Barriers and Facilitators of Mental Health Services Utilization Among Latinos

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DESCRIPTION (provided by applicant): Using a community-based participatory research (CBPR) model, this 5-year longitudinal cohort study will empirically assess the association of individual, partner/family, social context and larger community stressors, on clinical depression, depression severity, and cardiovascular disease (CVD) risk among Caribbean Latinos in Lawrence, MA, and assess the buffering effects of culture-specific types of social support and resources on these associations. Partners in this collaboration are: individual Latino residents of Lawrence; community- based organizations including the Greater Lawrence Family Health Center, the City of Lawrence Mayor's Health Task Force, the Lawrence Council on Aging/Senior Center, the YWCA of Greater Lawrence, Holy Family Hospital, Lawrence General Hospital; and UMass Medical School (UMMS). This collaboration began in 2003 and the proposed study builds from its prior CBPR work. The study will be conducted among 600 Caribbean Latino adults living in Lawrence, MA, a HRSA defined medically underserved community. Available evidence suggests that depressive symptoms and clinical depression are highly prevalent among low-income Latinos in the US. However, there is a scarcity of longitudinal studies of depression in this population, and relatively little is known about the risk and protective factors for these conditions in this population. Evidence indicates that depression is an independent risk factor for disability, excess mortality and adverse health outcomes, including cardiovascular disease, a leading cause of death among Latinos. Understanding the stressors that contribute to depression and CVD risk among Latinos is crucial to developing targeted interventions. The primary aims of the proposed study are to: 1) assess cross-sectional associations between stress (measured at the individual, partner/family, social and larger community levels) and measures of clinical depression and depression severity; 2) assess longitudinal associations between stress (measured at the individual, partner/family, social and larger community levels) and measures of clinical depression and depression severity; and 3) assess the mediating effect of social support and resources (measured at the individual, partner/family, social and larger community levels) on the associations between stress and measures of clinical depression and depression severity. The secondary aims are to: 4) assess the longitudinal association between stress and measures of depression with CVD risk and 5) investigate the mediating effect of health-related behaviors, namely diet, physical activity, smoking, alcohol use and sleep on the association between stress and measures of depression with CVD risk. Study participants will be followed for two years with measures taken annually. CBPR aims are to: 1) enhance the participatory infrastructure of the Partnership through continuous self-assessment; 2) evaluate the outreach process for diffusion and dissemination of study results; and 3) evaluate the success in implementing new programs and developing new research projects that build from the results of the proposed study.