Social Issues In The Latino Community

The Latino community is considered the largest demographic minority in the United States and is expect to increase by approximately 15% in 2050 (U.S. Bureau of the Census, 2002). The Latino population is comprised of many subgroups from many different regions that have developed unique beliefs, norms, and sociopolitical experiences. Although the term Latino is used throughout this paper, it is important to underscore the great diversity found within the Latino community to avoid the development and perpetuation of stereotypes. In clinical practice, it is important to evaluate the individual in terms of their racial identity, acculturation, and socioeconomic status among other factors to create a more individualized and effective treatment

plan (cite).
Despite the heterogeneity of the Latino population, there are several constructs and values that are common across the Latino subgroups (Romero, 2000). These commonalities give way to trends in the conceptualization, experience, and treatment effectiveness of various mental health issues. More specifically, certain values and cultural factors influence the development and maintenance of depression; they should be taken into account in developing appropriate diagnoses and treatment strategies for the Latino client (Comas-Diaz, 2006).

Conceptualization of Depression
Cultural differences may impact how depression is manifested, perceived, experienced, and treated (Karasz & Watkins, 2006). Research suggests that people of color (POC) and low socioeconomic status may conceptualize Depression very differently than mainstream models and treatment approaches (cite). The mainstream view of depression in United States’ culture is aligned with the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), which emphasizes depressed mood and loss of pleasure as integral components in the experience of depression (American Psychiatric Association, 2013). Although the DSM-5 is accepted and used in the U.S. for psychological diagnosis across cultural groups, it can be argued that it is actually a set of culturally encapsulated syndromes. As such, it may not account for Latino cultural views and characteristics that impact mental health such as greater tolerance for negative emotions, interpersonal attribution of depression, and greater connection between mind and body (Tsai & Chentsova-Dutton, 2002).
In the Latino culture, strength of character is often associated with control of oneself and the ability to withstand high levels of emotional pain or stress (Dana, 1993). These concepts are so pervasive in the culture, that there are terms unique to the Spanish language to convey them (controlarse & aguantarse respectively). Given the emphasis on being able to endure negative emotions, Latinos may present symptoms of depression in ways that are better aligned with their values and that are different than what is outlined in the DSM-5. For example, symptoms of depression may include more somatic complaints or focus on interpersonal relationships (cite). These different manifestations have the potential to result in misdiagnosis if culture is not taken into consideration during the diagnostic process.
Latino participants of low SES tend to emphasize social problems as the main component of Depression (Cabassa, Lester, & Zayas, 2007; Martinez Pincay & Guarnacia, 2007).

Social problems include difficulties with family relationships, isolation, interpersonal conflicts, and pressures of social roles. The Latino culture tends to place a higher premium on the well-being of the family unit over that of any one family member, a concept termed familialism (Smith & Montilla, 2006). In general, familialism emphasizes interdependence and connectedness in the family, and often extends familial ties beyond the nuclear family (Falicov, 1998). Given these values, Latinos often describe depression in terms of social withdrawal and isolation (Letamendi, et al., 2013). Social roles also play an important role in mental health, traditional gender roles in particular are strongly enforced and can be a source of distress. In Latino culture, men and women are expected to fulfill the roles outlined in the traditions of Machismo and Marianismo respectively. Machismo indicates that the man is supposed to be strong and authoritative, while Marianismo designates the woman as the heart of the family both morally and emotionally (Dreby, 2006). Although there is little research on causal factors, adherence to these traditional gender roles can pose a psychological burden and has been found to be strong predictor of depression (Nuñez, et al., 2015). The centrality of social problems in the conceptualization of depression for Latinos may be reflective of the collectivistic values that are characteristic of the group. Although these values have the potential to contribute to depression, they also have the potential to serve as protective factors and promote mental health (Holleran & Waller, 2003). Therefore, it is imperative that the counselor carefully consider cultural values, both in terms of potential benefits and drawbacks, to provide appropriate counseling to the Latino

client.
The Latino culture takes a more monistic approach to the mind-body problem. This may affect the ways in which depression is experienced and expressed. For example, studies have found that Latinos are more likely to express psychological distress in somatic terms such as lack of energy, sleep disturbances, and body aches (Martinez Tyson, Castaneda, Porter, Quiroz, & Carrion, 2011). Additionally, studies find that Latinos are more likely to take a holistic approach to healing as evidenced by the principle of “mente sana en cuerpo sano y alma sana’ (healthy mind in healthy body and healthy soul) which communicates the strong connection between mind, body, and soul (Comas-Diaz, 2006). This suggests that a purely physical approach to therapy may not be well-received by the Latino client, and is supported by studies showing Latino patients feel apprehensive towards being treated with anti-depressants even when they have positive attitudes towards receiving treatment for depression (Cabassa, Lester, & Zayas, 2007). Understanding the client’s perception of the self is important in diagnosing and treating depression. Therefore, an effective therapist must be able to understand and incorporate the client’s worldview throughout the therapeutic process.

Diagnostic issues
Good and Good (1985) identity factors that contribute to bias in diagnostic judgements for people of color: inappropriate assessments, language (e.g., idioms of distress), and internalized racism. Scales for measuring depression have been normed on Caucasian samples, and psychometric evaluations have largely excluded Latinos and other demographic minority groups (Velazquez, 1992). Moreover, scales used on Latino clients to assess depression tend to simply be translated and applied without further evaluation. This practice is problematic because studies have shown that translating or altering scales can change their psychometric properties (cite CLASS BOOK). A study of the Beck Depression Inventory (BDI), one of the most widely used measures of depression, identified four biased items that were more likely to be endorsed by Spanish-speaking clients regardless of their level of depression (Azocar, Arean, Miranda, & Munoz, 2001). These items may reflect culturally specific behaviors or experiences that are not necessarily indicative of depression but are nonetheless pathologized for the Latino community based upon cultural differences from U.S. American mainstream values.
Existing English scales can be successfully translated for use with Latino clients assuming that proper care is taken to provide culturally-appropriate interpretations of the items. For example, a study of the Spanish short-form version of the Center for Epidemiologic Studies – Depression Scale (CES-D) found that the form remained reliable and explained at least 87% of the variance in depressive symptoms scores (Grzywacz, Hovey, Seligman, Arcury, & Quandt, 2006). One of the strengths of the translation is the incorporation of culturally-appropriate items as exemplified by item four, which translates “I felt I could not shake off the blues” to “I felt I could not get rid of my troubles even with the help of my family or friends” (“Senti que no podia deshaceme de mis penas aun con la ayuda de mi familia o mis amistades”). This interpretation is more appropriate than a simple direct translation (“Senti que no podia sacudir los azules”), which would not make sense of a Spanish speaker because “shake off” and “blues” do not carry the same meaning. Existing scales have the potential to be adapted for use with the Latino client provided they accurately reflect cultural aspects of depression. However, misdiagnosis and inappropriate treatment can have a deleterious effect on the client, and the counselor has the responsibility to ensure the appropriateness of the diagnostic tools utilized (cite the abnormal psych book).
Differences in language use can influence diagnosis of Latino clients. Various studies have examined the