Background: Latinos are less likely than non-Hispanic whites to be adequately treated for depression. Intimate partner violence (IPV) is strongly associated with depression. Less is known about how Latina IPV survivors understand depression. Objective: To understand Latina women's beliefs, attitudes, and recommendations regarding depression and depression care, with a special focus on the impact of gender, ethnicity, violence, and social stressors. Design: Focus group study. Participants: Spanish-speaking Latina women with a lifetime history of IPV and moderate to severe depressive symptoms. Approach: We used a community-based participatory research (CBPR) approach to conduct a thematic analysis using an inductive approach. Results: Thirty-one women participated in five focus groups. Women felt depression is caused by "keeping things inside". They also felt that keeping things inside could lead to physical illness or an inability to function. Their inability to talk was fueled by issues such as stigma, fear, isolation, cultural norms, or simply "not having the words". They felt that the key to treating depression was finding a way to talk about the things that they had kept inside. They greatly valued information about depression and appreciated learning from providers that their physical symptoms were caused by depression. They wanted confidential depression care programs that not only helped them deal with their depression, but also addressed the violence in their lives, gave them practical skills, and attended to practical issues such as childcare. They had negative attitudes toward antidepressants, primarily due to experiences with side effects. Negative experiences with the health care system were primarily attributed to lack of good healthcare insurance. Conclusions: The concept of "keeping things inside" was key to participants' understanding of the cause of depression and other health problems. Clinicians and depression care programs can potentially use such information to provide culturally-appropriate depression care to Latina women.
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Acknowledgements: We would like to thank all of the women who participated in our focus groups, as well as the many community members who helped with recruitment efforts. We would also like to thank Kerth O’Brian, PhD, for leading the focus group facilitation training for the community partners, and Martha Gerrity, MD, PhD, Bentson McFarland, MD, PhD, and Mary Ann Curry, RN, DNSc, for providing mentorship and support to Dr. Nicolaidis. This study was funded by the National Institute of Mental Health (K23MH073008; Nicolaidis) and the Northwest Health Foundation Kaiser Permanente Community Fund (10571; Nicolaidis). We presented earlier versions of the manuscript as an oral abstract at the Annual Meeting of the Society of General Internal Medicine in Miami, in 2009 and as part of a workshop at the National Conference on Health and Domestic Violence in New Orleans, in 2009.
- community-based participatory research