Developing a Culturally Tailored Social Risk Assessment Tool for Depression Among Hispanic Women

Purpose: Depression is the number one cause of disability in the world, affecting over 350 million people. In the United States, Hispanic women experience depression around twice the rate of Hispanic males and are at a higher risk for depression than Caucasian and African American women due to multiple social determinants of health that affect the individual, family, aggregates, and community. The social determinants of health refer to conditions in which people are born, live, grow, work, and age. Mental health in the U.S. is affected by disparities among ethnic/racial groups. Barriers to assessment in the Hispanic populations subsequently lead to poor care for mental health illnesses This is evident in the vast research on depression in Hispanics, which suggests that in the U.S., depression in this group is underdiagnosed and undertreated The underdiagnosis is in part due to an inadequate screening or assessment of the social factors that are linked to depression among Hispanics, such as level of education (which leads to poor health literacy), acculturation level (adaptation process to a new culture), immigration-related issues (family separation), etc. Based on an extensive literature reviewed, a culturally tailored risk assessment tool that highlights the social determinants of depression in Hispanic women is nonexistent. This tool could be used in conjunction with other screening tools, such as the Patient Health Questionnaire-9 (PHQ-9) in settings where Hispanic women of reproductive age are seen.

Methods: This study is a secondary analysis study that uses cross-sectional data from SEPA III: The Effectiveness Trial. SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates to Health, Education, Prevention, and Self-Care. SEPA III, the parent study, is a randomized controlled experimental study with adult Hispanic women in Miami-Dade County, Florida, U.S.A. The sample of this study was n = 280 self-identified Hispanic women who completed baseline assessments from May 2013 to October 31, 2014. Descriptive statistics will be presented to show the characteristics of the study sample. Then, CFA models using Mplus (version 7.0) will be presented.

Results: Multiple models were analyzed. The prevalence of depression among the sample was 37.5% (mild to severe depression). Social determinants were subdivided as (a) intrapersonal factors (income, education, acculturation, health status, health insurance status, and employment status); and (b) interpersonal factors (relationship status, living with partner, and living with children). The final model, containing CFA and path analysis for both intra- and interpersonal level factors of the social determinants of depression, revealed that, even though the variables income, education, and employment status loaded significantly onto the latent intrapersonal factors, the latent variable did not significantly predict depression. A CFA was no longer possible to test the latent variable "interpersonal factors" due to being left with two variables after further analysis.

Conclusion: Findings of this study point out several important aspects about depression and social determinants among Hispanic women living in South Florida. Based on an extensive literature reviewed, a culturally tailored risk assessment tool that highlights the social determinants of depression in Hispanic women is nonexistent. The American Psychiatric Association (APA) clearly highlights the crucial importance of cultural issues for proper clinical practice in its DSM-V. Concepts such as cultural syndromes, cultural idioms of distress, and cultural explanation or perceived causes need to be taken into account during clinical encounters, as they assist in accepting or rejecting a specific diagnosis. Having taken this into consideration, this study will serve as a starting point to the development of such a screening tool, which could serve as a filter to help identify Hispanic women who may be prone to depression. In order to develop a comprehensive tool, many other possible social determinants of depression need to be explored, such as: familismo, marianismo, machismo, discrimination, separation from family, and family and partner conflict. Moreover, this tool would also need to be piloted, and checked for acceptance and feasibility. This study certainly informs and adds to the existent knowledge in order to effectively intervene and implement health care practices to reduce health disparities related to depression.