Summary of Relevant Literature
"Urban Latinx Parents' Attitudes towards Mental Health: Mental Health Literacy and Service Use"
Louise E. Dixon De Sylvia et al
In the qualitative study, “Urban Latinx parents’ attitudes towards mental health: Mental health literacy and service use”, Latino/Hispanic parents residing in urban communities were asked about their knowledge, beliefs, and perceptions regarding mental health and the use of mental health services for anxiety and depression in children. In comparison with their non-Latinx White counterparts, “Latinx youth report higher levels of internalizing symptoms and are less likely to seek mental health treatment” (Dixon et al). This study examined data collected from 15 different Hispanic/Latino parents who were concerned about their children's, ages 6-13, worried/sad behavior. Parents participating in this study were found to be, “from low-income urban neighborhoods in a large city on the west coast. Flyers were posted in community spaces in neighborhoods with a large resident representation from Latinx families, such as in coffee shops, grocery stores, and libraries” (Dixon et al). Researchers also partnered with charter schools to distribute recruitment information regarding the study. Interviewers created an interview guide, consisting of 6 concepts, to know what to analyze in parent responses. These concepts include, “(1) how parents describe worry and sadness in their children; (2) how parents describe their child’s problems to their family, friends, and community; (3) perceived stigma of child’s mental health problems and help-seeking; (4) cultural views about mental health; (5) knowledge of treatments for anxiety and depression; and (6) where and how people access information about their child’s mental health problems.” (Dixon et al). Results show that Hispanic/Latino parents have trouble identifying mental health problems, express stigma towards mental health, have trouble seeking help, yet are open to learning about exploring ways to help their children with mental health concerns.
Although parents reported stigma in regard to mental health and treatment, they were still open to using the resources that their child needs. Some limitations of the study were that it was a small sample of mostly women. It would have been beneficial if they had included fathers in their research, which could have pinpointed common themes in both mothers and fathers. They could have also identified any differences in knowledge about mental health in relation to the parents gender and parenting style. Additionally, “most of the parents who participated had male children, which may affect how parents conceptualize mental health problems such as anxiety and depression, perhaps taking greater note of such behaviors in boys compared to girls.” (Dixon et al). Finally, the research they conducted does not include US-born Latinx parents as well as the interviewing of children. Both of these inclusions could have made a bigger impact on their research as they could have found similarities from different perspectives on mental health. According to the findings, although stigma is prevalent, it may not stop some Latinx families from accessing services. This data was gathered through a series of questions, which responses were all audiotaped and translated.
"Considerations for Play Therapy Research with Latino Populations"
Peggy L. Ceballos et al
Although Latino’s are by far the biggest minority group in the US, with 10.4 million Latinos in the United States under the age of 9 (U.S. Census), there are many challenges Latino kids face that put them at risk for socioemotional problems. Young Latino kids are more likely to show behavioral problems, relational difficulties, and communication problems due to at-risk factors like language, acculturation, family separation, and poverty (Ceballos et al). Delinquency, mental health disorders, and youth violence can all happen if kids don't get early intervention. In spite of that, Latinos are frequently underrepresented in mental health services. This article provides play therapy researchers with practical guidelines about how to recruit Latinos effectively, minimize attrition rates, address cultural values, and advocate for Latinos when conducting play therapy research (Ceballos et al). The goal of this article is to provide researchers with the necessary tools to adequately provide mental health services to this underrepresented population.
Some key points the author included in this article were latino cultural values, considerations concerning language, recruitment of participants, equipping the play room, which can provide better service for the underrepresented latino youth. One Latino cultural value mentioned in the article was respeto. The article explains that respeto is “a demonstration of unconditional respect and deference toward elders and authority figures (Arredondo et al., 2014; Ojeda et al., 2011)”. Respect is important in the research process because researchers may hold authority over participants, especially if they're white. Participants may feel intimidated by a White researcher due to historical events of oppression, which is why it would be beneficial to have a bicultural and bilingual researcher. However, there are not a lot of Latino mental health professionals. Making participants feel comfortable should be a priority as it will reflect on their responses and behaviors while being in the playroom. Because children may feel inclined to show respect to researchers who are perceived as persons of authority, they might just do as they are told and say what they think a researcher would want them to say, instead of just acting as themselves which is the goal.
Additionally, most first-gen Latino immigrants speak Spanish in their households. Many Latino patients have trouble speaking English, which limits their access to mental health care. The underutilization of mental health services is also caused by the lack of Spanish-speaking health professionals. A “bilingual-bicultural member of the research team can ensure confidentiality and an accurate translation without using external translators” (Ceballos et al). It is important to provide culturally accurate translations to Latinx patients. By doing this, we'll keep the original meaning of words and phrases. For example, “the translation of research into Spanish is "investigación", which is more accurately understood as the English term investigation. Therefore, the word investigación can convey a negative meaning for Latinos, who may be undocumented or in the process of acquiring legal status in the United States. The word investigación can imply for many Latinos that they could be under investigation by a government institution” (Ceballos et al). Participants can be wary about participating in the research in fear because of their documentation status.
The Latino population has unique characteristics, so it's important to create a culturally inclusive framework. There isn't much research on play therapy for Latinos, but what's been done shows that play therapy interventions are effective for Latino kids and their families. Latino kids make up the fastest-growing population in the United States, and they face a lot of risk factors every day, so play therapy researchers need to figure out which play therapy interventions work for them. It is important to conduct culturally inclusive research, bearing in mind key factors such as language barriers, cultural family values, etc. It's important to consider participants' cultural values, parenting practices, acculturation, and language when doing research. Researchers can also make sure that research is culturally responsive by recruiting participants and using play materials that are culturally relevant. Last but not least, play therapists have a unique chance to advance advocacy skills and address social justice issues for Latinos. This can be done by addressing oppressive factors when conducting research with this population and discussing them in their publications.
"Conceptualizations of Suicide and Suicide-Related Stigma in Latino Communities in the United States"
Kathryne B. Brewer et al.
According to past studies, Latinos die by suicide less than their non-Hispanic Whites and Asians counterparts, but recent data indicate that suicide rates are going up among Latinos. This study looked at how 248 Latino adults in the United States perceived persons experiencing suicidal ideation by using an experimental vignette, since their is little research on how Latinos perceive those experiencing suicidal ideation and what causes stigma. Higher levels of stigma were associated with older participants and participants with more kids. Levels of stigma didn't differ by gender or age for people with suicidal ideation. This study examined Latinos' attitudes and stigma-related beliefs about suicide. The research team investigated the following questions: “(1) Are participant sociodemographic characteristics associated with attitudes toward suicide and suicide-related stigma? (2) Does the gender and/or age of the person experiencing suicidal ideation differentially impact suicide-related stigma? (3) Is the interaction between the demographic characteristics of the person experiencing suicidal ideation and the demographic characteristics of the participants associated with differing levels of stigma toward those experiencing suicidal ideation?” (Brewer et al) The results of the study indicate that there's a need to increase health literacy about suicide in Latino communities, especially in terms of identifying suicidal ideation early on.
A convenience sample of about 500 people who self-identify as Hispanic/Latino/ was recruited. An experimental vignette-based study recruited participants in person from Latino-focused organizations, such as churches and English as a Second Language classes. They had to be over 18, identify as Hispanic or Latino/a, and live in the U.S. full-time. Several things were measured in this study, including religiosity and acculturation. According to the article, "Religiosity was measured by six items from the Daily Spiritual Experiences Scale (Underwood & Teresi, 2002)" and acculturation was measured by the "Bidimensional Acculturation Scale for Hispanics (Martin & Gamba, 1996)" (Brewer et al). Researchers used a Vignette Experimental study to investigate community attitudes and beliefs. In addition, researchers asked participants additional questions such as whether they believed the person in the vignette had a problem and identify what it was based on the symptoms presented.
According to the article, 90% of the 248 participants said they thought the person in the vignette had a problem, while 8.5% said they didn't (Brewer et al). People most often described the problem in the vignette as depression, with only 8 participants identifying suicide risk correctly. In general, participants reported moderate levels of public stigma. The highest level of public stigma was associated with engagement with law enforcement, followed by community-level stigma. The results did not indicate any significant differences in the five domains of stigma based on the demographics of the vignette subject. This suggests that stigma doesn't depend on gender or age when it comes to stigma around suicidal ideation. However, the demographics of the respondents did impact various domains of stigma in relation to suicidal ideation.
Overall health literacy related to suicide needs to be improved within Latino communities, especially early detection of suicidal ideation. A mere 3.2% of participants correctly identified that the vignette subject was experiencing suicidal ideation, potentially putting that person at risk (Brewer et al). It doesn't mean they didn't see it, just that they didn't want to mention it. In the vignette, half of the respondents felt the person was depressed, which is good, however, these results show no explicit acknowledgment of specific self-harm thoughts. One of the most effective ways to prevent completed suicides is to identify early warning signs of self-harm or suicide intentions.
Educating the community might help reduce the stigma around suicidal ideation. To supplement other community-based education efforts, Latinos should be encouraged to enter behavioral health fields, such as social work and counseling, to gain a deeper understanding of mental health symptoms. Increasing the health literacy of faith-based organizations' leadership could also help increase their congregations' health literacy since most participants in this study reported high levels of religiosity.
Despite being very insightful, this study had some limitations. The results of this study may not apply to Latinx communities across the country since they were based on a convenience sample of heterogeneous Latino participants in a big city in Texas. To add on, recent research on Latinx acculturation in the United States suggests that acculturation is a multidimensional concept, not a bi-dimensional one. Lastly, all data were self-reported and social desirability bias could have influenced the results.