While nonadherence to psychiatric medications is a common barrier to recovery for many people with depression or schizophrenia, Latino individuals are at higher risk for antidepressant and antipsychotic nonadherence than non-Latino white patients.1 Even when socioeconomic status and access to quality care are controlled for, Latinos with depression have lower antidepressant adherence and engagement with depression care. For Mexican Americans with schizophrenia, nonadherence is close to 60%.2
Potential contributors to nonadherence include lower socioeconomic status, lack of health insurance, barriers to quality care, and monolingual Spanish speaking (though with mixed results for antipsychotics). On the other hand, family support and psychotherapy can promote adherence.
US Latinos generally share Spanish-speaking ancestry or have emigrated from Latin America, but they are highly heterogeneous with widely varying backgrounds, acculturation, and socioeconomic circumstances. To better understand the many ways culture influences adherence, qualitative interviews and focus groups are particularly well-suited to elicit patients’ many nuanced experiences.
CASE VIGNETTE 1
Maria is a 23-year-old unemployed, uninsured, bilingual Mexican American who is a devout Catholic. She lives with her parents, grandmother, and 2 younger siblings. Maria valued her friends and family but recently had been isolating herself, appeared progressively more unkempt, and mumbled to herself when alone. Her family, unaware of mental illness, became worried that she was possessed and prayed for the devil to leave her body. Her friend, Esperanza, became concerned after Maria told her she had been communicating with the devil.
Esperanza convinced Maria to see a psychiatrist, who diagnosed schizophrenia. After informing Maria about the diagnosis and reviewing medication options, including potential adverse effects, the psychiatrist prescribed an antipsychotic and scheduled a follow-up visit. Maria never returned.
Contrary to the psychiatrist’s explanation, Maria felt that she had wronged people and, in return, the devil gained control of her, which reinforced her grandmother’s trusted opinion. Maria had no hope that medication could get rid of the voices she heard and assumed she would not be able to afford the antipsychotic. Her mother was more open to medication but shared Maria’s concerns about adverse effects, particularly sedation, weight gain, and organ damage. Speaking only Spanish, Maria’s mother called the clinic to help Maria better understand the adverse effects, but she was unable to understand the monolingual English-speaking psychiatrist.
Dr. Martinez is a Resident Physician, and Dr. Lanouette is Associate Clinical Professor, Department of Psychiatry, University of California, San Diego.The authors report no conflicts of interest concerning the subject matter of this article.
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