Azúcar y nervios: Explanatory models and treatment experiences of Hispanics with diabetes and depression

Abstract

This study examined the explanatory models of depression, perceived relationships between diabetes and depression, and depression treatment experiences of low-income, Spanish-speaking, Hispanics with diabetes and depression. A purposive sample (n=19) was selected from participants enrolled in a randomized controlled trial conducted in Los Angeles, California (United States) testing the effectiveness of a health services quality improvement intervention. Four focus groups followed by 10 in-depth semi-structured qualitative interviews were conducted. Data were analyzed using the methodology of coding, consensus, co-occurrence, and comparison, an analytical strategy rooted in grounded theory. Depression was perceived as a serious condition linked to the accumulation of social stressors. Somatic and anxiety-like symptoms and the cultural idiom of nervios were central themes in low-income Hispanics' explanatory models of depression. The perceived reciprocal relationships between diabetes and depression highlighted the multiple pathways by which these two illnesses impact each other and support the integration of diabetes and depression treatments. Concerns about depression treatments included fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. This study provides important insights about the cultural and social dynamics that shape low-income Hispanics' illness and treatment experiences and support the use of patient-centered approaches to reduce the morbidity and mortality associated with diabetes and depression.

Perspectives of Vulnerable US Hispanics With Rheumatoid Arthritis on Depression: Awareness, Barriers to Disclosure, and Treatment Options

“…A proactive approach, where providers as-sess and address the concerns and fears of patients, may increase acceptance of antidepressants (26,27,32). Selfempowerment techniques and approaches were the most preferred, culturally appropriate interventions.…”

“…In addition, selfdirected interventions may have little impact due to lack of interpersonal interaction, which was so highly valued in this population (26,32). Instead, interventions should aim to increase such interactions between patients and the health care system.…”

Epidemiology of depression in diabetes: International and cross-cultural issues

“…Physical and anxiety symptoms were commonly used to describe depression, and were linked to emotional distress and reduced functioning in this low-income group (Cabassa et al, 2008). Interestingly, the relationship between depressive symptoms and physical functioning was stronger in Filipino Hawaiians than in native Hawaiians and Hawaiians from mixed ethnic ancestry or from Japanese descent (Keawe'aimoku et al, 2006).…”

Evidence produced by qualitative investigations on type 2 diabetes: a review of the literature

“…No caso de investigações com pacientes, as entrevistas foram realizadas, preferencialmente, na casa do entrevistado. Apenas dois estudos realizaram entrevistas por telefone (Cabassa et al, 2008;Montez, Karner, 2005). Grupos focais foram utilizados em nove estudos, realizados preferencialmente na instituição de saúde.…”

“…Em 17 pesquisas foram utilizados softwares para análise de dados qualitativos, com destaque para o Ethnograph (Arcury et al, 2004;Broom, Whittaker, 2004;Savoca, Miller, Quandt, 2004;MercadoMartinez, Ramos-Herrera, 2002;Liburd et al, 1999) e o NUD.IST (Lawton et al, 2005;Sarkadi, Rosenqvist, 2003;Daaleman, Cobb, Frey, 2001;Samuel-Hodge et al, 2000;Loewe et al, 1998), seguidos pelo Atlas.ti (Cabassa et al, 2008;Lutfey, Freese, 2007) e pelo NVivo (Polzer, Miles, 2007;Lawton, Peel, Parry, 2008).…”