According to the WHO (2014), depression causes significant burden for women all over the world. In the U.S., women are 70% more likely to experience depression during their lifetime than men (National Institute of Mental Health [NIMH], 2009; NIMH, 2012). Women ages 18 through 45 account for the largest group diagnosed with clinical depression in the U.S. (NIMH, 2009). Hispanic women have more than half the rate of depression than Hispanic men and are more likely to experience depression than Caucasian women in the U.S. (Shatell, Smith, Quinlan-Colwell, & Villalba, 2008). Even though Hispanic Americans have a higher prevalence of depression than Caucasians, they use mental health services at about one-half the rate of Caucasian Americans (Substance Abuse and Mental Health Services Administration [SAMHSA], 2015). Therefore, the purpose of these integrative review of the literature is to review the recent literature published describing the effects of depression on diverse health promotion behaviors among Hispanic women in the U.S., and to make recommendations for clinical nursing practice based on these findings.
Methods:
This review presents research focused on Hispanic women, where all or most of the sample of women are in the age range of 18 to 50. This is to account for the age group with highest prevalence of depression in the U.S., as mentioned above. The review encompasses studies found in electronic database search of PubMed, Cochrane, and CINAHL, inclusive from January 2006 through December, 2016. The search strategy included the use of the following terms: “health promotion,” “Hispanic,” “women,” “depression,” and “disease prevention.” Fifteen articles were obtained written in the English language only (as the focus was Hispanic women living in the U.S.) with heterogeneous samples of Hispanic women of all ages. Seven articles were selected after focusing on women of reproductive age only (18 to 50 years of age). These articles are presented from past to present.
In order to evaluate the research articles discussed, the Johns Hopkins Nursing Evidence-Based Practice, Research Evidence Appraisal Tool, was used (https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_e_research_evidence_appraisal_tool.pdf). According to this tool, all seven studies discussed belong to a level III level of evidence (non-experimental or qualitative). In addition, further evaluation of the quality rating of these studies place them at “good quality” based on multiple overall criteria using this tool.
Results:
Behaviors such as condom use, substance abuse, and noncompliance with medication, exercise and dietary regimens have been affected by depression among Hispanic women of reproductive age. It is imperative that all nurses need to be educated about the joint efforts in screening and managing depression. Awareness about depression has increased since the establishment of the National Depression Screening Day in the U.S. back in 1991 (in October of each year). However; screening should be done on a regular basis in adults, using validated tools, such as the PHQ-9 (United States Preventive Services Task Force, 2016).
Conclusion:
Depression is one of the most common mental conditions seen in primary care settings; therefore, emphasis should be placed on teaching nursing students how to adequately perform social assessments and use the proper screening tools for quick engagement in treatment. Modifications of lifestyle behaviors among women of reproductive age (through interventions promoting community teaching and counseling) have also shown promising outcomes in the reduction of depressive symptoms among minority women in the U.S. (Surkan et al., 2012). Depression can be adequately managed in the majority of the cases when treated early on.Research on depression among Hispanic women of reproductive age is critical, as the average age for the onset of depression among women is 32 years.
In addition to the above, advanced practice nurses must aim for optimization of health care outcomes. Collaborative and integrative models of care are needed in order to blend mental health and primary care and achieve holistic care (Ivbijaro et al., 2014). Currently only around 40% of people with a mental health condition received services for such (SAMHSA, 2014). Primary care settings continue to be the point of entry for people who exhibit depressive symptoms and treatment in these settings need improvement (Mojtabai, 2014). Primary care nurse practitioners should be aware that Hispanic women in particular present with multiple somatic complaints (aches and pains) which mask depression (Chong, Reinschmidt, & Moreno, 2010). These complains need to be further explored.
Maximization of depression treatment is also imperative, such as referral to psychotherapy and gradual escalation of antidepressants to maximize responsive, assessing for side effects. Collaboration between primary care nurse practitioners and mental health care providers (such as psychiatric mental health nurse practitioners) would also allow for referral while maximizing quality of care for the patients (Anthony et al., 2010).