One in five Hispanic or Latino/a/e/x (herein Latinx) individuals in the United States is affected by mental illness, yet among those affected, only 36% received mental health services (compared with 52% of White individuals with mental illness) (1). In the limited research exploring mental health in individuals with chronic kidney disease (CKD), Latinx individuals were at greater risk of experiencing depressive symptoms compared with non-Latinx White individuals; however, they were less likely to be treated for depression (2, 3).This raises a critical concern about the availability of appropriate mental health services for Latinx individuals with CKD.
Barriers to mental health support
The accessibility of mental health services in Latinx individuals in the United States may be impacted by the maldistribution of social determinants of health, including structural (i.e., the sociopolitical and economic context impacting access/quality of health care, socioeconomic status, and exposure to structural racism and discrimination) and intermediary (i.e., social risk factors, sociocultural context, and personal lived experiences) determinants (4) (Figure).
In terms of structural determinants, Latinx individuals compose the minoritized group with one of the largest uninsured healthcare coverage rates in the country (18%), significantly affecting their access to care (5). Even with insurance, it is challenging for Latinx patients to find a mental health practitioner who is culturally and language concordant. Many Latinx individuals also experience challenges that include personal experiences with discrimination in clinical encounters or fear of deportation; they have also witnessed racism and discrimination shared by the media. All of these examples may understandably foster a general lack of trust in the US health care system (6).
Regarding the intermediary determinants, the Latinx population is disproportionately impacted by social risk factors including food insecurity, housing instability, and financial strain, further affecting health care access (6–8). Furthermore, the pervasive stigma surrounding mental health persists in many Latinx communities and may lead to a reluctance in accessing care (8, 9). Other cultural beliefs and values may affect willingness to seek mental health care, such as fatalismo (attitude that a person's plight is religiously based or fate), machismo (attitude associated with exaggerated masculine pride), and marianismo (attitude associated with self-sacrifice and putting the needs of others first) (10). Traditionally, family relationships have been an important aspect of the Latinx culture (i.e., familismo), although it is important to note that family dynamics can serve as both a source of support or stress (8–10). The latter may occur in the context of multigenerational households in which adults have extended caregiving and financial responsibilities, delaying their own health needs. There may also be a desire to downplay symptoms to avoid burdening or causing shame to one's family (10).
Strategies to promote mental health well-being
To promote the mental health well-being of Latinx individuals with CKD, the nephrology community can implement diverse strategies (Figure). Health care teams can screen for mental health well-being, inquire about coping mechanisms and social-emotional support (e.g., family, religion, or other spiritual support), and direct patients to culturally responsive mental health services and resources. Future research should assess the associations between mental health disorders and CKD outcomes, identify barriers to mental health screening, and develop culturally responsive and community-based interventions to improve mental health well-being of Latinx individuals with CKD.
Potential barriers to obtaining mental health services among Latinx individuals with kidney diseases and strategies to improve care access and quality
Citation: Kidney News 16, 5
Footnotes
References
- 1.↑
Wassertheil-Smoller S, et al. Depression, anxiety, antidepressant use, and cardiovascular disease among Hispanic men and women of different national backgrounds: Results from the Hispanic Community Health Study/Study of Latinos. Ann Epidemiol 2014; 24:822–830. doi: 10.1016/j.annepidem.2014.09.003
- 2.↑
Missikpode C, et al.; CRIC Study Group Investigators. Association between depressive symptom trajectory and chronic kidney disease progression: Findings from the Chronic Renal Insufficiency Cohort study. Kidney360 2023; 4:606–614. doi: 10.34067/kid.0000000000000087
- 3.↑
Fischer MJ, et al.; CRIC Study Group Investigators. Factors associated with depressive symptoms and use of antidepressant medications among participants in the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC studies. Am J Kidney Dis 2012; 60:27–38. doi: 10.1053/j.ajkd.2011.12.033
- 4.↑
Powell-Wiley TM, et al. Social determinants of cardiovascular disease. Circ Res 2022; 130:782–799. doi: 10.1161/CIRCRESAHA.121.319811
- 5.↑
Census U.S. Bureau. Health insurance coverage by race and Hispanic origin: 2021. American Community Survey Briefs. November 2022. Accessed February 20, 2024. https://www.census.gov/content/dam/Census/library/publications/2022/acs/acsbr-012.pdf
- 6.↑
Espinoza-Kulick MAV, Cerdeña JP. “We need health for all”: Mental health and barriers to care among Latinxs in California and Connecticut. Int J Environ Res Public Health 2022; 19:12817. doi: 10.3390/ijerph191912817
- 7.
American Psychiatric Association. Mental health dispartities: Hispanics and Latinos. 2017. Accessed February 20, 2024. https://www.psychiatry.org/getmedia/5d5b46c3-9b28-4e50-9b73-7c738e0901d8/Mental-Health-Facts-for-Hispanic-Latino.pdf
- 8.↑
Cervantes L, et al. Social and cultural challenges in caring for Latinx individuals with kidney failure in urban settings. JAMA Netw Open 2021; 4:e2125838. doi: 10.1001/jamanetworkopen.2021.25838
- 9.↑
Molina Y, et al. Understanding complex roles of family for Latina health: Evaluating family obligation stress. Fam Community Health 2019; 42:254–260. doi: 10.1097/fch.0000000000000232
- 10.↑
Washburn M, et al. Latinos’ conceptualization of depression, diabetes, and mental health-related stigma. J Racial Ethn Health Disparities 2022; 9:1912–1922. doi: 10.1007/s40615-021-01129-x
