Abstract
This study was undertaken among Latinos receiving treatment from a community mental health center in New York City. The primary mental health concern was schizophrenia. We conducted three focus groups and present the viewpoints of consumers, family members, and providers. Using qualitative content analysis we identified four predominant categories: (1) the importance of family ties; (2) stigma about mental illness; (3) respect and trust in interpersonal relationships; and (4) facilitators and barriers to implementing Family Psychoeducation. Analysis of transcripts revealed specific subthemes for each category. Implications for imparting culturally sensitive material into mental health services for Latinos are discussed.
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Notes
For complete findings from the pre-focus groups, please contact the corresponding author, Dr. Molly Finnerty.
References
Angermeyer, M. C., Holzinger, A., & Martschinger, H. (2009). Mental health literacy and attitude toward people with mental illness: A trend analysis based on population surveys in the eastern part of Germany. European Psychiatry, 24(4), 225–232.
Arredondo, P., Orjuela, E., & Moore, L. (1989). Family therapy with Central American war refugee families. Journal of Strategic & Systemic Therapies, 8, 28–35.
Asbury, J. (1995). Overview of focus group research. Qualitative Health Research, 5(4), 414–420.
Barrio, C. (2000). The cultural relevance of community support programs. Psychiatric Services, 51, 879–884.
Barrio, C., & Yamada, A. (2010). Culturally based intervention development: The case of Latino families dealing with schizophrenia. Research on Social Work Practice, 20, 483–492.
Barrio, C., Yamada, A., Hough, R., Hawthorne, W., García, P., & Jeste, D. V. (2003). Ethnic disparities in utilization of public mental health care management services among clients with schizophrenia. Psychiatric Services, 54, 1264–1270.
Bennett, L., Thirlaway, K., & Murray, E. J. (2008). The stigmatizing implications of presenting schizophrenia as a genetic disease. Journal of Genetic Counseling, 17(6), 550–559.
Bernal, G., & Scharrón-Del-Rio, M. R. (2001). Are empirically supported treatments valid for ethnic minorities? Toward an alternative approach for treatment research. Cultural Diversity and Ethnic Minority Psychology, 7(4), 328–342.
Bradley, G. M., Couchman, G. M., Perlesz, A., Nguyen, A. T., Singh, B., & Riess, C. (2006). Multiple-family group treatment for English- and Vietnamese-speaking families living with schizophrenia. Psychiatric Services, 57, 521–530.
Burland, J. (1998). Family-to-family: A trauma and recovery model of family education. New Directions for Mental Services, 77, 33–44.
Cabassa, L. J., Zayas, L. H., & Hansen, M. C. (2006). Latino adults’ access to mental health care: A review of epidemiological studies. Administration and Policy in Mental Health and Mental Health Services Research, 33(3), 316–330.
Calzada, E. J., Fernández, Y., & Cortés, D. E. (2010). Incorporating the cultural value of respeto into a framework of Latino parenting. Cultural Diversity and Ethnic Minority Psychology, 16(1), 77–86.
Chow, W., Law, S., Andermann, L., Yang, J., Leszcz, M., Wong, J., et al. (2010). Multi-family psycho-education group for assertive community treatment clients and families of culturally diverse background: A pilot study. Community Mental Health Journal, 46, 364–371.
Cuijpers, P. (1999). The effects of family interventions on relatives’ burden: A meta-analysis. Journal of Mental Health, 8, 275–285.
Dixon, L. B., Dickerson, F., Bellack, A. S., Bennett, M., Dickinson, D., Goldberg, R. W., et al. (2010). The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin, 36(1), 48–70.
Dixon, L. B., Lucksted, A., Stewart, B., Burland, J., Brown, C. H., Postrado, L., et al. (2004). Outcomes of the peer-taught 12-week family-to-family education program for severe mental illness. Acta Psychiatrica Scandinavica, 109, 207–215.
Dixon, L. B., McFarlane, W. R., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., et al. (2001). Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services, 52, 903–910.
Dobalian, A., & Rivers, P. A. (2008). Racial and ethnic disparities in the use of mental health services. Journal of Behavioral Health Services Research, 35(2), 128–141.
Falloon, I. R. H., Boyd, J. L., & McGill, C. W. (1984). Family care for schizophrenia: A problem-solving approach to the treatment of mental illness. New York: Guilford Press.
Garza, Y., & Watts, R. E. (2010). Filial therapy and Hispanic values: Common ground for culturally sensitive helping. Journal of Counseling & Development, 88, 108–113.
Greenberg, G. A., & Rosenheck, R. A. (2003). Change in mental health service delivery among blacks, whites, and Hispanics in the Department of Veterans Affairs. Administration and Policy In Mental Health, 31, 31–43.
Guarnaccia, P. J. (1998). Multicultural experiences of family care giving: A study of African American, European American, and Hispanic American families. New Directions for Mental Health Services, 77, 45–61.
Jewell, T. C., Downing, D., & McFarlane, W. R. (2009). Partnering with families: Multiple family group psychoeducation for schizophrenia. Journal of Clinical Psychology, 65, 868–878.
Kermode, M., Bowen, K., Arole, S., Pathare, S., & Jorm, A. F. (2009). Attitudes to people with mental disorders: A mental health literacy survey in a rural area of Mahrashtra, India. Social Psychiatry and Psychiatric Epidemiology, 44(12), 1087–1096.
Kleinman, A. (1992). Local worlds of suffering: An interpersonal focus for ethnographies of illness experience. Qualitative Health Research, 2(2), 127–134.
Kopelowicz, A., Zarate, R., González Smith, V., Mintz, J., & Liberman, R. P. (2003). Disease management in Latinos with schizophrenia: A family-assisted, skills training approach. Schizophrenia Bulletin, 29(2), 211–227.
Laegsgaard, M. M., Stamp, A. S., Hall, E. O., & Mors, O. (2010). The perceived and predicted implications of psychiatric genetic knowledge among persons with multiple cases of depression in the family. Acta Psychiatrica Scandinavica, 122(6), 470–480. doi:10.1111/j.1600-0447.2010.01555.x.
Laria, A., & Lewis-Fernández, R. (2006). Issues in the assessment and treatment of Latino patients. In R. Lim (Ed.), Clinical manual of cultural psychiatry: A handbook for working with diverse patients (pp. 119–173). Washington DC: American Psychiatric Press.
Lewis-Fernández, R., Das, A. K., Alfonso, C., Weissman, M. M., & Olfson, M. (2005). Depression in US Hispanics: Diagnostic and management considerations in family practice. Journal of the American Board of Family Practice, 18, 282–296.
Lincoln, T. M., Wilhelm, K., & Nestoriuc, Y. (2007). Effectiveness of psychoeducation for relapse, symptoms, knowledge, adherence, and functioning in psychotic disorders: A meta-analysis. Schizophrenia Research, 96, 232–245.
López, S. R., Kopelowicz, A., Solano, S., del Carmen Lara, M. A., & Foncerrada, H. (2009). La CLAve to increase psychosis literacy of Spanish-speaking community residents and family caregivers. Journal of Consulting and Clinical Psychology, 77(4), 763–774.
Lucksted, A., McFarlane, W., Downing, D., Dixon, L., & Adams, C. (2012). Recent developments in family psychoeducation as an evidence-based practice. Journal of Marital and Family Therapy, 38, 101–121.
Magliano, L., Fiorillo, A., Malangone, C., De Rosa, C., & Maj, M. (2006). Patient functioning and family burden in a controlled, real-world trial of family psychoeducation for schizophrenia. Psychiatric Services, 57, 1784–1791.
Markowitz, J. C., Sapana, P. R., Balan, I. C., Bell, M. A., Blanco, C., Yellow Horse Brave Heart, M., et al. (2009). Toward an adaptation of interpersonal psychotherapy for Hispanic patients with DSM-IV major depressive disorder. Journal of Clinical Psychiatry, 70(2), 214–222.
Mausbach, B. T., Bucardo, J., Cardenas, V., McKibbin, C. L., Barrio, C., Goldman, S. R., et al. (2008). Evaluation of a culturally tailored skills intervention for Latinos with persistent psychotic disorders. American Journal of Psychiatric Rehabilitation, 11(1), 61–75.
McFarlane, W. R. (2002). Multifamily groups in the treatment of severe psychiatric disorders. New York: Guilford Press.
McFarlane, W. R., Dixon, L., Lukens, E., & Lucksted, A. (2003). Family psychoeducation and schizophrenia: A review of the literature. Journal of Marital and Family Therapy, 29(2), 223–245.
Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W. C., & LaFramboise, T. (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology, 1, 113–142.
Morgan, D. L. (1993). Qualitative content analysis: A guide to paths not taken. Qualitative Health Research, 3(1), 112–121.
Muhr, T. (2004). User’s manual for ATLAS.ti.5.0. Berlin, Germany: Scientific Software Development GmbH.
Nasr, T., & Kausar, R. (2009). Psychoeducation and the family burden in schizophrenia: A randomized controlled trial. Annals of General Psychiatry. Retrieved from http://www.annals-general-psychiatry.com/content/8/1/17. doi:10.1186/1744-859X-8-17.
Padgett, D. K., Patrick, C., Burns, B. J., & Schlesinger, H. J. (1994). Ethnicity and the use of outpatient mental health services in a national insured population. American Journal of Public Health, 84, 222–226.
Parra-Cardona, J. R., Cordova, D., Holtrop, K., Villaruel, F. A., & Wieling, E. (2008). Shared ancestry, evolving stories: Similar and contrasting life experiences described by foreign born and US born Latino parents. Family Process, 47, 157–172.
Passel, J. S., & D’Vera, C. (2008). US population projections: 2005-2050. Pew Research Center, Washington, DC. Retrieved from http://pewhispanic.org/files/reports/85.pdf.
Patterson, T. L., Bucardo, J., McKibbin, C. L., Mausbach, B. T., Moore, D., Barrio, C., et al. (2005). Development and pilot testing of a new psychosocial intervention for older Latinos with chronic psychosis. Schizophrenia Bulletin, 31, 922–930.
Pekkala, E. T., & Merinder, L. B. (2002). Psychoeducation for schizophrenia. Cochrane Database of Systematic Reviews, issue 2, article no:CD002831. doi:10.1002/14651858.CD002831.
Perlick, D. A. (2001). Special section on stigma as a barrier to recovery: Introduction. Psychiatric Services, 52, 1613–1614.
Rivera, F. I., Guarnaccia, P. J., Mulvaney-Day, N., Lin, J. Y., Torres, M., & Alegría, M. (2008). Family cohesion and its relationship to psychological distress among Latino groups. Hispanic Journal of Behavioral Sciences, 30(3), 357–378.
Rusch, L. C., Kanter, J. W., & Brondino, M. J. (2009). A comparison of contextual and biomedical models of stigma reduction for depression with a nonclinical undergraduate sample. Journal of Nervous and Mental Disease, 197(2), 104–110.
Sabogal, F., Marin, G., Otero-Sabogal, R., Marin, B., & Perez-Stable, E. (1987). Hispanic familism and acculturation: What changes and what doesn’t? Hispanic Journal of Behavioral Sciences, 9, 397–412.
Schooler, N. R., Keith, S. J., Severe, J. B., Matthews, S. M., Bellack, A. S., Glick, I. D., et al. (1997). Relapse and rehospitalization during maintenance treatment of schizophrenia: The effects of dose reduction and family treatment. Archives of General Psychiatry, 54, 453–463.
Soto-Fulp, S., & DelCampo, R. L. (1994). Structural family therapy with Mexican-American family systems. Contemporary Family Therapy: An International Journal, 16(5), 349–362.
Szapocznik, J., & Kurtines, W. M. (1993). Family psychology and cultural diversity: Opportunities for theory, research, and application. American Psychologist, 48(4), 400–407.
US Census Bureau. American Community Survey. (2009). Retrieved from: http://www.census.gov/acs/www/.
US Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD: US Government Printing Office. Retrieved from US Department of Health and Human Services: http://www.surgeongeneral.gov/library/mentalhealth/home.html.
US Department of Health and Human Services. (2003). Achieving the promise: Transforming mental health care in America (Publication No. SMA-03-3832). Rockville, MD: U.S. Government Printing Office.
US Department of Health and Human Services, SAMHSA, & Center for Mental Health Services. (2003). Family psychoeducation implementation resource kit. Rockville, MD: US Government Printing Office.
Vega, W. A., Karno, M., Alegría, M., Alvidrez, J., Bernal, G., Escamilla, M., et al. (2007). Research issues for improving treatment of US Hispanics with persistent mental disorders. Psychiatric Services, 58, 385–394.
Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., & Catalano, R. (1999). Gaps in service utilization by Mexican Americans with mental health problems. American Journal of Psychiatry, 156, 928–934.
Weiss, M. G., Jadhav, S., Raguram, R., Vounatsou, P., & Littlewood, R. (2001). Psychiatric stigma across cultures: Local validation in Bangalore and London. Anthropology and Medicine, 8, 71–87.
World Schizophrenia Fellowship. (1998). Families as partners in care: A document developed to launch a strategy for the implementation of programs of family education, training, and support. Toronto: World Schizophrenia Fellowship.
Acknowledgments
The authors thank Sharon Carpinello for her instrumental support in conducting this study. We also thank Dottie Castille, Leopoldo Cabassa, Rene Vázquez, Hector Rosales, Lara Brusa-O’Connell, and Alejandro Pawliszyn for their assistance. This study was supported by funds from a Substance Abuse and Mental Health Services Administration grant (No. 6HD9SM56135-02-01). Dr. Lewis-Fernández was supported by institutional funds from the New York State Psychiatric Institute and by the National Institute of Mental Health (R01 MH 077226). The contents of this article are solely the responsibility of the authors and do not necessarily represent the views of the funding agency.
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Hackethal, V., Spiegel, S., Lewis-Fernández, R. et al. Towards a Cultural Adaptation of Family Psychoeducation: Findings from Three Latino Focus Groups. Community Ment Health J 49, 587–598 (2013). https://doi.org/10.1007/s10597-012-9559-1
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DOI: https://doi.org/10.1007/s10597-012-9559-1