Promotoras as Mental Health Practitioners in Primary Care: A Multi-Method Study of an Intervention to Address Contextual Sources of Depression

We assessed the role of promotoras—briefly trained community health workers—in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention’s impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention’s implementation, involving infrastructure at the health centers, boundaries of the promotoras’ roles, and “turf” issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers

Naturalistic studies - Researching the everyday clinical world

During the last decade, a vast amount of research has been produced concerning the efficacy of different pharmacological and psychological treatments in psychiatry for various diagnoses. This movement towards evidence-based practices has aimed at grounding clinical practice in evidence derived from research, to optimize outcomes. Such developments should translate into the successful management of seriously mentally ill persons, allowing them to remain safely and productively in their communities rather than in more restrictive settings. Treatment regimens grounded in evidence are well behind the deinstitutionalization of mentally ill persons, which has sometimes even lead to their reinstitutionalization in unfavorable settings (jails, nursing homes, etc.) and unsafe living conditions (shelters, streets)

Prevalence of intimate partner violence among migrant and native women attending general practice and the association between intimate partner violence and depression

Item does not contain fulltextOBJECTIVE: To explore the prevalence of intimate partner violence (IPV) of women (aged >18 years) attending general practice and to assess the association between IPV and depression. METHODS: A cross-sectional survey was conducted within 15 general practices across Rotterdam. The study population was all women older than 18 years of age attending general practice. Women were screened for sociodemographic factors, IPV and depression using the Composite Abuse Scale and the Beck Depression Inventory. RESULTS: This study had a response rate of 63% (221 of 352 women). Two hundred and fourteen women were included in the study of whom 41% were migrants. Thirty per cent of the women attending general practise ever experienced IPV. Migrants experienced IPV 1.5 times more often compared to Dutch women. A significant association between IPV and depression was found. Half of the abused women were suffering from a depression. More than three-quarter of depressed women ever experienced IPV. CONCLUSIONS: IPV is common in women attending general practice and it is significantly associated with depression. To improve recognition of abused women, doctors should ask depressed women if they ever experienced IPV

Development of the Stress of Immigration Survey

The Stress of Immigration Survey (SOIS) is a screening tool used to assess immigration-related stress. The mixed methods approach included concept development, pretesting, field testing, and psychometric evaluation in a sample of 131 low-income women of Mexican descent. The 21-item SOIS screens for stress related to language, immigrant status, work issues, yearning for family and home country, and cultural dissonance. Mean scores ranged from 3.6 to 4.4 (a scale of 1-5, higher is more stress). Cronbach α values were more than 0.80 for all subscales. The SOIS may be a useful screening tool for detecting high levels of immigration-related stress in low-income Mexican immigrant women

A Syndemic Model of Substance Abuse, Intimate Partner Violence, HIV Infection, and Mental Health Among Hispanics

Hispanics are disproportionately affected by substance abuse, HIV infection, intimate partner violence, and mental health conditions. To address health disparities among Hispanics and other vulnerable groups, it is necessary to understand the complex interactions between health conditions clustering together (e.g., substance abuse, intimate partner violence, and HIV) and the social ecology in which these conditions exist. A syndemic orientation, a consideration of clustering epidemics and common individual, relationship, cultural, and socioenvironmental factors linking these conditions, may be helpful in developing comprehensive models that expand our ability to understand and address health disparities. The purpose of this paper is to introduce a Syndemic Model of Substance Abuse, Intimate Partner Violence, HIV Infection, and Mental Health among Hispanics, and provide evidence from the research literature to support the central relationships and risk and protective factors (i.e., potential links between conditions) depicted by the model. The development and evaluation of interventions aimed at the prevention of substance abuse, intimate partner violence, HIV/AIDS, and mental health problems as a syndemic affecting Hispanics is urgently needed. Public health nurses can initiate this endeavor with the guidance of a Syndemic Model

Prevalence of violence against immigrant women: a systematic review of the literature

Interest in studying the particular case of the victimization of immigrant women has increased. This systematic review intends to document the violence that is experienced by immigrant women within their host country and its prevalence. Research was conducted using five databases: PsycArticles, Pubmed, Web of Science, Scopus and ScienceDirect. We selected 24 quantitative studies, according to the following inclusion criteria: published between 2003 and 2013, that focused on an adult study population, and that revealed the prevalence of victimization that is experienced by immigrant women. These studies were mainly conducted in America (67 %) and Europe (33 %), and the participants were mostly Asian and Latin women. The large majority of the studies focused their attention on intimate partner violence, whose prevalence ranges between 17 % and 70.5 %. There is a high variability of the prevalence rates, which could be due to cultural factors and/or to methodological issues. These matters should be addressed by future researchers to allow for a better understanding of the phenomena.info:eu-repo/semantics/publishedVersio

Social, Occupational, and Spatial Exposures and Mental Health Disparities of Working-Class Latinas in the US

Grounded in ecosocial theory, this paper discusses the mental health disparities of working-class Latinas from multiple perspectives. An overview of working-class Latinas’ prevalent mental health disorders, barriers to care and suggestions for interventions and future studies are provided