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

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

Adult experience of mental health outcomes as a result of intimate partner violence victimisation: a systematic review

Background: Intimate partner violence (IPV) has been known to adversely affect the mental health of victims. Research has tended to focus on the mental health impact of physical violence rather than considering other forms of violence. Objective: To systematically review the literature in order to identify the impact of all types of IPV victimisation on various mental health outcomes. Method: A systematic review of 11 electronic databases (2004–2014) was conducted. Fifty eight papers were identified and later described and reviewed in relation to the main objective. Results: Main findings suggest that IPV can have increasing adverse effects on the mental health of victims in comparison with those who have never experienced IPV or those experiencing other traumatic events. The most significant outcomes were associations between IPV experiences with depression, posttraumatic stress disorder, and anxiety. Findings confirm previous observations that the severity and extent of IPV exposure can increase mental health symptoms. The effect of psychological violence on mental health is more prominent than originally thought. Individual differences such as gender and childhood experience of violence also increase IPV risk and affect mental health outcomes in diverse ways. Conclusions: Psychological violence should be considered as a more serious form of IPV which can affect the mental health of victims. Experiencing more than one form of IPV can increase severity of outcomes. Researchers should look at IPV as a multi-dimensional experience. A uniformed definition and measure of IPV could help advance knowledge and understanding of this disparaging global issue

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