U.S. Census Bureau). As the general population ages, the proportion of Latino OAs in need of mental health treatment will increase. Latino OAs have high rates of depression; compared to non Latino OAs (16%-45%) (Ortiz & Romero, 2008). Research suggests that Major Depression is most prevalent among Latinos (10.8%), followed by African Americans (8.9%) and Caucasians (7.8%) (N = 7690) ; the odds of depressive disorders among Latino OAs are 44% greater than among non-Latino OAs (Dunlop, Song, Lyons et al.). Anxiety disorder is also commonly reported by Latino OAs (24%-58.8%) (Tolin, et al., 2007). As the Lationo population ages, providers will need to address barriers related to age and culture and increase culturally competent mental health services. Despite the substantial need for mental health services, Latino OAs underutilize mental health services (Tennstedt et al., 1998), have poor access to treatment (Cabassa et al., 2006), and often receive inadequate treatment (Ell, 2006). Data Collection A self-report survey instrument was designed to collect data. The Holyoke Interview Guide served as the foundation for the survey and was chosen due to the high external validity of the instrument (Rosental-Gelman, 2002). Modifications were made to the Holyoke Interview Guide based on a comprehensive literature review of the mental health needs of Latino OAs and clinical experts. Sample Population Five focus groups were conducted in Senior Centers and Residential Facilities (N=121). The majority of the focus group participants identified themselves as Puerto Rican (74%). To investigate the mental health needs of Latino OAs through examining the: (1) effectiveness of existing services; (2) quality of care; (3) access to care/barriers to treatment; (4) service utilization; and (5)medication adherence. Objectives Abstract Methods Conclusions (N=60) n (%) Transportation (n=58) 34(59%) Cost (n=57) 30(53%) Language (n=55) p=.010 * 37(67%) Physician's understanding of culture (n=56) p=.037* 46(82%) No health insurance (n=60) p=.011* 42(70%) Family approval (n=56) 36(64%) Immigration Status (n=58) 11(19%) Stigma (n=55) 9 (16%) ( N=121 ) Percent Age Group (121) 60-64 13% 65-79 61% 80 + 21% Gender (111) Female 66% Male 26%

Latino Older Adult Mental Health Needs Assessment 4.14.10

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Latino Older Adult Mental Health Needs Assessment 4.14.10