Post-partum Latinas Cry for Mental Health Services

Latinas mothers got an “F” when it came to reporting depression after delivery. The grade from the 2007 North Carolina Women’s Health Report Card was the worst possible. Latinas mostly received average to below grades in other health areas.

In 2006, Latino births accounted for 21,202 or 16.6% of the live births in North Carolina, according to the NC State Center for Health Statistics. In contrast, the Latino rate was 14.4% or 17,291 births in 2004. It is estimated that 10% to 15% of women experience post-partum depression after giving birth. And even though the rates for Latinas are not well documented, it is speculated to be higher. Considering the prevalence of post-partum depression and the increasing rate of Latino births in the state, it makes sense for health providers to learn more about how to identify, screen and treat Latino women for post-partum depression.

Understanding Latina Mental Health Barriers
Latinas are not a homogenous group. Socioeconomic status and acculturation can play a large role on how Latinas perceive and seek help for post-partum depression. When talking with pregnant or new Latino mothers you may want to consider the following:

1. Level of Acculturation
   The new Latina immigrant faces a different set of stressors than the more acculturated Latina. Recent immigrants may struggle to settle into their new life in the U.S., often feeling helpless and dependent on their husbands or relatives. Little knowledge of the U.S. health system and limited English can accentuate isolation and depression symptoms. On the contrary, the more acculturated Latinas may lose family support and other protective social factors of their culture. They also face higher rates of substance abuse and increased levels of stress in trying to balance the dominant American culture and maintain their native culture. Mental health concerns seem to accentuate as Latinas acculturate. English fluency is not exclusively an indicator of acculturation.
2. Age
   Latino youth are at a significantly high risk for poor mental health outcomes. Evidence suggests that they are more likely to drop out of school, report depression and anxiety, and consider suicide than white youth. According to the Adolescent Pregnancy Prevention Coalition of North Carolina, Hispanic teens had the highest pregnancy rate in the state. In 2006 the pregnancy rate among Hispanic adolescents was 173.1 per 1,000 girls aged 15-19 compared to African American teens with 86.2 per 1,000 girls and white teens 52.9 per 1,000.
3. Cultural Beliefs
   Many Latinas interpret depression, anxiety and sorrowfulness as estar mal de los nervios (to be a bundle of nerves) or tired. Depression is viewed as something temporary that will go away without needing to take any pills or medication. Latinas will often use folk remedies like te de manzanilla (chamomile tea) to calm frayed nerves, or te de tila (lime blossom tea) which brings on blissful sleep. For energy recovery, vitamin B12 injections are common. Sometimes, a folk healer, partera (midwife) or la comadre (female friend) can bring some comfort with a “spiritual cleansing” or through prayer. Occasionally, Latinas may talk to their health provider about their feelings but rarely will seek directly the help of a mental health professional on their own. Latinas may be reluctant to disclose their participation in folk healing practices with non-Latinos, so be aware of health beliefs and don’t stereotype.
4. Women’s Role
   Ser una buena madre (to be a good mother) is the Latina mother’s main role and everything else is secondary, including her own health. With post-partum depression comes feelings of guilt and shame for not being able to care for their babies and home.
5. Domestic Violence
   Domestic violence has serious consequences on mental health. Latinas are at high risk to suffer from and stay in abusive relationship due to their limited resources and lack of knowledge of services. Social and traditional cultural dynamics and other unfavorable factors, such as a partner who drinks heavily, or poor socioeconomic status can play a role in domestic violence and depression.
6. Culturally Competent Mental Health Services
   The lack of bicultural/bilingual staff creates yet another challenge for health providers in identifying post-partum depression in time. There is a Spanish version of the Edinburgh Postnatal Depression Scale, a quick, 10-question screening tool for maternal depression that care providers can use. Conducting interventions in Spanish or by means of a trained medical interpreter is a good first step in helping Latinas with depression.
7. Health Insurance
   The lack of health insurance is another significant obstacle for mental health care services for Latinas. Although Hispanics comprise 12% of the U.S. population, they represent nearly one out of every four uninsured Americans (Brown et al., 2000; Kaiser Commission, 2000).

Post-partum depression is treatable when detected early. However, health providers should not rely on Latino mothers to report depressive feelings. Because it may take longer to recognize their depression and for them to accept and talk about it, more attention to screening for depression is needed during both prenatal and post-partum visits. Depression has a better prognosis when identified during pregnancy, but screening for it during well-baby visits also needs to be common practice. Providing culturally appropriate screening tools as well responsive therapy is necessary to alleviate the silent cry of Latina new mothers.