Latina Mothers' Perceptions of Mental Health and Mental Health Promotion

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  • 230 journalofMulticulturalcounselinganddevelopMentoctober2007vol.35

    2007americancounselingassociation.allrightsreserved.

    latinaMothersperceptionsofMentalhealthandMentalhealthpromotion

    ElizabethM.VeraandWendyConner

    latinamothersperceptionsofmentalhealthandfactorsthatpromote/restorementalhealthwereexploredinthisqualitativestudy.participantsdiscussedthe importance of community, safety, and financial stability in addition toconventionalfactorsthatarerelatedtomentalhealth.implicationsforworkingwithurbanlatinasandtheirfamiliesarediscussed.enesteestudiocualitativoseexploraron laspercepcionesde lasmadreslatinassobresaludMentalylosfactoresquelafomentan/restablecen.lasparticipantesdiscutieronacercadelaimportanciadelacomunidad,lase-guridadylaestabilidadfinancieraademsdeotrosfactoresconvencionalesrelacionadosconlasaludmental.sediscutenlasimplicacionesparaeltrabajoconlatinasresidentesenncleosurbanosysusfamilias.

    Theunderutilizationofmentalhealthservicesbypeopleofcolorhasbeenwelldocumented(Akutsu,Snowden,&Organista,1996;Padgett,Patrick, Burns,& Schlesinger, 1994; Pumariega,Glover,Holzer,&Nguyen,1998).Althoughavailabilityofmentalhealthservicesundoubtedlyaffectsutilization,ratesofutilizationdifferamongethnicgroupsevenwhenaccesstoservicesissimilaracrossethnicgroups(Alvidrez,1999).Oneaspectofunderstandingthecausesofunderutilizationisexaminingtheculturalap-propriatenessofavailableservices.ThiscontentionissupportedbypoliciessuchastheMulticulturalCounselingCompetencies(Roysircar,Arredondo,Fuertes, Ponterotto,&Toporek, 2003) and theGuidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists(AmericanPsychologicalAssociation,2003),whichofferrecommendationsforadaptingservicestomeettheneedsofdiverseconstituents.Understandingculturalbeliefsandvaluesofethnicgroupsisimportanttothe

    developmentoftreatmentapproachesthatareculturallycongruent.InthecaseofLatinoclients,muchhasbeenwrittenabouttheculturalcharacteristicsofthispopulation.Forexample,MarinandMarin(1991)characterizedLatinosas(a)grouporiented,(b)valuingharmoniousinterpersonalrelationships,(c)loyaltofamily,(d)deferenttoauthorityfiguresorreveredrelatives,and(e)valuingtraditionalgenderroles.Onthebasisofthisinformation,groupandfamily-basedmodalitiesofcounselingmightbeviewedasculturallyap-propriateforLatinoclients(Falicov,1996),primarilybecauseofthesystemicnatureofconceptualizationsthatmayappeal tomembersofcollectivistorinterdependentcultures(Triandis,1988).Althoughsuchtreatmentapproaches

    Elizabeth M. Vera, School of Education, and Wendy Conner, Department of Counseling Psychology, both at Loyola University Chicago. Correspondence concerning this article should be addressed to Elizabeth M. Vera, School of Education, 820 N. Michigan Avenue, Loyola University Chicago, Chicago, IL 60611 (e-mail: evera@luc.edu).e-mail: evera@luc.edu).evera@luc.edu).

  • journalofMulticulturalcounselinganddevelopMentoctober2007vol.35 231

    maybeeffectivewiththispopulation,Latinoclientsperceptionsofwhethercounselingisaculturallyappropriateoptionisdirectlyrelatedtotheirutiliza-tionrates.ThisissuemaybeparticularlyrelevanttotailoringmentalhealthservicestomeettheneedsofLatinawomen.Giventhatwomenoftenattendtotheemotionalneedsofthefamilies,understandingtheirperceptionsofmentalhealthandhelp-seekingbehaviorsare important tounderstandingtreatmentdecisionsofLatinofamilies.

    purpose of the studyIncreasingthefieldsknowledgeofhowwomenofcoloringeneral,andthosewhoaremothersinparticular,conceptualizementalhealthanditsmaintenancemaybeinformativetothedevelopmentofculturallyrelevantindividualandfamilymentalhealthpromotionandremediationefforts.Becausemothersareoftenthemonitorsoftheirchildrensemotionalneeds,theirperceptionsofmentalhealthandrelatedinterventionswouldhaveimplicationsforworkingwithLatinasandtheirfamilies.Itisnotassumedthatbeingamother,perse,wouldaffectthementalhealthbeliefsandexperiencesofserviceprovisionsofLatinas.However,giventhepowerfulrolethatmanyLatinamothershaveinprotecting themental health of their families, this populationwas thefocusof thepresent investigation.This studywasguidedbyan interest intheparticipantsbeliefsaboutthefollowingissues:(a)Howismentalhealthunderstoodor conceptualizedbyurbanLatinamothers? (b)What factorsaffectmental health, bothpositively andnegatively? and (c)What formalandinformalmethodsofhelpseekingareusedforthementalhealthneedsofLatinamothersandtheirfamilymembers?

    relevant literatureIncomparisonwiththeamountofliteratureonLatinawomen,arelativelylargerbodyofresearchexistsonwomenofcoloringeneralandtheirdeci-sionstousementalhealthservices.Severalrecentstudieshaveexaminedthehelp-seekingattitudes,explanationsofpsychologicaldisorders,andcopingstrategiesofwomenofcolor(Alvidrez,1999;Brodsky,1996).Alvidrezfoundthat,forlow-incomewomenofcolor,thelikelihoodofmakinganappoint-ment to see amental healthprofessionalwas predictedby problem type,beliefsabouttheoriginofmentalhealthproblems,andhavingafriendorfamilymemberwhohad sought services. Inher sample, stigma regardingpsychologicalproblemsandpreferenceforinformalmeansofhelpseekingwerenotfoundtoberelevantpredictorsofseeingamentalhealthprofes-sional.Alvidrezsstudywasveryhelpfulinclarifyingsomeofthefactorsthatleadwomenofcolor toseektheassistanceofmentalhealthprofessionals,butitdidnotexploreawiderangeofprecipitatingeventsthatmightresult

  • 232 journalofMulticulturalcounselinganddevelopMentoctober2007vol.35

    inawomanseekingservicesinthefirstplace.Additionally,theroleoflargersystemic factors such aspovertyor community in jeopardizing thementalhealthofwomenwasnotexplored.Brodsky(1996)examinedtheroleofpovertyandcommunity factors in

    thementalhealthandresiliencyoflow-incomeAfricanAmericanwomen.Resiliencyisdefinedastheabilitytopersevereinthefaceofobstacles(Mas-ten, 2001).Brodsky found that, forwomenwho see the community as aburdenasopposedtoaresource,distancingfromthecommunitywasseenasacopingmechanismthatenhancedresiliencyandmentalhealth.Herfindingschallengedtheextantliteraturethatfoundcommunityinvolvementandbelongingtoberelatedtopositivementalhealthforwomenofcolor(McMillan&Chavis,1986).Yetthefindingscouldhavebeenafunctionofsocial class rather than the ethnicity of theparticipants. Inotherwords,Brodskysparticipantsresidenceinanimpoverishedneighborhood,nottheirethnicbackgrounds,wasmostlikelywhatinfluencedtheirperceptionsoftheneighborhoodasunsafe.ThemostdistinctiveaspectofBrodskysstudyis that it is oneof theonly investigations inwhichwomenof colorwereinterviewedabouttherelevanceofcommunityandneighborhoodfactorsinrelationtomentalhealthandresiliency.Otherthantheaforementionedstudies,therehasbeenrelativelylittlere-

    searchdoneonmothersperceptionsofmentalhealth,barrierstotreatment,ormentalhealthpromotion.WefoundevenlessresearchonLatinamothersperceptionsofmentalhealth.Onerecentstudy(Christie-Mizell,Steelman,&Stewart,2003)focusedonethnicdifferencesinperceptionsofmaternaldistressandneighborhooddisorderinanonclinicalsampleofmothers.ThatstudyfoundthatMexicanAmericanandAfricanAmericanmothersperceivedhigher levelsofneighborhooddisorder thandid theirWhitecounterpartsandthatperceivedneighborhooddisorderwassignificantlypredictiveofma-ternaldistress(afindingthatwasexacerbatedforAfricanAmericanmothersbynumberofchildren).However,themajorityofextantresearchonLatinamothershasfocusedon

    motherswhosechildrenhaveidentifiedpsychologicalorbehavioraldisordersoronthementalhealthproblemsofthemothersthemselves(Ainsenberg,2001;LaRoche,Turner,&Kalick,1995;Pavuluri,Luk,&McGee,1996;Raviv,Raviv,Propper,&Fink,2003).Ingeneral,thisresearchhasusedsurveyre-search that limits responses topredeterminedcategoriesofmentalhealthproblemsandresources.Thisisproblematicbecausewomenofcoloroftenhavealternativeconceptualizationsofmentalhealthproblemsandappropriateresponsestosuchproblems(Alvidrez,1999).Thepaucityofmorediscovery-orientedresearchunderscorestheneedforadditionalempiricalstudiesthataddressLatinamothersgeneralperceptionsofmentalhealthbarriersandattitudestowardhelpseeking.Aqualitativeresearchapproachwasselectedforthisstudytogeneratesuchdiscovery-orienteddata.

  • journalofMulticulturalcounselinganddevelopMentoctober2007vol.35 233

    Thisstudyusednarrativeinquiry(Guba&Lincoln,1985)asaqualitativemethodologytoinvestigateperceptionsofandattitudestowardmentalhealthinasampleofresilient,urbanLatinamothers.Innarrativeinquiry,first-personaccountsofexperienceformthenarrativetextofthisresearchapproach(Mer-riam,2002).Thegoalofnarrativeinquiryistomakesenseofexperiencebycommunicatingandconstructingmeaning(Chase,1995).Theinterpretationofnarrativedata involves the identificationof thematiccategories thataredescriptive(vs.interpretive)andareallowedtoemergefromthedatausinganopen-codingprocess(Miles&Huberman,1994;Strauss&Corbin,1990).Narrativeinquirydiffersfromotherapproachestoqualitativeresearch,suchasgroundedtheory,inthatitaimstodescribeexperienceasopposedtode-velopandprovisionallyverifytheorycontainedinthedata(Merriam,2002).GiventhelimitedresearchonLatinamothersperceptionsofmentalhealth,itwouldbeprematuretoconstructtheory.Narrativeinquiryisappropriatewhendiscoveryofphenomenaisthegoalofthestudy.Whereaspaststudies(Alvidrez,1999;Landrine&Klonoff,1994)havelargely

    usedquantitative approaches tounderstandingmental health conceptual-izationandpatternsofserviceutilizationinwomenofcolor(e.g.,symptomandresourcechecklists),existingsurveysoftenfailtoincorporateprotectivefactorsorprocessesthatmaypromotementalhealth,notjeopardizeit.Thedecisiontouseaqualitative,discovery-orientedapproachwasalsobasedontheanticipationofilluminatingprotectivefactorsorfactorsthatareimportanttomaintainingmentalhealth.

    methodparticipants

    Participantsinthisstudywere10Latinamotherswhoresidedinalow-incomeneighborhoodinalarge,midwestern,urbancommunity.Participantswerenominatedbytheirchildrensschooladministrators,bycommunityleaders,andbyotherparentswhosechildrenattendedthelocalpublicelementaryschool.Thecriteriafornominationwerewomenwhowereperceivedassuc-cessfulinovercomingchallengesofraisinghealthychildren(i.e.,anexampleofresiliency)andlivinginalow-incomeenvironment.The10motherswhowereselectedforparticipation,then,werenotthoughttoberepresentativeofparentsingeneralorLatinamothersasagroup,butratherwerethoughttobepotentiallyeffectivespokespersonsforresilientLatinamothersinthecommunity. This participant selectionprocedurehas beenused in otherstudies(e.g.,Brodsky,1996).Mothersrangedinagefrom30to43years.Sixwerefirst-generationMexican

    immigrantswhohadlivedintheUnitedStatesformorethan10years(rang-ingfrom10to18years).Oftheremainingfourparticipants,threewereborninthecontinentalUnitedStatesandwereofArgentinian,PuertoRican,and

  • 234 journalofMulticulturalcounselinganddevelopMentoctober2007vol.35

    multiracialethnicbackgrounds.OnemotherwasbornontheislandofPuertoRico.Allmothershadworkedoutsidetheirhomesinpositionsthatrangedfrompaidemploymentassecretariestovolunteerworkasteachersaidesorcrosswalkguards.Nospecificdataweregatheredontheincomesearnedbytheparticipantsbecauseitwasdeterminedthroughconsultationwithleadersinthecommunitythatsuchaquestionwouldbeviewedasculturally inap-propriate.Sevenofthemothersweremarriedtothefathersofatleastoneoftheirchildren,andthreewereinnonmarital,cohabitatingrelationships.Thenumberofparticipantschildrenrangedfromonetothree.Theagesofthechildrenrangedfrom18monthsto12years.Themotherswereinvitedtoparticipateinthestudybytheprimaryinvesti-

    gator(firstauthor)atatimethatwasconvenientforthemintheirchildrensschoolsetting.Motherswhowereemployedbyorvolunteeredattheschoolreceivedpermissionfromtheprincipaltoparticipateintheinterviewsduringtheirworkdays.Informedconsentwasobtainedpriortothebeginningoftheinterviews,andtheparticipantswereassuredthattheinformationgatheredwasanonymousand thatpseudonymswouldbeused in thedescriptionofthefindings.Aftertheinterviewswerecompleted,giftcertificatestoalocalgrocerystorewereofferedtoparticipantsastokensofgratitude.Noincentivewasofferedtomotherswhentheywereinvitedtoparticipate.

    procedureIndividualinterviewswereconductedforthisstudybyabilingual,doctoral-levelpsychologist(firstauthor) inEnglish,orSpanish,orboth languages,dependingonthepreferencesoftheparticipants.Interviewslastedapproxi-mately30minutesandwereguidedbythefollowingopen-endedquestions,derivedfromareviewofpreviousliterature:(a)Howdoyouunderstandthetermmental health?withafollow-upprobe,Forexample,whatwouldbesomeofthecharacteristicsofpeoplewhohavegoodmentalhealth?(b)Whatarethekindsofthingsthathelppeopletostaymentallyhealthy?(c)Whatarethekindsofthingsthatcandamageorthreatenmentalhealth?(d)Whatwouldbeacceptablewaystoaddressamentalhealthprobleminyourcom-munity?(e)Whatisavailabletopeopleinthecommunityrightnowthathelpspromoteandmaintainmentalhealth?and(f)Whatarethingsthatarenotavailablerightnowbutwouldbebeneficialinpromotingandmain-tainingmentalhealthforpeopleinthecommunity?

    dataanalysisIndividualinterviewsweretranscribedfromaudiotapes,andthetranscriptswereinitiallyreviewedbytheparticipantsforaccuracy.Secondaryinterviewswerescheduledwiththeparticipantsafterthenarrativedatahadbeenana-lyzedandcategorizedbythecoders.Atthetimeofthefollow-upinterviews,

  • journalofMulticulturalcounselinganddevelopMentoctober2007vol.35 235

    participantswereabletocommentontheextenttowhichthecategorizationoftheirindividualresponsesappearedappropriateandtoelaborateontheirinitialresponses.Thisprocesswasusedtoenhancethecredibilityandvalidityofthedataobtained.Additionally,inanefforttominimizepersonalbias,theinterviewerkeptfieldnotes,whichwerelatercomparedagainsttheresultsofthefinalanalysis.Twoindependentcodersidentifiedemergentdescriptivethemesfromthe

    transcribedinterviewsinthisstudy.OneofthecoderswasaWhite,femalegraduatestudentwhohadpreviousclinicalandresearchexperienceworkingwithLatinos,and theotherwasaLatinaprofessor.The themeswere thencomparedandintegratedintoaninitiallistofcodingcategories.Onceafinallistofthemeswasconstructed,twoadditionalcoderstestedthereliabilityofthecodingscheme.ThesesecondarycoderswereWhite,femalegraduatestu-dents.Eachcoderhadbeentrainedinqualitativeresearchanddataanalysisinthecourseoftheirstudies,andneitherwasinvolvedintheplanningofthisstudy.Thedecisiontousetheseadditionalcoderswaspartofastrategytoincreasetherelativeobjectivityofthedataanalysisandtopreventresearcherbiasfrominfluencingtheresults.Thesecondarycoderscategorizedsamplesofthedataintotheexistingschemawitha90%successrate.Discrepanciesincategorizationwerediscusseduntilconsensuswasachieved.Narrativesampleswerethenselectedfromtheinterviewstoillustratethemes.Illustrativesampleresponseswereattributedtoparticipantsusingonlypseudonymsandbriefdemographicdescriptors.

    resultsWhatdefinesMentalhealth?

    Participantsdescribedavarietyofcharacteristicsofmentallyhealthypeople,suchasstabilityandhappiness.Onerepeatingthemeinall10interviewswastheinterpersonalnatureofmentalhealth.Harmoniousrelationshipswithinthefamily,providingsupporttoothers,andfosteringinterdependencewereassociatedwithpositivemental health.Every participant talked about theconnectionbetweenparentalandchildmentalhealth.Parentswereviewedasrolemodelswhotau...

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