The Association between Acculturation and the Utilization of Mental Health Services in Latinos with Type 2 Diabetes and Depression

Latinos represent one of the fastest growing populations in the United States, with distinct health behaviors and health outcomes compared to their non-Latino counterparts. This group also experiences more noted deteriorations in health as the time spent in the U.S. increases. In addition, Latino adults are diagnosed with chronic medical conditions such as diabetes at higher rates than any other ethnic group. Simultaneously, more Latino patients report symptoms of depression, however, they are less likely to receive any form of treatment despite studies indicating that pharmacotherapy and psychotherapy are effective in impacting the improvement of psychosocial outcomes and depressive symptoms. The purpose of this study was to investigate the role of acculturation in the low rates of utilization of mental health services in Latinos with type 2 diabetes and depressive symptoms at federally qualified health centers in Southern California. Specific aims addressed in this investigation included determining whether acculturation level was associated with individual reports of depressive symptoms after controlling for potential confounding variables and assessing whether levels of acculturation were correlated with low rates of utilization of mental health services in Latinos with clinically meaningful levels of depressive symptoms. This was a cross-sectional study using data from the Reducing Racial/Ethnic Disparities in Diabetes: The Coached Care (R2D2C2) Project. Participants were 749 individuals recruited from diverse outpatient clinics affiliated with an academic center in Southern California. Participants were Latino, mostly Mexican-American, adults with type 2 diabetes. A logistic regression analysis was used to examine the association between acculturation levels and reports of depressive symptomatology and mental health service utilization. Results demonstrated that, after controlling for socioeconomic status, individuals with lower acculturation were less likely to report depressive symptoms and, among those with depression, were less likely to report have seen a mental health provider. There was also no association, however, between acculturation and the documentation of diagnosis of depression/anxiety or the prescription of medications to treat those conditions. The effects of acculturation on reports of depressive symptoms and mental health utilization cannot be explained by socioeconomic factors alone. Therefore, the underlying causes for the lower level of depressive symptoms reported by less acculturated individuals with diabetes, and the discrepancy between provider recognition of depression and patient-reported mental health service utilization in these patients, warrants further investigation