Symptom expression and mental health literacy among low-income Latina women: A qualitative analysis

Low levels of mental health literacy (i.e., knowledge/beliefs about mental disorders that aid recognition) may contribute to adverse health effects and mental health service disparities among Latinos. The focus of this qualitative study was to describe factors that characterize psychiatric symptom expression for Latina women during mental health intake sessions and generate theory to inform development of mental health literacy interventions.

We analyzed videotaped mental health intakes of 20 Latina women with depression or anxiety, selected from a parent study of 129 intakes. We varied our sample according to new versus previous history of mental health treatment and English versus Spanish speaking. A coding team identified factors related to symptom expression in the intake, and documented provider input. These factors were grouped into categories and compared across sample characteristics.

Four primary factors emerged: labeling of disorder; problem recognition; knowledge about mental health treatment; and social/cultural expressions of disorder. Most previously treated patients labeled disorders using psychiatric language, while new to treatment Spanish speaking patients used cultural idioms. Spanish speakers expressed somatic symptoms, but also utilized psychiatric terminology to describe mental health symptoms. Patients frequently linked symptom expression with social stressors and cultural issues. Providers and patients combined sociocultural and medical explanatory frameworks when discussing symptomatology.

Even patients new to treatment demonstrated some degree of mental health literacy. Mental health literacy interventions should address cultural idioms and somatic symptoms, but also expand to consider how providers could better address the intersection between social stressors and psychiatric symptomatology with this population.