Issues in screening and referral practices for mental health problems among Mexican immigrant women and their children

While a growing number of researchers are addressing the high rates of depression and suicidal ideation among Latinos in epidemiological studies and clinical trials, there remains an issue regarding screening for mental health problems and subsequent follow-up. The purpose of this presentation is to describe the referral practices, follow-up completion rates and impact on study outcomes of Mexican immigrant mothers and their fourth and fifth grade children who met criteria for mental health referral. The Rush Mexican American Problem Solving program clinical trial was a mother child linked mental health promotion intervention delivered on home visits to mothers individually and to children in small groups (N = 302 dyads). The measure for mothers' depression symptoms was the Hopkins Symptom Checklist and for family communication, Family Problem Solving Communication Scale. The measure for children's depression symptoms was the Child Depression Inventory, health conceptions the Child Health Self Concept and school behavior, school work habits on the school report card. Descriptive statistics and Analysis of the Variance (ANOVA) were conducted. The results indicate that 38% of mothers in the treatment condition were referred for diagnosis on the basis of published cutpoints compared to 33% of mothers in the control condition. Among children in the treatment condition, 63% were referred compared to 60% of children in the control condition. At follow-up post intervention (20 weeks after baseline), 57% of referred mothers in the treatment condition followed through on the referral and 29% of referred mothers in the control condition. In the children's treatment condition, 19% of referred children had completed referrals compared to 10% in the control condition. Referral completion had no impact on change scores on family communication, child depression symptoms, child health conceptions or school work habits. Referral completion did have a statistically significant effect on change scores in depression symptoms for mothers (F = 8.33, p=0.000). Details of the referral process and issues surrounding the differences in mother and child follow-up rates, as well as ethical concern for research participants contrasted to the compromising effect of completed mental health referrals will be discussed.