Advertisement

Mindfulness

, Volume 10, Issue 12, pp 2522–2531 | Cite as

Adapting Mindfulness to Engage Latinos and Improve Mental Health in Primary Care: a Pilot Study

  • J. Alexis Ortiz
  • Bruce W. Smith
  • Brian M. Shelley
  • Kelly S. EricksonEmail author
ORIGINAL PAPER
  • 98 Downloads

Abstract

Objectives

Latinos comprise a sizeable and growing population that experiences unmet health needs and health inequities. Mindfulness-based interventions may be a cost-effective way to address mental health problems in primary care. We sought to adapt a mindfulness-based intervention to better serve and improve the mental health of Latinos in the primary care setting.

Methods

The authors employed a unique set of adaptations to increase retention and engagement of Latinos in a mindfulness-based stress reduction (MBSR) intervention. These adaptations included (1) group motivational interviewing, (2) problem-solving barriers to retention, (3) a testimonial by a prior Latino MBSR participant, and (4) modifications to increase perceived applicability of MBSR for Latinos. Thirty Latino participants were recruited for an 8-week mindfulness intervention adapted (MBSR-A) specifically for Latino populations.

Results

Twenty-six out of thirty (87%) participants completed at least five of the eight sessions, which was significantly greater than in previous studies targeting Latino participants (60–66%). Of those who completed and provided pre- and post-data, there were decreases in anxiety and depression, and increases in measures of general mental health and physical health.

Conclusions

The adaptations utilized in this pilot study may increase retention and engagement of Latinos in mindfulness-based interventions and may be a cost-effective way to reduce mental health problems in this growing population.

Keywords

Latino Hispanic Mindfulness Primary care Anxiety Depression 

Notes

Acknowledgments

The authors wish to thank Beth Roth for her inspiring pioneering work in this area, First Choice Community Healthcare, and all the participants who gave their time and effort to be involved in this study.

Author Contributions

JAO: created MBSR-A adaptations, selected measures, recruited participants, facilitated MBSR-A groups, analyzed data, wrote and revised the manuscript, and oversaw first submission. BWS: provided critical mentorship and feedback through all processes, assisted JAO in writing Results, Introduction, and Discussion sections. BMS: assisted in the recruitment and running of the MBSR-A groups, writing the Method section, and editing. KE: did an initial update of the manuscript, handled all aspect of the revise and resubmit process: literature review, editing, and all analyses.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of New Mexico Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Abdullah, T., & Brown, T. L. (2011). Mental illness stigma and ethnocultural beliefs, values, and norms: an integrative review. Clinical Psychology Review, 31(6), 934–948.PubMedGoogle Scholar
  2. Alegría, M., Canino, G., Shrout, P. E., Woo, M., Duan, N., Vila, D., et al. (2008). Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups. American Journal of Psychiatry, 165(3), 359–369.PubMedGoogle Scholar
  3. Andres-Hyman, R. C., Ortiz, J. A., Anez, L. M., Paris, M., & Davidson, L. (2006). Culture and clinical practice: recommendations for working and Puerto Ricans and other Latinas(os) in the United States. Professional Psychology: Research and Practice, 37(6), 694–701.Google Scholar
  4. Barrera, M., & Castro, F. G. (2006). A heuristic framework for the cultural adaptation of interventions. Clinical Psychology: Science and Practice, 13(4), 311–316.Google Scholar
  5. Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the hospital anxiety and depression scale: an updated literature review. Journal of Psychosomatic Research, 52(2), 69–77.PubMedGoogle Scholar
  6. Chapman, D. P., Perry, G. S., & Strine, T. W. (2004). The vital link between chronic disease and depressive disorders. Preventing Chronic Disease, 2(1).Google Scholar
  7. Cohen, J. (1998). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Erlbaum Associates, Inc..Google Scholar
  8. Concato, J., Shah, N., & Horwitz, R. I. (2000). Randomized, controlled trials, observational studies, and the hierarchy of research designs. New England Journal of Medicine, 342(25), 1887–1892.PubMedGoogle Scholar
  9. Corringan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614–625.Google Scholar
  10. D’Amico, E. J., Osilla, K. C., & Hunter, S. B. (2010). Developing a group motivational interviewing intervention for first-time adolescent offenders at-risk for an alcohol or drug use disorder. Alcoholism Treatment Quarterly, 28(4), 417–436.PubMedPubMedCentralGoogle Scholar
  11. Durden, T. E., & Hummer, R. A. (2006). Access to healthcare among working-aged Hispanic adults in the United States. Social Science Quarterly, 87(5), 1319–1343.Google Scholar
  12. Falicov, C. J. (1998). Latino families in therapy: a guide to multicultural practice. New York: Guilford Press.Google Scholar
  13. Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy—a systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124(2), 102–119.PubMedGoogle Scholar
  14. Franzini, P. L., Ribble, M. J. C., & Keddie, M. A. M. (2011). Understanding the Hispanic paradox. Ethnic Disparities, 11(3), 496–518.Google Scholar
  15. Gaynes, B. N., Rush, J., Trivedi, M. H., Wisniewski, S. R., Balasubramani, G. K., Spencer, D. C., et al. (2007). Major depression symptoms in primary care and psychiatric care settings: a cross-cultural analysis. Annals of Family Medicine, 5(2), 126–134.PubMedPubMedCentralGoogle Scholar
  16. Goldberg, J., Hayes, W., & Huntley, J. (2004). Understanding health disparities. Columbus, Ohio: Health Policy Institute of Ohio.Google Scholar
  17. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: a meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43.PubMedPubMedCentralGoogle Scholar
  18. Kabat-Zinn, J. (1987). Six-month hospital visit cost reductions in medical patients following self-regulatory training. Paper presentation presented at the Society of Behavioral Medicine, Washington, DC.Google Scholar
  19. Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Delta.Google Scholar
  20. Kabat-Zinn, J. (1994). Mindfulness-based inner-city community stress reduction clinic. Worchester: University of Massachusetts Medical Center.Google Scholar
  21. Kouyoumdjian, H., Zamboanga, B. L., & Hansen, D. J. (2003). Barriers to community mental health services for Latinos: treatment considerations. Clinical Psychology: Science and Practice, 10(4), 394–422.Google Scholar
  22. Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317.PubMedGoogle Scholar
  23. Lewinsohn, P. M., Seeley, J. R., Roberts, R. E., & Allen, N. B. (1997). Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12(2), 277–287.PubMedPubMedCentralGoogle Scholar
  24. Lochman, J. E., & Curry, J. F. (1986). Effects of social problem-solving training and self-instruction training with aggressive boys. Journal of Clinical Child Psychology, 15(2), 159–164.Google Scholar
  25. Markides, K. S., & Eschbach, K. (2011). Hispanic paradox in adult mortality in the United States. In International Handbooks of Population, International Handbook of Adult Mortality (pp. 227–240).Google Scholar
  26. Marmot, M. G., Wilkinson, R. G., & Brunner, E. (2006). Social determinants of health. New York: Oxford University Press.Google Scholar
  27. McEwen, B. S., & Seeman, T. E. (1999). Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostatic and allostatic load. Annals of the New York Academy of Sciences, 896(1), 30–47.PubMedGoogle Scholar
  28. Meadow, M. J., & Culligan, K. (2007). Christian insight meditation: following in the footsteps of John of the Cross. Boston: Wisdom Publications.Google Scholar
  29. Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: helping people change (3rd ed.). New York: Guilford Press.Google Scholar
  30. Peek, M. K., Cutchin, M. P., Salinas, J. J., Sheffield, K. M., Eschbach, K., Stowe, R. P., & Goodwin, J. S. (2010). Allostatic load among non-Hispanic Whites, non-Hispanic Blacks, and people of Mexican origin: effects of ethnicity, nativity, and acculturation. American Journal of Public Health, 100(5), 940–946.PubMedPubMedCentralGoogle Scholar
  31. Radloff, L. S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.Google Scholar
  32. Reibel, D. K., Greeson, J. M., Brainard, G. C., & Rosenzweig, S. (2001). Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. General Hospital Psychiatry, 23(4), 183–192.PubMedGoogle Scholar
  33. Roche, M. J. L. (2002). Psychotherapeutic considerations in treating Latinos. Harvard Review of Psychiatry, 10(2), 115–122.PubMedGoogle Scholar
  34. Roth, B. (1997). Mindfulness-based stress reduction in the inner city. Advances, 13(4), 50–58.Google Scholar
  35. Roth, B., & Creaser, T. (1997). Mindfulness meditation-based stress reduction: experience with a bilingual inner-city program. The Nurse Practitioner, 22(3), 150–157.PubMedGoogle Scholar
  36. Roth, B., & Robbins, D. (2004). Mindfulness-based stress reduction and health-related quality of life: findings from a bilingual inner-city patient population. Psychosomatic Medicine, 66(1), 113.PubMedGoogle Scholar
  37. Roth, B., & Stanley, T. (2002). Mindfulness-based stress reduction and healthcare utilization in the inner city: preliminary findings. Alternative Therapies in Health & Medicine, 8(1), 60–66.Google Scholar
  38. Smith, B. W., Shelley, B. M., Dalen, J., Wiggins, K., Tooley, E., & Bernard, J. (2008). A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction. The Journal of Alternative and Complementary Medicine, 14(3), 251–258.PubMedGoogle Scholar
  39. Swanson, A. J., Pantalon, M. V., & Cohen, K. R. (1999). Motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients. The Journal of Nervous and Mental Disease, 187(10), 630–635.PubMedGoogle Scholar
  40. Tarricone, I., Stivanello, E., Poggi, F., Castorini, V., Marseglia, M. V., Fantini, M. P., & Berardi, D. (2012). Ethnic variation in the prevalence of depression and anxiety in primary care: a systematic review and meta-analysis. Psychiatry Research, 195(3), 91–106.PubMedGoogle Scholar
  41. U.S. Department of Health and Human Services. (2001). Mental health: culture, race, and ethnicity. A supplement to mental health: a report of the Surgeon General. Rockville: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.Google Scholar
  42. Vega, W. A., Rodriguez, M. A., & Gruskin, E. (2009). Health disparities in the Latino population. Epidemiologic Reviews, 31(1), 99–112.PubMedPubMedCentralGoogle Scholar
  43. Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.PubMedGoogle Scholar
  44. Wittchen, H.-U., Kessler, R. C., Beesdo, K., Krause, P., Höfler, M., & Hoyer, J. (2002). Generalized anxiety and depression in primary care: prevalence, recognition, and management. The Journal of Clinical Psychiatry, 63(Suppl 8), 24–34.PubMedGoogle Scholar
  45. Zigmond, A. S., & Snaith, R. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • J. Alexis Ortiz
    • 1
  • Bruce W. Smith
    • 2
  • Brian M. Shelley
    • 3
  • Kelly S. Erickson
    • 2
    Email author
  1. 1.Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordUSA
  2. 2.Department of PsychologyUniversity of New MexicoAlbuquerqueUSA
  3. 3.Department of Family and Community MedicineUniversity of New Mexico School of MedicineAlbuquerqueUSA

Personalised recommendations