PERCEPTIONS ON MENTAL HEALTH SERVICES: MEXICAN IMMIGRANT
WOMEN
Jana Delgado-Jimenez
B.S., Brigham Young University, Idaho, 2008
PROJECT
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
SPRING
2011
PERCEPTIONS ON MENTAL HEALTH SERVICES: MEXICAN IMMIGRANT
WOMEN
A Project
by
Jana Delgado-Jimenez
Approved by:
__________________________________, Committee Chair
Maria Dinis, Ph.D., MSW
____________________________
Date
ii
Student: Jana Delgado-Jimenez
I certify that this student has met the requirements for format contained in the University
format manual, and that this project is suitable for shelving in the Library and credit is to
be awarded for the Project.
__________________________, Graduate Coordinator
Teiahsha Bankhead, Ph.D., LCSW
Division of Social Work
iii
________________
Date
Abstract
of
PERCEPTIONS OF MENTAL HEALTH SERVICES: MEXICAN IMMIGRANT
WOMEN
by
Jana Delgado-Jimenez
This study explored the perceptions and barriers that Mexican immigrant women have
with regards to mental health services. An exploratory survey research design was used to
gather information from these individuals. Purposive sampling was used to identify 33
Mexican immigrant women in support groups in Yolo County and Solano County,
California. Statistically significant relationships were found between level of English and
perceptions of the woman’s role in the Mexican culture, as well as level of English and
perceived social stigma. Amount of time in the United States and beliefs surrounding
culturally competent services, as well as education level and perceptions of the woman’s
role in the Mexican culture were among other statistically significant relationships. No
other statistically significant relationships emerged. Findings suggest that lower
education level and lower language level results in more traditional beliefs may impact
the seeking of services. Future research is important to understand the likelihood of
seeking services for this population in the United States.
iv
Implications for multi-level social work practice are discussed.
_______________________, Committee Chair
Maria Dinis, Ph.D., MSW
_______________________
Date
v
DEDICATION
Dedico esta tesis a mi esposo y el amor de mi vida, Leo. Gracias por todo tu amor,
apoyo, ánimo, y paciencia durante este proceso. No pudiera hacerlo sin ti a mi lado; eres
mi inspiración. Gracias por decirme cada día que soy inteligente y bonita, y por decirme
que estas orgulloso de mi. Te amo chaparrito con todo mi corazón, y no puedo esperar
pasar el futuro contigo.
vi
ACKNOWLEDGEMENTS
First and foremost, I want to thank my Heavenly Father and my Friend and Savior
Jesus Christ for all of the blessings and opportunities they have given me. I count my
blessings every day and give all credit to these two perfect beings that have placed their
hand in my life to direct me to this point. Thank you for the unconditional comfort and
love that you give me every day.
The two most influential people in this entire process have been my parents. Mom
and Dad, I want to thank you for your constant love and support. You were there with me
every single step of the way. Every day you were there to listen to my struggles and my
journey throughout my entire educational and life experience. Words could never express
my appreciation and love for the both of you. I strive to become, as you both are. Dad,
with your levelheadedness, problem-solve thinking, and how loving and supportive you
are to others. And you Mom, with your beauty, strength, wisdom, and power to stand up
for who you are, and, especially, your ability to make others feel comfortable and loved,
even if you have known them for less than a minute. Thank you both for being my very
best friends and the best parents one could ever have. I love you.
I want to acknowledge my grandparents; my dear Grandpa Olmstead, who taught
me that I “sparkle” and that I am important, and that no limits can bind me down. My
sweet Grandma Olmstead, you have taught me to always strive to progress in this life to
prepare for the next, and you have always loved me as your little “angel”. My inspiring
vii
Grandpa Gomm, who taught me by his own example the importance of enduring in all of
my endeavors and loving others unconditionally. My loving Grandma Gomm, you have
taught me to love and serve others by your own example of loving and serving me.
I also want to acknowledge my older brothers and their families, for cheering me
on throughout the years to get me to this point. Jake, thanks for all of our intellectual
conversations in which you helped me see things in another perspective and think outside
of my box. Matt, thank you for your support by telling me how proud you are of me and
how much you love me. Finally, Spencer, you have been a lifesaver so many times in this
process and throughout my life. Thank you for always being just a phone call away and
for all of your advice and insight in so many different aspects. I love all of you!
To my sister Bree (Regina) thanks for your daily support and being a sounding
board for all of my struggles, frustrations, and joys. Thanks for telling me not to take
things so seriously and to take a break. Thanks for making me laugh. You have been an
example of strength to me. You are my best friend and I love you!
Finally, none of this would have been possible without my amazing thesis advisor
and friend, Dr. Maria Dinis. Thank you for taking me under your wing and walking me
through this process. Thank you for your hours of work in order to help me succeed, and
lending your listening ear so that I could express my worries and frustration. Every
advisor should be just like you, as you are truly a phenomenon in this field, and an asset
to this school and department. You are someone I look up to and aspire to be like, so
thank you.
viii
TABLE OF CONTENTS
Page
Dedication .......................................................................................................................... vi
Acknowledgements ........................................................................................................... vii
List of Tables .................................................................................................................... xii
Chapter
1. INTRODUCTION ......................................................................................................... 1
The Problem ............................................................................................................ 1
Background of the Problem .................................................................................... 2
Statement of the Research Problem ........................................................................ 5
Purpose of the Study ............................................................................................... 6
Research Questions ................................................................................................. 7
Theoretical Framework ........................................................................................... 7
Definition of Terms............................................................................................... 11
Assumptions.......................................................................................................... 12
Justification ........................................................................................................... 12
Delimitations ......................................................................................................... 14
Summary ............................................................................................................... 14
2. REVIEW OF THE LITERATURE ............................................................................. 16
Introduction ........................................................................................................... 16
Historical Background on Mexican Immigration ................................................. 16
Identified Barriers to Mental Health Services ...................................................... 21
Use of Social Support and Religion ...................................................................... 27
Gender Roles in the Mexican Culture ................................................................... 30
Traditional Beliefs Regarding Health and Mental Health .................................... 32
Gaps in the Literature............................................................................................ 35
Summary ............................................................................................................... 36
ix
3. METHODS .................................................................................................................. 37
Introduction ........................................................................................................... 37
Research Questions ............................................................................................... 37
Research Design.................................................................................................... 37
Variables ............................................................................................................... 39
Conceptual and Operational Definitions of Study Variables ................................ 40
Study Population ................................................................................................... 44
Sample Population ................................................................................................ 44
Instrumentation ..................................................................................................... 45
Cultural Competence in Research ......................................................................... 47
Data Gathering Procedures ................................................................................... 48
Data Analysis ........................................................................................................ 50
Protection of Human Subjects .............................................................................. 50
Summary ............................................................................................................... 51
4. RESULTS .................................................................................................................... 52
Introduction ........................................................................................................... 52
Research Question ................................................................................................ 52
Survey Responses ................................................................................................. 53
Independent Variables .......................................................................................... 53
Dependent Variables ............................................................................................. 59
Education Level and Perceptions of the Mexican Woman’s Role ....................... 61
Education Level and Understanding Mental Health ............................................. 64
Time in the U.S. and Perceived Stigma ................................................................ 67
Time in the U.S. and Perceived Cultural Competency ......................................... 71
Level of English and Woman’s Role in the Mexican Culture .............................. 74
Level of English and Perceived Stigma ................................................................ 77
Summary ............................................................................................................... 81
5. DISCUSSION .............................................................................................................. 82
x
Introduction ........................................................................................................... 82
Summary ............................................................................................................... 82
Discussion ............................................................................................................. 84
Limitations ............................................................................................................ 89
Implications for Social Work Practice and Policy ................................................ 90
Recommendations ................................................................................................. 92
Conclusion ............................................................................................................ 93
Appendix A. Consent to Participate in a Study ................................................................ 97
Appendix B. Consentimiento Para Participar en un Estudio ............................................ 99
Appendix C. Perceptions of Mental Health Services: A Survey .................................... 101
Appendix D. Encuesta: Percepciones de los Servicios de Salud Mental ........................ 108
References ....................................................................................................................... 116
xi
LIST OF TABLES
Page
1.
Table 1 Demographic Characteristics and Percentage of Participants ................. 54
2.
Table 2 Emotions that Cause a Need to Seek Therapy ......................................... 57
3.
Table 3 Would Consider Speaking to a Therapist ................................................ 58
4.
Table 4 Accepts Therapy ...................................................................................... 58
5.
Table 5 Mental Health Issues Caused By Supernatural ........................................ 58
6.
Table 6 Discrimination Due to Race ..................................................................... 60
7.
Table 7 Discrimination Due to Gender ................................................................. 60
8.
Table 8 Discrimination Due to Immigration Status .............................................. 61
9.
Table 9 Education Level and Mexican Woman’s Emotions ................................ 62
10.
Table 10 Education Level and Mexican Woman’s Focus .................................... 63
11.
Table 11 Education Level and Mexican Woman Asking Husband/Partner ......... 64
12.
Table 12 Education Level and Where to Find Services ........................................ 65
13.
Table 13 Education Level and Recognizes Symptoms of Mental Illness ............. 66
14.
Table 14 Education Level and Understands Mental Health Disorders ................. 67
15.
Table 15 Time Lived in the U.S. and Family Accepts Therapy ........................... 68
16.
Table 16 Time Lived in the U.S. and Boss Accepts Therapy ............................... 69
17.
Table 17 Time Lived in the U.S. and Friends Accept Therapy ............................ 70
18.
Table 18 Time Lived in the U.S and Therapists Speak Spanish ........................... 72
19.
Table 19 Time Lived in the U.S. and Therapists Understand Religion ................ 73
xii
20.
Table 20 Time Lived in the U.S. and Therapists Understand Role ...................... 74
21.
Table 21 Level of English and Mexican Woman’s Emotions .............................. 75
22.
Table 22 Level of English and Mexican Woman’s Focus .................................... 76
23.
Table 23 Level of English and Mexican Woman Asking Husband/Partner ......... 77
24.
Table 24 Level of English and Family Accepts Therapy ..................................... 78
25.
Table 25 Level of English and Boss Accepts Therapy ......................................... 79
26.
Table 26 Level of English and Friends Accept Therapy ...................................... 80
xiii
1
Chapter 1
INTRODUCTION
The Problem
In my position as an intern for Child Protective Services, I have had several
opportunities to refer Mexican immigrants to mental health service programs. During
these referrals, I have mostly received a hesitation or out-right refusal to attend services.
The basis of the refusal, as they would explain it to me, was that they did not see
themselves “crazy enough” to participate in mental health services such as counseling or
receiving psychotropic medication.
As I attempted to further my own cultural knowledge and sensitivity, I came to
find several reasons contributing to this lack of desire to attend counseling. In the
literature, many barriers have been mentioned as being contributors to Latino’s lack of
utilization in mental health services, (e.g., social stigma associated with mental health
issues, lack of knowledge as to where to seek services, perceptions of discrimination, and
the belief that there was a lack of culturally sensitive services) (Alegria et al., 2002;
Ojeda & Bergstresser, 2008). Furthermore, I discovered that women have a different
outlook on seeking counseling or psychotropic services than men, mainly due to cultural
limitations that are placed on females in the Mexican culture (Adames & Campbell,
2005; Dobalian & Rivers, 2008; Edelson, Hokada, & Ramos-Lira, 2007; Hancock, 2007).
Women also experience several contributors to mental health issues at a higher frequency
than men do, including transnational mothering, domestic violence, sexual assault, and
2
post-partum depression (Edelson et al., 2007; Falcon, 2001; Hancock, 2007; Hewett,
2009; Hondagneu-Sotelo & Avila, 1997).
As I started to recognize that many needs were not being met, I desired for more
cultural competence and awareness within the social work profession. I determined that
more research needed to be done in order to help social workers assist Mexican female
immigrants in recognizing the experiences and barriers facing this particular population
when seeking mental health services.
Background of the Problem
The underutilization of mental health services among the Mexican population has
been the focus of researchers, in different aspects, for several decades. Since the 1970s,
scholars have identified several obstacles, including language difference, stereotypes, and
social class as issues affecting Mexicans’ choice to seek and obtain mental health
services (Acosta, 1979).
In 2000, an estimated 35 million Hispanics were residing in the United States
(Vega, & Lopez, 2001). Since then, this population has increased by approximately 12
million, making current estimates at 47 million. Within this ethnic group, Hispanics of
Mexican origin were about 30.7 million, making up about 66% of the total Hispanic
population. It is estimated that there are another 12 million undocumented Hispanics that
are not included in these estimates (U.S. Census Bureau, 2008). The problem of
underutilization of mental health services has evolved into a much larger issue because
3
there are an increased number of Mexican immigrants (especially undocumented) in
America that might need mental health services.
Research has documented stressors that specifically influence Mexican female
immigrants and their mental health. Generally, research has distinguished that these
stressors are directly related to 1) being an immigrant and 2) being a Mexican female
(Edelson et al., 2007; Falcon, 2001; Hancock, 2007; Hewett, 2009).
Once an individual migrates to another country, they immediately are put at risk
for mental health burdens. Social networks in their home country are lost and grief is
often felt with the separation from family and friends (Ornales, Perriera, Beeber, &
Maxwell, 2009; Santos, Bohan, & Sanchez-Sosa, 1998). With more Mexicans migrating
to the U.S. each day, the pressure to learn the language and quickly acculturate can cause
stress, anxiety, and depression on these individuals (Ornales, et al.; 2009; Paynter &
Estrada, 2009; Santos, et al., 1998; Shattel, Hamilton, Starr, Jenkins, & Hinderliter,
2008). Discrimination caused by a lack of acculturation can also be an issue that
influences immigrant’s mental health status (Araújo & Borrell, 2006).
The legal status of the individual migrating to the U.S. from Mexico can be a
cause of extreme stress. Individuals entering the country without proper documentation
(visas, residency papers, or citizenship) can experience fear, anxiety, paranoia, and anger
(Lagomasino, et al., 2005; Paynter, & Estrada, 2009; Shattel, et al., 2008). In addition,
these individuals often encounter overwhelming traumatic experiences while trying to
cross the Mexico-America border undocumented (Custred, 2005; Falcon, 2001).
4
Female immigrants encounter these stressors and more. When married or cohabiting Mexican females migrate to the U.S., the roles of the male and female in these
relationships often shift and take on new meanings that create strain (Adames &
Campbell, 2005; Wilkerson, Yamawaki, & Downs, 2009; Parrado, & Flippen, 2005).
These new meanings include women working outside of the home and contributing to an
egalitarian family lifestyle. In the Mexican culture, it is common that women are to play a
submissive role to their husbands and work only within the home if at all possible. Often
physical abuse, coerced sexual intercourse, and infidelity are experienced by these
women at a greater frequency than non-Latino women (Edelson, et al, 2007). Some
scholars suggest that this may occur in migrant families as their husbands attempt to
overcompensate and reestablish their domineering positions as a response to the
adaptation into an egalitarian culture (Adames & Campbell, 2005; Hancock, 2007;
Parrado & Flippen, 2005). Often, this abuse continues and goes unreported due to
language barriers, fear, and isolation experienced by these women (Frias & Angel, 2005;
Hancock, 2006; Shattel, et al., 2008). This violence is not exclusive to the home either, as
female immigrants from Mexico can experience horrendous physical torture, rape, and
even death while crossing the U.S.-Mexico border (Custred, 2005; Falcon, 2001).
Cabassa (2007) found that Latina women are two times more likely than Latino
men to be diagnosed with depression. Some stressors related to this statistic can be linked
to motherhood. Migrating women from Mexico often have the burden of safely crossing
the border with their young children. Additionally, like women in other racial/ethnic
5
groups, Mexican female immigrants are at risk for experiencing post-partum depression
and may not know where to seek resources to help with these feelings (Lagomasino et al.,
2005; Ornales et al., 2009). When these mothers are forced to leave their children behind
in Mexico, the phenomenon of transnational mothering occurs. They often leave their
children in Mexico with a relative and then care for their children from another country
through letters, phone calls, and brief visits. While mothers in this situation are doing this
with the best of intentions (often to send money back to their children or create a better
life and then bring their children to the U.S.), the guilt and shame of leaving their
children behind can cause these women to have depression, anxiety, and other mental
health issues (Hewett, 2009; Hondagneu-Sotelo & Avila, 1997).
Despite increases in population size and the identification of specific population
needs, there continues to be a lack of mental health services aimed at first generation
Mexican immigrant women that incorporate culturally competent practices (Dobalian &
Rivers, 2008; Lagomasino et al., 2005; Paynter & Estrada, 2009; Shattell et al., 2008).
This includes practitioners that do not speak the Spanish language, practitioners that do
not have sufficient knowledge regarding the Mexican culture or the role of the woman in
the culture. It can also include a lack of culturally appropriate resources that can respond
to this population’s needs.
Statement of the Research Problem
The amount of Mexican immigrant women migrating to the United States of
America continues to increase significantly. This population experiences mental health
6
stressors due to their gender, race, and migration experience, and documentation status as
they attempt to acculturate in this country. Despite considerable stressors that could lead
to severe mental health issues, the process of seeking and obtaining mental health
services is very difficult for Mexican immigrant women. This is due to multifaceted
barriers they must overcome, including social stigma associated with mental health
issues, lack of culturally sensitive services, and perceptions of discrimination.
Further exploration of this experience is needed to determine which barriers are
considered the most influential on this population. Additionally, factors that can help to
alleviate these obstacles should be investigated. Finally, once this information has been
discovered, it could be used to strengthen cultural knowledge and understanding in
practitioners.
Purpose of the Study
The purpose of this study is to identify barriers that influence immigrant
women of Mexican descent in their utilization of mental health services and explore how
these barriers relate to demographic characteristics. This population was chosen due to
the issues that women face (e.g. transnational mothering, domestic violence, sexual
assault and depression) at a greater frequency than men (Frias & Angel, 2005; Hancock,
2007; Hondagneu-Sotelo & Avila, 1997; Santos et al., 1998). While several studies
identify several potential barriers (e.g., language issues, lack of knowledge of where to
obtain mental health services, lack of medical insurance), no recent studies were found
that focus primarily on comparing these barriers, particularly among this population. The
7
findings of this study may have important implications for social workers and other
mental health professionals working with this population to potentially increase cultural
competence and reduce barriers to utilization of mental health services.
Research Questions
There are two major questions posed for this research study. They are:
(a) What is the relationship between the participants’ reported likelihood to seek services
and their reported levels of perceived barriers? (b) How do the reported levels of
perceived barriers relate with the reported demographics of the participants?
Theoretical Framework
The two theoretical frameworks used in this study are feminist and social
constructionist theoretical perspectives. Both of these theories will be discussed and then
its components will be applied to the research study.
Feminist theory. This theory was developed in the 1960s, and has a primary
focus on the social differences between men and women as determined by society or a
culture (Payne, 1997). While Feminism consists of several different perspectives, all of
these perspectives concentrate in similar aspects (e.g. patriarchy and gender inequality,
oppression, and empowerment). Additionally, a person’s social world, environment, and
connection to society as a whole are a main focus (Greene, 2008).
Robbins, Chatterjee, and Chanda (2006) define Patriarchy as “the domination of
the major political, economic, cultural, and legal systems by men” (p. 97). This dominion
forces women to assume a subservient role that suppresses their capabilities and positions
8
in the family and in society’s institutions. The discrimination due to gender difference is
only one aspect of this resulted oppression. The fundamental thought is that “oppressive
environments have historically limited the opportunities for women, racial minorities, and other
marginal groups” (Ruiz, 2009, p. 143). In response, feminists are focused on representing
and encouraging social justice for these oppressed populations. Feminists desire to reduce
the inequality between the genders, celebrate the women’s role in existing structures, and
stop the socialization of gender-specific or race-specific roles in the next generation
(Payne, 1997). Feminists promote this change by empowering women and other
disempowered individuals to recognize inequality, redefine roles, and reconstruct the
patriarch system into an egalitarian system (Shriver, 2004).
Application of feminist theory. This theory is essential to this study, as the
oppressive factors that have contributed to Mexican immigrant women to underutilize
mental health services will be analyzed. These elements include discrimination, the
women’s acquiescent role in the Mexican culture, and society’s lack of culturally
sensitive services. This population’s vulnerability in society will be examined, as feminist
theory would recognize them as being in “triple jeopardy.” Triple jeopardy results when
an individual is considered a minority in three aspects, such as race, disability, gender,
etc. (Payne, 1997). This population is an example of individuals in triple jeopardy, as
they are minorities in three areas: (a) women, (b) Mexican, and (c) immigrants.
Feminism contributes to awareness and empowers the oppressed individual to
recognize the repression and to strive for social change (Stephens, Jacobson, & King,
9
2010). This would be the optimal outcome of this study; to ultimately empower the study
population to overcome these identified barriers and seek mental health services.
Additionally, a desired effect of the study would be to educate mental health providers in
the community as to this population’s difficulties and assist in the growth of competent
services to accommodate the particular needs.
Social constructivist theory. This theory examines the construction of social
realities at the micro, mezzo, and macro levels. This theory maintains that “all knowledge
and claims to certainty are culturally, politically and historically saturated” (Korobov,
2000, p. 369). In other words, social reality is based upon historical social experience,
political understanding, culture and language, learned concepts, and intellectual schemas,
and all of these experiences are unique to each individual and community. As a result,
each individual or community responds, behaves, and interacts with others differently.
On a micro, or individual, level, Shriver (2004) discusses the concept that every
single event that happens is subject to multiple perceptions by diverse individuals. These
perceptions are all valid, true, and different, because the event is interpreted differently
by each person. As these individuals are unified through languages, cultures and subcultures, their communities are solidified in similar thinking and their construct of social
reality is similar. According to Robbins et al. (2006), communities develop into societies
with built patterns of behavior that are repeated and reinforced by routine reaction and
outcomes. These customs become the accepted, normal terms and rules of society’s
construct. At a macro level, “institutions play an important roles in controlling our
10
behavior by setting up pre-defined patterns of conduct to which we are expected to
adhere to” (Robbins et al., 2006, p. 55). When a social reality is determined to be
incorrect or dysfunctional, individuals are encouraged to ‘deconstruct’ this reality, and
are empowered to restructure their reality (Payne, 1997).
Application of social construction theory. This study will examine social stigma
and cultural views towards mental health services. The role of the female in the Mexican
culture will also be studied. Since these perspectives are enveloped in the social reality, it
is important that this theoretical lens be applied to this specified population their
particular background. Additionally, social constructivist theory allows one to discover
alternate forms of thinking and behaving, empowering the individual to abandon their
own schemas and reconstruct new ways of thinking and understanding.
The constructed reality of mental health services to a Mexican immigrant
woman can be approached and understood through the three levels of micro, mezzo, and
macro. For example, on a micro level, a Mexican woman immigrant that has been raised
in a sheltered rural area in Mexico might not have been exposed to the Westernized
concept of mental health or services. Therefore, the individual may need education to
alter their personal schema and gain understanding in this area. Additionally, a Mexican
immigrant woman that has learned, through social interactions, to act in a traditional,
submissive role, may not seek mental health services because she may not think it is her
right to do so. Empowerment could be use to change this understanding and reconstruct
new perspectives concerning women and their rights. Finally, this education and
11
empowerment could be used to strengthen the amount of accessible services to these
women and improve the cultural competency of the institutions that serve this population
on a macro level.
Definition of Terms
The following terms are used throughout this project in relation to the topic of
mental health utilization, Mexican women, and immigrants. Additional terms and their
conceptual and operational definitions are provided in chapter three.
Latino and Hispanic. A person of Central or South American descent (Webster’s
Dictionary, 2002). In this study, the words Latino and Hispanic are used interchangeably.
It is important to note that while this researcher is using these terms collectively to define
race and ethnicity, the U.S. Census only uses Latino and Hispanic to describe ethnicity.
The U.S. Census provides multiple choices for race for Hispanics (e.g. Hispanic-White,
Hispanic- Black, etc) (U.S. Census, 2008) while this researcher does not differentiate
these variations throughout the study.
Mexican. A native or inhabitant of Mexico, or a person of Mexican descent.
(Merriam-Webster, 2011)
Barriers. A natural formation or structure that prevents or hinders movement or
action (Merriam-Webster, 2011). In this study, the focus on barriers involves anything
that may prevent an individual from using available mental health services. These can be
physical or psychological in nature and can be objective or subjectively perceived.
12
Immigrant. A person who comes to a country to take up permanent residence
(Merriam-Webster, 2011).
Utilization. To make use of (Merriam-Webster, 2011).
Mental health services. Beneficial activities which aim to overcome issues
involving emotional disturbance or maladaptive behavior adversely affecting
socialization, learning, or development. Usually provided by public or private mental
health agencies and includes both residential and non-residential activities (National
Child Abuse and Neglect Data System Glossary, 2000).
Perceptions. A result of perceiving (understanding), or a mental image (MerriamWebster, 2011). For this study, a perception is defined as: observations, beliefs, or
understanding regarding a particular subject (e.g. discrimination, stigma, etc).
Assumptions
The assumptions to be considered in this study include: (a) Mexican Women
immigrants will likely experience mental health stressors due to issues surrounding
gender, race, and their migration experience; (b) Mental health stressors, if left untreated,
can lead to mental illness; and (c) Obtaining and implementing mental health services is a
complex process with many possible barriers that lead to underutilization..
Justification
Social work students learn that respecting diverse situations and populations is
essential to being an affective worker. Consistent self education on the circumstances of a
13
client and their culture is encouraged. The process of this continual learning is often
referred to as cultural competence.
Cultural competence is defined as having a basic understanding and respect of
another individual’s ways of behaving and thinking within the context of their culture,
beliefs, language, religion, and applying this knowledge into one’s practice to address the
needs within the culture appropriately (Lee, 2001; Samantrai, 2004).
The National Association of Social Workers (NASW) has devoted an entire
ethical section to cultural competence and social diversity. This section maintains that
social workers should (a) understand how culture relates to human behavior and
recognize strengths in diverse societies; (b) gain knowledge about their clients’ cultural
background and be sensitive to these differences; and (c) seek education and
understanding with respect to all forms of diversity and oppressed populations (NASW,
2008).
The implication of this study is that knowledge regarding barriers to mental health
service utilization among first generation Mexican immigrant women will promote
cultural competence among all social workers assisting this population in obtaining
mental health services. Specifically, licensed clinical social workers (LCSW) potentially
working with this population can benefit from this knowledge. For example, the
knowledge gained from this study regarding service use barriers can be used by LCSW to
decrease potential obstacles that influence the use of their services among this population.
14
Delimitations
This study is limited in that there is little research to account for the experiences
of this particular population and their perceptions on mental health services. The present
study will add to this research and attempt to encourage practitioners to increase practice
awareness with regards to the barriers experienced specified here within this study.
Another limitation identified is the use of a non-probability method to locate participants.
The majority of the respondents are persons who are participating in Spanish speaking
support groups for women. The agencies that provide these groups also offer a variety of
other services, including counseling. Therefore, these women may have already been
exposed or participate in services focused on mental health and have specific views of
mental health. As a result, the study sample may not be a truly diverse sample that
represents this population across a differing spectrum.
Summary
Chapter one included the introduction, a background of the problem, a statement
of the problem, the purpose of this research and the theoretical frameworks. Additionally,
Chapter one contained definitions of several terms and a section that described the
delimitations of the project. Chapter two is a review of relevant literature with sections
covering a description of the history of Mexican immigration in the United States of
America, identified barriers to mental health services which include: use of self, social
support, and religion, gender roles, traditional beliefs regarding health and mental health,
and demographic characteristics. Any gaps in the literature are also discussed. Chapter
15
three is a description of the methodology. In chapter four, the data retrieved for this study
is examined and analyzed. Finally, in chapter five, the summary of the findings are
presented in addition to recommendations and implications for social work practice.
16
Chapter 2
REVIEW OF THE LITERATURE
Introduction
In chapter one, the research demonstrated that Mexican immigrant women
experience a large amount of stressors that may contribute to mental health difficulties,
and yet underutilize mental health services. Several central themes and subthemes
emerged with regards to this population. This chapter is divided into six sections detailing
these central themes. Section one will discuss the historical background on Mexican
immigration. The second section will describe several identified barriers to mental health
services. Section three will discuss the use of social support and religion. Section four
will cover gender roles in the Mexican culture. The fifth section will discuss traditional
beliefs regarding health and mental health. In the final section, gaps in the literature will
be identified and a summary will conclude this chapter.
Historical Background on Mexican Immigration
In order to comprehend the experience of a Mexican immigrant in the United
States of America, and more specifically, in California, it is essential to understand the
historical context and evolution of Mexican immigration throughout the centuries. One of
the earliest accounts of Spanish exploration into the United States of America and
Mexico dates back to the year 1513, when Juan Ponce de Leon from Spain conducted
several expeditions exploring the coast of Florida down throughout Mexico (Weber,
2003). By 1521, Spanish conquerors had overthrown the Mexican Aztec Empire and
17
began to create the Spanish colony of “New Spain.” This included areas of what is now
part of the United States of America, including California, Arizona, New Mexico, Texas,
Nevada, Utah and Colorado (Weber, 2003). Throughout the sixteenth and seventeenth
centuries, several well-known missions were founded, including St. Augustine,
Jamestown, New Mexico, and Santa Fe, reinforcing Europe’s desired combination of
church and state (Weber, 2003).
In 1769, the Spanish-Mexicans began to colonize California. They began the
“Sacred Expedition” to northern California and established the first mission. By 1823, a
total of 21 missions had been established in California (Weber, 2003). As the Spanish
population began to grown on the frontier (the states that now make up the border of the
United States of America and Mexico), the mixing of different races began to take place.
This required the Spanish to re-categorize races with new names. The first official census
conducted in California was completed in 1781 in El Pueblo de Nuestra Señora la Reina
de los Ángeles del Rio de Porciúncula (now known as Los Angeles) (Weber, 2003).
There were six official categories of determined race at this time, Negro, Spanish,
Mulatto (a person of one Negro parent and one Spanish parent), Mestizo (a person of one
Indian parent and one Spanish parent), Coyote (a person of one Indian parent and one
Mestizo parent), and Chino (a person of one Indian parent and one Mulatto parent). It is
important to note, that only two people in the census claimed to be pure Spanish,
indicating that racial mixture was of the majority (Weber, 2003).
18
In the year 1810, the Mexican War of Independence commenced. This war was
fought by Mexicans seeking independence from Spain and the Spanish military that had
settled in Mexico since the time of the Spanish conquest. After 11 years of war, the
Treaty of Cordova was signed in Vera Cruz, Mexico, on August 24, 1821. This treaty
declared the desired independence from Spain and recognized the liberty of The First
Mexican Empire (Acuna & Compeau, 2008). It is important to note, however, that the
official Independence Day in Mexico is recognized and celebrated as September 16th.
This is related to El Grito de Dolores, a cry from civilians that is considered to mark the
beginning of the Mexican War of Independence on September 16, 1810 (Acuna &
Compeau, 2008).
The year 1835 marked the beginning of the Texas Revolution, a war in which
Texas sought independence from Mexico (Acuna & Compeau, 2008; Weber, 2003).
Texas gained their independence in 1836 and became the Republic of Texas. Some
consider this as the initial beginning of the U.S. – Mexican war, even though this war did
not commence until 1846 (Weber, 2003). This war lasted approximately two years, and
ended with the signed Treaty of Guadalupe Hidalgo (Acuna & Compeau, 2008; Weber,
2003). This treaty outlined the area that belonged to the United States of America and the
area belonging to Mexico, which are the same defined territories today. Mexico lost over
half of its territory in the treaty (Weber, 2003). The treaty also included three options for
Mexicans that would then be considered to be living in United States of America
territory. These options were to: (a) declare to be a citizen of the United States of
19
America and renounce Mexican citizenship; (b) return to Mexico; and (c) remain in the
United States of America and declare the intent to remain a Mexican citizen within one
year (Weber, 2003).
During the late 1920s through the 1930s, a time which is referred to as “The Great
Depression” in United States of America’s history, several reform acts were instigated by
the immigration department of the United States government (this is now referred to as
Immigration and Customs Enforcement or I.C.E.). These acts were known as part of the
“Repatriation Campaign” and were focused on Mexican immigrants (Hayes, 2001;
Hoffman, 1974). The repatriate programs and acts mark the beginning of deportation and
official recognition of immigrants being in the United States “illegally.” The focus of
these campaigns was to locate illegal immigrants and send them back to their country of
origin (Hayes, 2001; Hoffman, 1974). There have even been several accounts of the
government accidently deporting citizens of the United States to Mexico due to their
associated culture and race, “depriving American children of Mexican descent of rights
guaranteed them by the Constitution” (Hoffman, 1974, p. 3).
The United States government quickly changed their ideas at the start of World
War II. The United States was entering the war and had a shortage in individuals to care
for their agriculture. Fearing that the economy would begin to downturn once more, the
United States and Mexico created an agreement known as the “Bracero” program in 1942
(Borjas & Katz, 2007; Hayes, 2001; Hoffman, 1974). This program invited over five
million workers from Mexico to come to the United States and work seasonally (Borjas
20
& Katz, 2007). Soon the fear that Mexicans were depriving jobs and wages of Nativeborn Americans caused the termination of the Bracero program in 1965. Some speculate
that this is when the illegal flow into the United States from Mexico increased (Bean,
Edmonston, & Passel, 1990; Borjas & Katz, 2007).
As illegal immigration rose at a rapid rate, the United States congress determined
to pass the Immigration Reform and Control Act (IRCA) of 1986. This act is an
important turn in United States legislative history. The purpose of IRCA was to grant
amnesty to illegal immigrants that had been in the United States since 1982 or before,
further regulate the heavy flow of immigrants through border control, and to make it
illegal for employers to hire immigrants that were in the country illegally (Bean, 1990).
Since IRCA, the United States of America has seen numerous legislative plans
involving immigration. Some of the most memorable include California Proposition 187,
also known as “Save Our State” or “SOS.” This 1994 proposition recommended barring
illegal immigrants and their offspring (whether born on U.S. soil or not) from receiving
public education, non-emergency health care, and social services (Hayes, 2001). This
proposition originally passed with 60% of California’s votes, but was later appealed in
1999 due to being considered unconstitutional. Another infamous act was the 2005
Border Protection, Antiterrorism, and Illegal Control Act, which included an amendment
that called for a wall to be built on the border between the United States and Mexico.
Many individuals, including the former President of the Soviet Union, Mikhail
Gorbachev, have made comparisons of this wall to the Berlin Wall of Germany and The
21
Great Wall of China (Langerbein, 2009). A total of 180 miles of the fence has already
been built in Texas, with plans of continuing the construction throughout all of the states
that meet the border of Mexico. This wall has been estimated as costing roughly 4 million
dollars per mile (Garrett, 2010). Finally, one of the most recent and controversial
legislative acts has been Governor Jan Brewer’s 2010 Senate Bill 1070. This bill’s intent
is to allow a police officer in the state of Arizona, during the investigation of any offense
against the law (including a traffic ticket), to ask a person for proof of their legal status if
reasonable suspicion arises that the person is in the United States illegally (Kobach,
2010). President Obama is one of many individuals against this bill, stating that it is
against the constitution to use racial profiling during police investigations. Others have
made a comparison between this bill and laws that were passed in Nazi Germany that
contributed to World War II. The bill has not yet passed in the state of Arizona, but
continues to be appealed (Kobach, 2010).
Identified Barriers to Mental Health Services
In this section, the following areas will be discussed: (a) Perceived discrimination
due to gender, race, and documentation status; (b) Perceived lack of culturally competent
services; and (c) Migration and acculturation.
Perceived discrimination due to gender, race, and documentation status.
Research has revealed that Mexican immigrant women encounter discrimination on a
macro, mezzo, and micro level (Chavez & French, 2007; Chung, Bemak, Ortiz, &
Sandoval-Perez, 2008; Terhune & Perez, 2005). Perceived discrimination has serious
22
repercussions among this community. It can contribute to a feeling of distrust with
community service providers, instill fear within an interdependent community, contribute
to a negative development of self-identity, and negatively influence mental health and
physical health (Chakraborty & McKenzie, 2002; Chavez & French, 2007; Finch &
Vega, 2003; Flores et al., 2008; Ornales et al., 2009).
Chung, et al. (2008) completed a thorough review of factors influencing social
justice for Latino immigrants. On the topic of discrimination, these researchers found that
Latinos are discriminated against from several institutions in society. These institutions
included court systems, school systems, and organizations. One such organization, the Ku
Klux Klan, declared that more actions would be directed towards increasing communities
with a large immigrant population. Terhune and Perez (2005) reported in an article in The
Wall Street Journal that amidst the natural disaster of Hurricane Katrina, Latinos were
forced to provide proper documentation to prove that they were not illegal immigrants
before they could receive food, water, and supplies. These types of discriminatory
practices affect the psychological wellbeing of Mexican immigrant women and influence
their willingness to utilize available community services (Shattell, et al., 2008; Ornales et
al., 2009).
Researchers noted that discrimination can occur between community members,
which can further perpetuate the building of negative self identities. Shattell, et al. (2008)
conducted a study in which health service providers in the community were asked to help
identify the needs of the nearby Latino community. Education regarding available
23
services for undocumented individuals was amongst the reported changes needed. One
service provider expressed that their clients, mainly Mexican immigrants, did not know
about services, but also felt persecuted and afraid of being reported to immigration and
then deported. Even Latino college students reported experiencing discrimination
generated by their fellow classmates (Chavez & French, 2007).
Individual encounters with discrimination in mental health services can intensify
social stigma within a community (Lagomasino et al., 2005). For example, one Mexican
immigrant woman reported having a service provider tell her to go home and that she did
not belong in the United States of America (Ornales et al., 2009). This type of
discriminatory practice can also increase mental health issues such as depression (Flores
et al., 2008). Additionally, discrimination associated with legal status can be a contributor
to high levels of stress that influence physical health in Latinos (Finch & Vega, 2003).
Perceived lack of culturally competent services. Wing Sue and Sue (2008) state
that “mental health practice has been described as a White, middle-class activity that
often fails to recognize the economic implications in the delivery of mental health
services” (p. 135). Research suggests that this is congruent with the experience of Latinos
in seeking mental health services (Dobalian & Rivers, 2008; Kanel, 2002; Lagomasino et
al., 2005). More particularly, it has been suggested that the language barrier between
Caucasian professionals and Mexican immigrants negatively affects their utilization of
services (Derose & Baker, 2000; Sisneros & Alter, 2009; Suarez, 2000) and can victimize
the individual to an even greater extent (Wing Sue & Sue, 2008). It has even been
24
suggested that a lack of cultural competence leads to more misdiagnoses in mental health
patients from other cultures (Bhugra & Arya, 2005; Lagomasino et al., 2005).
In a study completed by Kanel (2002), 268 Hispanics (a combined group of
college students and low-skilled workers) were surveyed regarding mental health services
in Orange County, California. Each individual was given the option of completing the
questionnaire in either Spanish or English. When asked if they believed there were
enough Spanish speaking therapists, 71% responded no to the question. In the same
study, 43 therapists that frequently work with Spanish speaking clients were asked the
biggest difference between their work with Spanish speaking clients and their work with
English speaking clients. The most replied answer was dealing with more cultural issues
with Spanish speaking clients, implying the need for mental health specialists that are
knowledgeable and skilled in this area.
In another study involving Latinos, 56 men were asked to rate different foreseen
barriers to mental health services in the order of how influential was that barrier. Lack of
health insurance and low income levels were the two highest barriers cited. The third
highest barrier, problems with language, received 63% of the participants stating that it
was a serious obstacle for Latinos (Cabassa, 2007).
Lagomasino et al. (2005) conducted a study comparing the use of care among
1,175 clinically depressed individuals. Of these individuals, 777 were Caucasian and the
other 398 defined themselves as Latino. Even though each of these individuals had equal
access to mental health care on a regular basis, the study found that the Latino group was
25
less than half as likely to have received quality care as the Caucasian group. Two
particular barriers identified as having contributed to this finding were social stigma and
a lack of culturally centered services.
Researchers continue to conduct studies to improve knowledge in how to meet the
needs of immigrants and minorities within the realm of their culture (Kwong, 2009; Wing
Sue & Sue, 2008). Some schools have even chosen cultural competency as an area of
emphasis for their students. For example, the University of Denver, Colorado, has a
Latino Certificate Program for graduate level students in Social Work. This program is
focused on training social workers to become culturally competent when working with
Latinos. This is achieved by directing the student’s education to specialize in Latino
history and culture, understand policies and programs that affect Latinos, and mastering
the Spanish language (Sisneros & Alter, 2009). When conducting research to question
students that had graduated from this program, 97% stated that they were working
directly with Latinos.
Migration and acculturation. The migration experience occurs in three distinct
phases, with the first phase being the pre-migration phase (Bhugra & Arya, 2005). This is
the phase in which an immigrant prepares for the journey and relocation into a new
country. For a Mexican woman, this phase may include deciding on whom to leave her
children when she leaves due to the fact that often times her husband will have migrated
before her (Wilkerson et al., 2009). This is an important decision to make, as this may be
the place that she will raise her children through transnational mothering until they are
26
adults or can join her in the United States (Dreby, 2006; Hewett, 2009; HondagneuSotelo & Avila, 1997). Another vital preparation in the pre-migration phase often made is
to hire someone to lead them across the border illegally. These persons are known to
Mexican immigrants as “Coyotes” and can cost a considerably large amount of money
(Blitz & Pender Greene, 2006; Custred, 2005).
The second phase is the actual migration or relocation to the new country (Bhugra
& Arya, 2005). The migration to the United States for a Mexican immigrant can happen
two different ways: legally migrating to the United States, or risking their life to attempt
to illegally cross the well-guarded United States/Mexico border (Blitz & Pender Greene,
2006). There have been several books and articles written about the trauma associated
with crossing the border illegally. One article states that the consistency of rapes that
women experience by border control officials is so high that Mexican women know to
take birth control pills before making the journey across the border (Falcon, 2005). The
voyage across the border can also consist of serious injuries, being robbed and assaulted,
dehydration, border control brutality, capture by “La Migra” (border control), and death
(Blitz & Pender Greene, 2006; Custred, 2005).
Finally, the third phase is known as the post-migration phase (Bhugra & Arya,
2005). In this phase, an immigrant attempts to adapt or acculturate to the new country’s
standards and norms. Acculturation can be both a promoter of mental health wellness and
identity but can also cause of distress for an immigrant (Bryant-Davis, Chung, & Tillman,
2009). This is due to the elevated stress associated with the feeling a loss of cultural
27
familiarity, attitudes, beliefs (Bhugra & Arya, 2005; Bryant-Davis et al., 2009; Finch &
Vega, 2003). In fact, several studies have found that high acculturation rates are actually
correlated with a decrease mental health and physical health in Mexican immigrants
(Davila, McFall, & Cheng, 2008; Escobar, Hoyos Nervi, & Gara, 2000; Waldstein,
2008). One of the features most often considered when judging acculturation level is
language (Alegria et al., 2002; Folsom, Gilmer, Barrio, & Moore, 2007).
Folsom et al. (2007) conducted a longitudinal study examining differences in
mental health service use among three separate groups with serious mental illness. The
groups were Spanish speaking Latinos, English speaking Latinos, and English speaking
Caucasians. The study’s results indicated that the Spanish speaking Latinos were very
different in their demographics and clinical service usage than the two English speaking
groups, while the English speaking groups were actually quite similar to one another. The
study concluded what other studies have also found, that Spanish speaking Latinos utilize
mental health care at a much lower rate than Caucasians (Alegria et al., 2002; Vega,
Kolody, Aguilar-Gaxiola, & Catalano, 1999).
Use of Social Support and Religion
Researchers have shown that Latinos rely on three distinct support systems when
they feel they need help: their family, the community (including friends), and God
(spirituality and religion) (Cabassa 2007; Falicov 2009; Jurkowski, Kurlanska, & Ramos,
2010; Ornales et al., 2009; Waldstein, 2008). This support could be considered as a
strong point in the Latino community, but can also be a barrier to seeking mental health
28
services. For example, in a study by Kanel (2002), 15% of 268 Latinos stated that they
would not seek mental health services because they would prefer to speak to a family,
friends, or clergy. This is congruent with another study by Cabassa (2007) where 70% of
56 Mexican immigrants reported that they would prefer to rely on family members for
help. Ornales et al. (2009) also completed a qualitative study focusing on strategies to
maintaining emotional health utilized by Mexican immigrant mothers. One of their
results was that all 20 of their participants reported relying on first their husbands for
support, and then their other family members and friends. Concerning use of social
support and religion, the following sub-sections will be discussed: (a) Familismo; and (b)
Religion.
Familismo. This concept has been described as “loyalty, reciprocity, and solidarity
within the immediate and extended family” (Galanti, 2003, p. 181). The loyalty within
the Mexican family extends beyond being a source of support, but includes keeping
private matters within the confines of marriage and the family (Dreby, 2006; Waldstein,
2008). After speaking with a researcher about personal experiences involving being a
transnational mother, one Mexican woman hesitated to refer the researcher to other
mothers, for fear that they would know that she shared personal, family experiences to
someone outside of the family (Dreby, 2006). This may contribute to the social stigma
associated with mental health services in the Mexican community, as telling private
matters to others is looked down upon (Dreby, 2006). Mexican women rely on their
family for physical matters, not just emotional ones (Falicov, 2009; Ornales et al., 2009;
29
Waldstein, 2008). An example of this is “la cuarentena”, the 40 days following child birth
in which a woman is expected to refrain from participation in sexual activities (Ornales et
al., 2009). During this time, traditional Mexican women will look to their mothers,
sisters, sisters-in-law, and sometimes close friends to help with housework, the children,
and other domestic duties. Additionally, these women take care to watch for any signs of
depression or other symptoms with the new mother (Falicov, 2009; Ornales et al., 2009).
Religion. Religion and spirituality are important features of the Mexican culture as they
influence beliefs and behaviors associated with mental health and physical health
(Falicov, 2009; Jurkowski et al., 2010). Jurkowski et al. (2010) formed several focus
groups that consisted of 47 Latino women total. These focus groups were transcribed and
studied in order to measure the perceived contribution of spirituality or religion on mental
and physical health. All 47 of the women made a connection between spirituality and
health. Several women even spoke about spirituality affecting their mental health,
contributing to positive physical health. One woman stated “to gain mental health, we
have to pray to God and ask him for help because with all of the difficulties we face in
life, only God can help us” (p. 22).
The belief that religion helps mental health does not exist strictly in Latinas. In
the findings of one study, Cabassa (2007) found that 79% of 56 Latino males agreed or
strongly agreed that faith in God would heal depression and 68% agreed or strongly
agreed that merely asking God for forgiveness could heal depression.
30
Gender Roles in the Mexican Culture
In this section, the following will be discussed: (a) Machismo; and (b)
Marianismo.
Machismo. Traditional Mexican households are patriarchic-centered and focused
on the male’s position of power and control, which is often referred to as “machismo”
(Galanti, 2003; Villegas, Lemanski & Valdez, 2010; Wilson, 2003). Maintaining
machismo masculinity may include being in control over major family decisions, acting
aggressively towards their spouse, participating in extramarital relationships, and
demanding respect “respeto” from their children (Dreby, 2006; Galanti, 2003; Wilson,
2003). The role of the woman, therefore, is to be a submissive, compliant wife that cares
for the children and other domestic responsibilities (Galanti, 2003; Villegas et al. 2010).
While a more modern perspective may reject these strict gender roles, machismo has
been suggested to have positive aspects as well, such as the father being an advocate to
their family in the community and being the breadwinner that maintains employment to
provide for the family (Wilson, 2003).
Villegas et al. (2010) analyzed the content of Mexican television advertisements
and how they reinforce defined gender roles, especially that of the woman. How women
were portrayed in the commercials and where the location of the woman was during the
commercial (in the home, school, business, etc) were examined. These researchers found
that women were shown interacting in a dependent role (i.e. mother) 54.3% of the time
versus 19.5% in an independent role (i.e. professional). Additionally, the study noted that
31
most women in the commercials remained either neutral or calm in their emotions,
reinforcing the belief that Mexican women should be calm and not show emotions
(Villegas et al., 2010). Additionally, only 18.9% of commercials depicted males in the
location of the home, as compared to the larger amount of 32% portraying females in the
home.
Marianismo. The submissive, emotion-less, self-sacrificing role of the Mexican
woman is referred to as “marianismo” (Dreby, 2006; Galanti, 2003; Villegas et al., 2010;
Wilson, 2003). This role is often considered honorable and celebrated by Mexican
women due to the belief that the Virgin of Guadalupe (equated to the Virgin Mary)
possesses these same characteristics of strength (Dreby, 2006). Beneria and Roldan (as
cited in Wilson, 2003) completed a study in which 140 female domestic home workers in
Mexico City were interviewed. The majority of these women reported that they had to
ask for their husband’s permission to visit family or friends, to work, and to discipline
their children. Furthermore, these women reported having to serve their husbands and
their husbands’ friends at any hour of the day or night, and never answer to demands in
negative tones. The need of Latina women to ask permission of their spouse is a cited
barrier to seeking mental health services, especially concerning domestic violence
situations (Gonzales-Guarda et al., 2009).
A large part of marianismo is the responsibility of the mother to care for the
children. Galanti (2003) suggests that women may actually prefer to have smaller
families due to the amount of pressure and work involved. Their husbands, however, may
32
equate larger family size with masculinity; this may account for the commonality of
Mexican families being larger in the number of children they have (Galanti, 2003).
Traditional Beliefs Regarding Health and Mental Health
The following sections will be discussed: (a) Supernatural explanations; (b)
Susto/mal de espanto; (c) Ataque de nervios; (d) Mal aire; (e) Mal de ojo; and (f)
Curenderos and limpias.
Supernatural explanations. Mexico has a history of interpreting physical
symptoms as being caused by witchcraft or magical folktale thinking that can be traced
back to pre-Hispanic times and the Spanish conquest (Castro, 2001; Subbotsky &
Quinteros, 2002; Walsh, 2009). These folktale-based explanations are widely accepted
and can influence a Mexican’s likelihood to seek services that are based on Western
societal thinking. Some of these identified causations to illnesses are: Susto (fright),
ataque de nervios (nervous attacks), mal aire (bad air), mal de ojo (evil eye), and brujería
or maleficio (witchcraft). In addition, sickness has also been claimed as being a result of
entrance of either extreme hot or cold temperatures into the body (Castro, 2001; Loue,
1999).
Susto/mal de espanto. (Meaning fright or bad spirit) is often referred to when a
person is restless, irritable, depressed, or has a loss of appetite (Bryant-Davis et al., 2009;
Castro, 2001). This normally occurs after a traumatic experience and may resemble post
traumatic stress disorder. The remedies used to treat these symptoms include herbs and
massage, burning coals in order to sweat off the experience, praying to the spirits to
33
relieve the sickness, or sweeping a broom over the body to cast off the fright (Castro,
2001; Loue, 1999; Trotter & Chavira, 1997; Walsh, 2009).
Ataque de nervios. (Meaning nervous attack) refers to a sudden onset of anxious
(ansiedad) feelings (Bryant-Davis et al., 2009; Falicov, 2009). This can cause headaches,
insomnia, or dizziness as well as auditory or visual hallucinations. This can be accepted
as a normal response to difficult life situations (Falicov, 2009; Loue, 1999).
Mal aire. (Meaning bad air) causes flu-like symptoms, including chills
(escalofríos), nausea, vomiting, ear infections, and fever. This is thought to be caused by
being in a cold draft or too much contact with night air (Falicov, 2009).
Mal de ojo. (Meaning evil eye) and brujería (witchery) are conceptualized as
being witchcraft being practiced on a person. This is diagnosed when a person suddenly
has a change of physical or emotional well-being. Common symptoms are infertility,
depression, enojo (anger), overall malice. When another person pays too much attention
to a particular child or person in the community, they may be accused of practicing
witchery and placing an evil spell on the other person (Castro, 2001; Falicov, 2009; Loue,
1999; Trotter & Chavira, 1997).
In an effort to investigate the belief of magical occurrences in Mexico versus
Great Britain, Subbotsky and Quinteros (2002) completed an experiment comparing these
14 males for each of the two groups. The experiment involved the use of a “magical” box
to destroy a plastic card after a fake magic spell was placed on it. These researchers
found that Mexicans tended to verbally claim that they did not believe the magic spell
34
affected the plastic card. However, after the spell was cast and the card was indeed
affected, 85% of the Mexican group accepted that the magic spell had indeed worked.
Additionally, the Mexican group expressed their belief in mythical creatures, and a few
even claimed to have seen a mythical creature. Great Britain also believed in the magic
spell and mythical creatures, however at the significantly lower rate of only 19%.
Curanderos (folk healers) and limpias (cleansings). When experiencing any of
these aforementioned illnesses, it is an accepted practice to visit a curandero (folk healer)
and ask for a limpia (cleansing) (Castro, 2001; Trotter & Chavira, 1997). A curendero/a
is a folk healer that uses holistic ways (such as herbs) to treat illnesses or disease (Trotter
& Chavira, 1997). Waldstein (2007) interviewed 37 Mexican women and found that all
of them preferred to use homemade herbal remedies to treat health issues instead of
prescription medicine, if possible. Some common herbs used by Mexican folk healers
are: manzanilla (chamomile), yerbabuena (mint), ruda (rue), albajaca (basil), and
pomadas (salves) (Waldstein, 2007).
The purpose of a limpia is to cast out a bad spirit or feelings, or to stop the evil
spell that has been cast on the individual (Falicov, 2009). A limpia can be performed
using massage, brooms, eggs, and perfumed water, depending on what the identified
problem is (Castro, 2001; Trotter & Chavira, 1997). Often limpias include a spiritual
ritual and prayer (Castro, 2001).
These supernatural explanations and use of traditional healing can decrease the
desire for Latinos to seek out mental health professionals (Waldstein, 2007). This may be
35
due to a lack of knowledge regarding mental illness and its symptoms (Lagomasino et al.,
2005).
Gaps in the Literature
In reviewing the literature on the topics of Mexican immigrant women and
mental health services, several areas were identified that could have an increase of
research and understanding with regard to this population. While conducting research for
this study, there was no data found correlating a relationship between an immigrant’s
demographic area of origin (from a rural or city area) and their beliefs about mental
health services. In addition, there is no specific study focused on age and how this
corresponds with knowledge pertaining to mental health services. There is no information
about the amount of time a Mexican immigrant has been in the United States and their
level of adoption of Westernized thinking towards mental health services. There is little
information examining the link between the underutilization of services and the level of
discrimination felt by Mexican immigrant women. There is not sufficient research
completed regarding social stigma in this community and its impact on patients receiving
services. Finally, there is no particular study focused on Mexican immigrant women and
a ranking of barriers that would cause them to underutilize mental health services.
Prevalence data, especially pertaining to this specific population, is lacking.
There is hardly any information on the cultural competency and what this means to
Mexican immigrant women that are seeking services, beyond the language barrier. This is
36
an area that should be researched in order to promote and sustain more knowledgeable
professionals that are providing services to this community.
This study will investigate barriers to mental health services in relation to
demographic characteristics, as well as the likelihood of utilization of mental health
services in relation with barriers in an attempt to provide more insight in this area of
research. Also, these aspects will be examined in order to provide information to
professionals that will be working with Mexican immigrant women with the hope of
increasing utilization and mental health wellness in this population.
Summary
This chapter contained detailed sections pertaining to this project. A history of
Mexican immigration into the United States and recent and current legislation were
discussed. Relevant literature pertaining to this project was reviewed in this chapter with
areas of interest including: identified barriers to mental health services, the use of social
support and religion, gender roles in the Mexican culture, and traditional beliefs
regarding health and mental health. Important demographic characteristics and other
barriers that were identified but not a focus of this project was also examined. Finally,
gaps in the literature were discussed. In the next chapter, the methodology of the study is
detailed and explained.
37
Chapter 3
METHODS
Introduction
This chapter describes the research design, variables, and methodology used for
this study. The study population is defined and the precautions taken to ensure their
safety and protection are also discussed. Also explained are the procedures for gathering
and analyzing the data as well as providing a description and explanation of the survey
questionnaire. Finally, human subject protections and summary are presented.
Research Questions
This study investigates the following research questions: (a) How do the
reported levels of perceived barriers (i.e. social stigma, social role, discrimination, etc)
relate with the participant’s willingness to seek mental health services? (b) What is the
relationship between the reported demographics of the participants (i.e. age, relationship
status, area of Mexican origin, years in the U.S.A., etc) and their perceptions of barriers
to mental health services?
Research Design
The purpose of this study is to explore perceptions of barriers to mental health
services that immigrant Mexican women experience and how this is related to their
demographic characteristics. It also explores any under-utilization of mental health
services with relation to these perceived barriers. The study uses an explorative
quantitative survey research design method because of the exploratory nature of the study
38
topic. This approach can also facilitate in the examination of a variety of understudied
social phenomenon (Royse, 2008), including this under-utilization of mental health
services.
The survey research method has been described as being one of the best methods
to utilize when collecting data to describe a large population (Rubin & Babbie, 2001).
This may be due to the ability to distribute surveys to a large amount of people through a
wide variety of methods, including through the mail, telephone, internet, or in person.
Out of all of these techniques, a researcher that conducts a survey in person normally has
a better response rate than those who conduct the survey through other means (Rubin &
Babbie, 2001). As Mexican female immigrants living in the United States is a large,
understudied population, this researcher determined that distributing surveys in person to
this population would be the most appropriate method to use for this study.
Like other research designs, there are both strengths and weaknesses to using the
survey research method. Rubin and Babbie (2010) suggest several strengths involved in
using this design. One of the strengths of using a survey research design is the ability to
analyze multiple variables at once. More specifically, one noted strength in distributing
surveys in person is that it allows the researcher to explain confusing items to the
subjects. Another strength is that surveys can be flexible and allow several questions to
be asked at one variable, therefore allowing the researcher to develop operational
definitions of variables widening the flexibility with the eventual data analysis (Rubin &
Babbie, 2001). Finally, survey research is considered strong on reliability, as the data is
39
based on objective means (answered questions) instead of subjective means (the
researcher’s observations) (Rubin & Babbie, 2001).
Royse (2008) notes that there are also several weaknesses to using this design. For
example, an in-person survey distribution can impede the likelihood of anonymity in the
project, which can result in fewer participants and increases the possibility of inaccurate
data retrieval from these participants. Rubin and Babbie (2001) also mention that while a
survey may be able to contribute to general information about a given topic, it rarely
gives a well-rounded and in-context picture of the whole situation at hand. Finally,
survey research is considered to be weak in validity, as the complex ideas and opinions
regarding the topic being studied rarely can be contained and communicated through a
form that only measures agreement or disagreement on the subject (Rubin & Babbie,
2001).
Variables
The independent variables in this study are: (a) demographic characteristics and
(b) the likelihood of seeking mental health services. The dependent variables in this study
are (a) the level of perceived social stigma associated with mental health services; (b)
level of utilized social support; (c) level of perceived discrimination in mental health
services; (d) level of perceived cultural sensitivity in mental health practitioners; (e) the
perceived role of women in the Mexican culture; and (f) level of knowledge regarding
mental health and mental health services.
40
Conceptual and Operational Definitions of Study Variables
Demographic background in Mexico. This variable is measured by asking the
participant to differentiate whether they lived in a rural area (a farming or countryside
area with low population levels), a suburbs area (often just outside of a city, with higher
population levels and more evidence of industrial growth), or a city (an area with high
population levels and evidence of industrial growth).
Social economic status/income. the reported annual income level of the
participants’ household. This variable is measured by asking the participant to choose
between an annual income of less than $20,000, or more than $20,000.
Religion. Self reported religious denomination or sect. This variable is measured
by asking the participant to choose between Catholic, Non-Catholic Christian,
Atheist/Agnostic, or Other, in which the participant could specify their particular religion.
Civil relationship status. Current status of one’s romantic relationship. This
variable is measured by asking the participant to choose between Single,
Married/Partnership, Widow, Separated, or Divorced.
Level of English language. The participant’s reported use of the English
language. This variable is measured by asking the participant to choose whether she felt
she spoke Not much English at all, Some English, A lot of English, or English mixed
with Spanish.
Level of education. The number of years the participant has received formal
education in a school setting. This variable was measured by asking the participant to
41
choose between No education, Less than High School, High School graduate, Some
college, and Other, in which the participant could specify what kind of other education
they had received.
Amount of time in the United States of America. The number of years the
participant has lived in the United States of America. This variable is measured by asking
the participant to choose between 5 years or less, 10 years or less, or more than 10 years.
Perceived role of women in the Mexican culture. Participant’s beliefs regarding
the normative roles and responsibilities that a woman has in the Mexican culture. This
variable is measured by giving the participants four statements regarding the woman’s
role, and asking them to indicate whether they strongly agreed, agreed, disagreed, or
strongly disagreed with each statement. The statements were: (a) A Mexican woman
must always act strong and not show emotions; (b) A Mexican woman should be more
focused on her responsibilities in the home and workplace and not take time to go to
therapy; (c) A Mexican woman should talk about family problems to people outside of
the family; and (d) A Mexican woman should ask her husband/partner before talking to a
therapist.
Perceived cultural sensitivity in mental health services. Participants’
perceptions of culturally sensitive services in their community. This variable is measured
by giving the participants three statements regarding the cultural sensitivity at mental
health services (including aspects of language, religion, and culture), and asking them to
indicate whether they strongly agreed, agreed, disagreed, or strongly disagreed with each
42
statement. The statements were: (a) There are many therapists in the community that
speak Spanish; (b) In my community, there are therapists that understand my religion and
how it relates with the Mexican culture; and (c) In my community, there are therapists
that understand the role and responsibilities of a woman in the Mexican culture.
Knowledge level concerning mental health and mental health resources.
Participants’ knowledge regarding mental health and where to obtain mental health
services. This variable is measured by giving the participants three statements regarding
their knowledge of location mental health services and their overall knowledge about
mental health, and asking them to indicate whether they strongly agreed, agreed,
disagreed, or strongly disagreed with each statement. The statements were: (a) I have a
clear understanding of mental health disorders; (b) I know what symptoms would
describe or indicate a mental health illness; and (c) If someone asked me where they
could find a therapist to talk to, I know where I could send them.
Social stigma regarding mental health. Perceptions of social views of mental
health issues. This variable is measured by giving the participants three statements
regarding their perceptions on people socially connected to them and their beliefs
regarding someone obtaining mental health services, and asking them to indicate whether
they strongly agreed, agreed, disagreed, or strongly disagreed with each statement. The
statements were: (a) I believe that my family accepts therapy as a common and
acceptable practice for anyone to use, including me; (b) I believe that my boss accepts
therapy as a common and acceptable practice for anyone to use, including me; and (c) I
43
believe that my friends accept therapy as a common and acceptable practice for anyone to
use, including me.
Perceived discrimination. The level of perceived or experienced stigmatization
or discrimination (based on race, gender, or immigration status) when seeking mental
health services. This variable is measured by giving the participants three statements
regarding their perceptions on whether a person would be treated differently due to
different aspects (including race, gender, and immigration status), and asking them to
indicate whether they strongly agreed, agreed, disagreed, or strongly disagreed with each
statement. The statements were: (a) A woman seeking therapeutic services will be treated
differently because of her gender; (b) A Mexican seeking therapeutic services will be
treated differently because of their race; and (c) An undocumented immigrant seeking
mental health services will be reported to immigration.
Social support utilization. Level of likelihood to seek other sources of social
support instead of seeking mental health services. This variable is measured by giving the
participants two statements regarding their perceptions on whether a person should
discuss issues with other individuals before mental health services and asking them to
indicate whether they strongly agreed, agreed, disagreed, or strongly disagreed with each
statement. The statements were: (a) A Mexican woman should talk about family
problems to people outside of the family; and (b) A Mexican woman experiencing
problems should talk to a leader in her church or a leader in her community first, before
talking to a therapist.
44
Likelihood of seeking mental health services. Willingness to seek mental health
services, accept therapy as an tolerable practice for self or others, and willingness to refer
others to seek services. This variable is measured by giving the participants three
statements regarding their own perceptions on whether another person or they should
seek mental health services and if mental illness is caused by supernatural forces and
asking them to indicate whether they strongly agreed, agreed, disagreed, or strongly
disagreed with each statement. The statements were: (a) I would consider speaking to a
therapist as an option for me if I felt I wanted or needed it; (b) I believe that therapy is a
common and acceptable practice for anyone to use, including me; and (c) If someone has
mental health issues, they could be cursed/ possessed by a supernatural power (a witch,
bad spirit, or the devil).
Study Population
The study population includes any person who meets the following criteria: (a)
over 18 years of age; (b) female; and (c) immigrant in the U.S. that has migrated from
Mexico at some point in their lives. Agencies that offer Spanish-speaking women-only
support groups in Solano County and Yolo County were identified and invited to
participate in the study.
Sample Population
Due to the potential difficulty in locating willing participants that meet the
parameters of this population, purposive sampling was used to identify a variety of
respondents that could be found in one location. In addition, a nonprobability snowball
45
sampling technique allowed for more participants within the study population definition
to participate. According to Rubin and Babbie (2008), snowball sampling is effective for
use among sensitive minority populations, such as immigrants. Therefore, participating
agencies were invited to give the researcher’s phone number to any person that fit the
identified study population. This approach allowed potential participants to contact the
researcher to become involved in the study. A total of 51 women were invited to
complete the survey questionnaire and 33 research subjects accepted the invitation to
participate in this study. Only one person had contacted the researcher with four women
that would be willing to participate in taking the survey. Targeting these support groups
with a trusted facilitator was a practical way to find participants that would be open and
willing to participate in a survey questionnaire with a researcher that they did not know,
as opposed to targeting random individuals in the community.
Instrumentation
The questionnaire consists of 8 multiple-choice demographic-related questions
and 21 statements to which the respondents can rate their level of agreement or
disagreement according to a Likert-type scale (Appendices A and B). Closed-ended
questions were chosen because they allow for easy statistical collection of data and do not
require the interpretation of research subjects’ responses (i.e., qualitative analysis of
open-ended responses).
The demographic questions focus on as the following: income, education,
language, religion, age, the type of geographic area in Mexico that the participant is from,
46
relationship status, and how long the person has lived in the United States. None of the
demographic items are specific enough to identify individual participants. In order to
examine the frequency distributions, some of the demographic items have been divided
into data groups. Rubin and Babbie (2010) suggest that this approach is a more
manageable way to group data, with a weakness of reducing the detail of the data.
The statement section of the survey instrument consists of statements concerning
the subject’s knowledge and perceptions in the following areas regarding mental health
services: cultural competency of practitioners, social stigma, perceived discrimination,
the woman’s role, likelihood of seeking these services, use of social support instead of
mental health services, personal knowledge of mental health, and where to obtain mental
health services. Participants will be asked to rate their level of agreement or disagreement
with each statement.
The survey instrument uses a Likert-type Scale, which is an ordinal level of
measurement. In 1932, the original Likert scale was created by Renis Likert, as a means
to measure attitudes and opinions (Gob, McCollin, & Ramalhoto, 2007). While the
original Likert scale has a 5 point response range, this project will use a Likert-type scale
containing a range of 4 responses and are in reverse numerical order to the original Likert
scale. These responses are: 1 strongly agree, 2 agree, 3 disagree, and 4 strongly
disagree. The purpose of eliminating any neutral answer in the Likert-type scale is to
force the participant to make a choice. One considered disadvantage to using a scale with
47
limited responses is that there is not a wide range of intervals to which the participant can
respond (Allen & Seaman, 2007).
To ensure that respondents understand the statements and their associated
response options, the survey instrument was pre-tested. The pre-test was completed by
individuals with a similar background to the sample population, such as education level
and cultural background. These individuals were not asked to actually complete the
questionnaire as if they were participating, but both to read the instructions and questions
and then report their understanding of what they were being asked. This pre-test helped to
eliminate or clarify confusing questions that did not capture the intended meaning that the
researcher was seeking and increased the content validity of these questions (Rubin &
Babbie, 2008).
Cultural Competence in Research
Rubin and Babbie (2010) also identify the importance of conducting culturally
sensitive research. One major issue they report is language difficulties. Inaccurate
language use can occur when the measurement instrument must be translated from
English into another language (i.e., Spanish). This is called translation validity, as it can
reduce the instrument’s content validity and reliability if it does not reflect the true
intended questions of the research and is understood differently by different participants.
To avoid this, the researcher had several bilingual individuals complete a pre-test with the
survey instrument. One procedure these individuals completed was a back-translation.
This was done by translating the survey from Spanish into English and then comparing
48
with the original English questionnaire. This helped to identify any discrepancies
between the two versions of the survey and the researcher made the necessary
adjustments. When tested again, the researcher achieved linguistic equivalence, which is
the successful back translation necessary before distributing a survey in another language
(Rubin & Babbie, 2010).
Papadopoulos and Lees (2001) identify four areas within which a researcher must
develop themselves before conducting cross-cultural studies. These areas include cultural
awareness, competence, sensitivity, and knowledge. The researcher has taken appropriate
steps to become immersed in these areas. To improve cultural awareness, the researcher
has become more self-aware in the areas of bias and transference that can occur during
the study. To build cultural competence and cultural knowledge, the researcher has
studied literature in relation to the population’s belief systems, cultural traditions, and
attitudes towards mental health services. In addition, the researcher has professional and
personal experience working with the sample population, and is bilingual in Spanish and
English. In order to build cultural sensitivity, the researcher has become educated in the
correct use of body language and verbal language when interacting with individuals in
the sample population.
Data Gathering Procedures
The agencies that were invited to participate in this study are located in Solano
and Yolo counties, and are agencies that serve Mexican women by conducting support
groups for Spanish speaking women. The purpose of the support groups is to build a
49
network of relationships in the community with persons of a similar background.
Although these groups have an agency leader and can be considered therapeutic in nature,
they are not identified as group therapy. To establish rapport with the agencies’ group
leaders, explain the intent of the survey, and ensure that this is indeed a place to find the
study population, the researcher met with the group leaders for brief one-on-one
meetings. In these meetings, the facilitators gave full support to the project, and informed
the researcher that all women in these groups are Mexican immigrants. In addition, each
agency provided written authorization to invite the participants to complete the survey
questionnaire.
After signing informed consent (Appendices C and D), participants were provided
as much time as needed to complete the demographic and survey instrument. Upon
completion, participants were asked to place their survey into a manila folder so as to
ensure privacy and confidentiality. The participants were also given the telephone
number of the researcher and project faculty advisor in the event that they had questions
or concerns, as well as to provide referrals for future study participants (snowball
sampling).
Only one participant applied the snowball sampling method and referred four
other women to participate in the study. The researcher met the four women at the time
and place that they specified and administered the questionnaire to them in a place where
they felt comfortable.
50
Data Analysis
The survey was distributed in person, gathered, and stored in a secured lock box
maintained by the researcher until the data could be input into PASW for analysis.
Common barriers were identified and analyzed using descriptive univariate and bivariate
statistics. Univariate analysis allows for the exploration of each variable individually.
Bivariate analysis allows for the comparison of independent variables with one another
and the relationship between independent and dependent variables (Rubin & Babbie,
2010). Frequency distributions were performed using the PASW software. Chi-square
analyses were conducted to determine any statistically significant relationships between
the dependent variables (demographic characteristics and likelihood to seek services) and
the independent variables (perceived level of cultural competency in mental health
practitioners, perceived discrimination, social stigma, beliefs about social support,
knowledge on mental health and services, beliefs on the woman’s role in the culture).
Protection of Human Subjects
Prior to data collection, the researcher completed the necessary steps to ensure the
protection of study participants. Following protocol, the researcher submitted necessary
documentation to the Division of Social Work Human Subjects Review Committee at
California State University, Sacramento. This committee endorsed the approval of this
project on November, 17, 2010. This study was considered to present minimal risk to
participants. Precautionary steps were taken to ensure that the questions asked within this
study would cause minimal risk to participants. This included revising questions and
51
statements that may be viewed as too personal and becoming more competent and
sensitive to this sample population’s beliefs and culture. This study is confidential,
wherein the demographic and survey instrument items were developed to protect
participants’ identity.
Each participant signed an informed consent prior to receiving and completing the
survey instrument. All documentation was provided in the language in which the subject
felt most comfortable, so that the participant would know in exactly what they were
agreeing to participate. The informed consent notified each participant of the voluntary
nature of the study, and that they could skip questions or withdraw from the study at any
time. Each participant was provided with a list of agencies that offer free services and
resources in both English and Spanish, in the case that the survey instrument or type of
questions used resulted in painful or uncomfortable memories from current or past
experiences.
Summary
This section included a description of the purpose, design, and methodology of
the research study. Conceptual and operational definitions of variables were provided.
Information about the study population and study sample was included, as well as the use
of the survey questionnaire how an analysis of the data was to be performed. Also
included was a discussion on the importance of conduction culturally sensitive research.
Finally, the protection of human subjects was outlined in detail to make certain that
ethical practice was being practiced. In the next chapter, data will be presented.
52
Chapter 4
RESULTS
Introduction
This chapter will examine the results of this study on Mexican immigrant women.
The research question will be presented. Survey responses to the independent variables
(demographic characteristics) will be presented. A frequency analysis on the statements
measuring the likelihood to seek services will be provided. Demographic characteristics
will be compared with responses to each dependent variable through Chi-square tests,
which will determine the presence of significantly statistical relationships. A summary of
the data presented will conclude this chapter.
This study attempts to investigate the relationship between demographic
characteristics of Mexican immigrant women and perceived barriers to mental health
services. The data for this study was obtained through a survey of Mexican immigrant
women attending women support groups in Yolo County, California and Solano County,
California.
Research Question
The research questions examined in this study were: (a) What is the
relationship between the participants’ reported likelihood to seek services and their
reported levels of perceived barriers? (b) How do the reported levels of perceived barriers
relate with the reported demographics of the participants?
53
Survey Responses
A total of 51 Mexican immigrant women were asked to complete the survey. Of
those 51 Mexican immigrant women, a total of 33 completed the survey. The response
rate is 64.7%.
Independent Variables
Demographic characteristics. A total of 8 different demographic characteristics
were examined in this study. The options of response for each characteristic will be
explained, as well as any re-coding that was necessary for meaningful analysis.
Age. The participants were given 2 options to answer for age: (a) 18-34 years and
(b) 35+ years. Of the 33 Mexican immigrant women surveyed, 13 (39.4%) indicated that
they were 18-34 years old, and 20 (60.6%) were 35 years old or more (Table 1).
Religion. Most participants reported that they were Catholic (90.9%) (Table 1).
Less than one-fifth (6.1%) selected Non-Catholic Christian as their religion and 1 person
(3%) marked No Religion on their survey. None of the participants marked the option of
Other, please explain, therefore, it is not featured in the presented table (Table 1). Due to
the high frequency of participants marking Catholic as their religion (30 out of 33
participants), this variable does not provide enough variation for significant data and was
not examined in correlation with the dependent variables.
Area of origin in Mexico. Over half of the respondents selected urban area in
Mexico where they had lived before coming to the United States (Table 1). Less than a
quarter lived in either the city or in a rural area in Mexico. Due to the high frequency of
54
participants marking urban as their area of origin (17 out of 33 participants), and 2
participants choosing not to answer this question, this variable does not provide enough
variation for significant data and was not examined in correlation with the dependent
variables.
Table 1
Demographic Characteristics and Percentage of Participants
Age
18-34 years 39.4%
35+ years 60.6%
Religion
Catholic
Non-Catholic Christian
No Religion
Area of Origin in Mexico
Rural
Suburbs
City
Income Level
Less than $20,000
More than $20,000
Level of Spoken English
No English
Some English or More
Time lived in the U.S.
Less than 10 Years
10 Years or More
Relationship Status
Single
Married/Partnership
90.9%
6.1%
3%
21.2%
51.5%
21.2%
75.8%
21.2%
42.4%
57.6%
42.4%
57.6%
39.4%
60.6%
Education Level
Less than High School 57.6%
High School Graduate and/or Some 39.4%
College
55
Income level. Over three-quarters of the respondents in this study made less than
$20,000 per year and one fifth earned over $20,000 (Table 1). Due to the high frequency
of participants making less than $20,000 as their income level (25 out of 33 participants)
and 1 participant choosing to not answer this question, this variable does not provide
enough variation for significant data and was not examined in correlation with the
dependent variables.
Level of spoken English. This variable was re-coded into 2 different options: (a)
No English and (b) Some English or more. Over two-fifths of the participants indicated
that they speak No English, and almost three-fifths reported speaking Some English or
more (Table 1).
Time lived in the United States (U.S.). This variable was re-coded into 2
categories: (a) 10 years or less and (b) more than 10 years. Over three-fifths of the
participants had lived in the United States 10 years or less. Almost three-fifths had lived
in the United States more than 10 years (Table 1).
Relationship status. Almost two-fifths (39.4%) of participants considered
themselves as single, and three-fifths (60.6%) were married or in a partnership (Table 1).
Education level. More than half (57.6%) of participants were considered to have
less than a high school education, and almost three-fifths (39.4%) had graduated high
school and/or had some college (Table 1).
Likelihood to seek mental health services. The judged level of each participant’s
likelihood to seek mental health services was based upon 4 separate statements that were
56
presented to the participants. The women were asked to rate their response to the
statements on a scale ranging from 1 strongly agree to 4 strongly disagree. To allow for
significant statistical analysis, these variables were re-coded into the two response
categories: 1 agree, which included both original responses of strongly agree and agree;
and 2 disagree, which included both original responses of strongly disagree and disagree.
The researcher chose the following statements to represent the participant’s
likelihood to seek services: (a) If someone is experiencing extreme stress, sadness, or
anxiety, they should speak with a therapist. (b) I would consider speaking to a therapist as
an option for me if I felt I wanted or needed it. (c) I believe that therapy is a common and
acceptable practice for anyone to use, including me. (d) If someone has mental health
issues, they could be cursed/ possessed by a supernatural power (a witch, bad spirit, or
the devil).
In order to determine if there was enough variation to answer question (a) what is
the relationship between the participants’ reported likelihood to seek services and their
reported levels of perceived barriers? The researcher performed frequency analyses on
each statement regarding likelihood to seek services. This was done to determine if there
was sufficient data to compare with the perceived barriers variables.
With response to the statement “If someone is experiencing extreme stress,
sadness, or anxiety, they should speak with a therapist,” 31 (93.9%) of the participants
answered agree and 1 (3%) participant answered disagree. In addition, 1 participant
chose to not answer this question (Table 2). When responding to the statement “I would
57
consider speaking to a therapist as an option for me if I felt I wanted or needed it,” 28
(84.8%) of participants answered agree and 4 (12.1%) answered disagree. 1 participant
chose not to answer this question (Table 3). With response to the statement “I believe
that therapy is a common and acceptable practice for anyone to use, including me,” 28
(84.8%) of participants answered agree and 4 (12.1%) answered disagree. In addition, 1
participant chose not to answer this question (Table 4). When responding to the
statement “If someone has mental health issues, they could be cursed/ possessed by a
supernatural power (a witch, bad spirit, or the devil),” 5 (15.2%) of the participants
agreed with the statement and 28 (84.8%) disagreed with the statement (Table 5).
Due to the majority of participants responding to the statements equally, and due
to participants choosing not to answer statements, this variable of seeking mental health
services does not provide enough variation for significant data. Chi-square tests did not
provide any statistical associations between seeking services and participants’ perceived
barriers. Therefore, question (a) was unable to be answered through this study.
Table 2
Emotions that Cause a Need to Seek Therapy
Frequency
Valid
Missing
Total
Agree
Disagree
Total
999
31
1
32
1
33
Percent
93.9
3.0
97.0
3.0
100.0
Valid Percent
96.9
3.1
100.0
Cumulative
Percent
96.9
100.0
58
Table 3
Would Consider Speaking to a Therapist
Frequency
Valid
Missing
Percent
Valid Percent
Agree
Disagree
28
4
84.8
12.1
87.5
12.5
Total
999
32
1
97.0
3.0
100.0
33
100.0
Total
Cumulative
Percent
87.5
100.0
Table 4
Accepts Therapy
Valid
Missing
Total
Agree
Disagree
Total
999
Frequency
28
4
32
1
33
Percent Valid Percent
84.8
87.5
12.1
12.5
97.0
100.0
3.0
100.0
Cumulative
Percent
87.5
100.0
Table 5
Mental Health Issues Caused By Supernatural
Frequency
Valid
Percent
Valid Percent
Agree
Disagree
5
28
15.2
84.8
15.2
84.8
Total
33
100.0
100.0
Cumulative
Percent
15.2
100.0
59
Dependent Variables
The dependent variables in this study were based upon potentially perceived
barriers to Mexican immigrant women seeking mental health services. These barriers are:
(a) the woman’s role in the Mexican culture, (b) the use of social support instead of
mental health services, (c) perceived discrimination in mental health services, (d)
perceived cultural competency in mental health practitioners, (e) level of understanding
of mental health, and (f) level of perceived stigma at micro, mezzo, and macro levels.
The level of perception on each of these variables was according to the
participant’s answer to 3 separate statements regarding each variable, with the exception
of “social support,” which consisted of only 2 statements. The participants, Mexican
immigrant women, were asked to rate their response to the statements on a scale ranging
from 1 strongly agree to 4 strongly disagree. To allow for significant statistical analysis,
these variables were re-coded into the two response categories: 1 agree which included
participants that answered with the original responses of “strongly agree” and “agree”
and 2 disagree which included participants that answered with the original responses of
“strongly disagree” and “disagree”. The exact statements for each dependent variable will
be presented with the corresponding correlation analysis between the perceived barrier
and the demographic characteristic. .
Discrimination. After performing a frequency count on the statements that
examined the dependent variable of discrimination in terms of gender, race, and
60
immigration status (Table 6, 7, and 8), it was determined that the majority of participants
responded to the statements equally. Therefore, this variable does not provide enough
variation for significant data and was not examined in correlation with the independent
variables. It is important to note, however, that out of the three statements relating to
discrimination, more women agreed to the notion that a Mexican would be treated
differently because of their race (11 women agreed), then a woman due to gender (4
women agreed), or an immigrant due to immigration status (7 agreed).
Table 6
Discrimination Due to Race
Valid
Agree
Disagree
Total
Frequency
11
22
33
Percent Valid Percent
33.3
33.3
66.7
66.7
100.0
100.0
Cumulative
Percent
33.3
100.0
Table 7
Discrimination Due to Gender
Valid
Agree
Disagree
Total
Frequency
4
29
33
Percent Valid Percent
12.1
12.1
87.9
100.0
87.9
100.0
Cumulative
Percent
12.1
100.0
61
Table 8
Discrimination Due to Immigration Status
Frequency
Valid
Agree
Disagree
Percent
Valid Percent
7
25
21.2
75.8
21.9
78.1
Total
Missing System
32
1
97.0
3.0
100.0
Total
33
100.0
Cumulative
Percent
21.9
100.0
Education Level and Perceptions of the Mexican Woman’s Role
The remainder of the analyses addresses question (b): How do the reported levels
of perceived barriers relate with the reported demographics of the participants?
Education and a Mexican woman’s emotions. This analysis compared the
reported level of education with the respondents’ agreement/disagreement with the
statement: “Mexican women must act strong and not show emotions.” Over threequarters (76.5%) of the respondents agreeing with this statement had less than a high
school education. Furthermore, nearly two-thirds (60%) of the participants that had
disagreed with this statement about Mexican women and showing emotion were high
school graduates or had some college education (Table 9). Chi-square testing indicated a
statistically significant association between these two variables (X²=4.394; df=1; p=.036).
62
Table 9
Education Level and Mexican Woman’s Emotions
Education Level
High School
Less than
Graduate or
High School Some College
Mexican
Woman’s
Emotions
Total
Agree
Total
Count
% within Emotions
13
76.5%
4
23.5%
17
100.0%
% within Education
% of Total
Disagree Count
% within Emotions
% within Education
% of Total
Count
% within Emotions
% within Education
% of Total
68.4%
40.6%
6
40.0%
31.6%
18.8%
19
59.4%
100.0%
59.4%
30.8%
12.5%
9
60.0%
69.2%
28.1%
13
40.6%
100.0%
40.6%
53.1%
53.1%
15
100.0%
46.9%
46.9%
32
100.0%
100.0%
100.0%
Education and a Mexican woman’s focus. This analysis compared the reported
level of education with the respondents’ agreement/disagreement with the statement: “A
Mexican woman should be more focused on her responsibilities in the home and
workplace and not take time to go to therapy.” More than four-fifths (81.8%) of the
respondents agreeing with this statement had less than a high school education. Over half
(52.4%) of the participants that disagreed with this statement about a Mexican woman’s
focus being in the home and workplace instead of therapy were high school graduates or
had some college education (Table 10). The Chi-square test was approaching significance
(p=.061); however, one cell had an expected count less than 5.
63
Table 10
Education Level and Mexican Woman’s Focus
Education Level
Less than
High School
Mexican Agree
Woman’s
Focus
Total
High School
Graduate or
Some College
Total
Count
% within Woman’s Focus
9
81.8%
2
11
18.2% 100.0%
% within Education
% of Total
Disagree Count
% within Woman’s Focus
% within Education
% of Total
Count
% within Woman’s Focus
47.4%
28.1%
10
47.6%
52.6%
31.3%
19
59.4%
15.4% 34.4%
6.3% 34.4%
11
21
52.4% 100.0%
84.6% 65.6%
34.4% 65.6%
13
32
40.6% 100.0%
100.0%
59.4%
100.0% 100.0%
40.6% 100.0%
% within Education
% of Total
Education and a Mexican woman asking husband/partner. This analysis
compared the reported level of education with the respondents’ agreement/disagreement
with the statement: “A Mexican woman should ask her husband/partner before talking to
a therapist.” Almost four-fifths (78.6%) of the respondents agreeing with this statement
had less than a high school education. Over half (55.6%) of the participants that disagreed
with the notion that a Mexican woman’s should ask their husband or partner before
speaking to a therapist were high school graduates or had some college education (Table
64
11). The Chi-square test revealed that the relationship between these two variables was
approaching significance (X²=3.802; df=1; p=.051).
Table 11
Education Level and Mexican Woman Asking Husband/Partner
Education Level
Mexican
Agree
Woman Asking
Husband/Partner
Count
% within Woman Ask
% within Education
% of Total
Disagree Count
% within Woman Ask
% within Education
% of Total
Total
Count
% within Woman Ask
% within Education
% of Total
Less than High School
High
Graduate or
School
Some College
11
3
78.6%
21.4%
57.9%
23.1%
34.4%
9.4%
8
10
44.4%
55.6%
42.1%
76.9%
25.0%
31.3%
19
59.4%
100.0%
59.4%
13
40.6%
100.0%
40.6%
Total
14
100.0%
43.8%
43.8%
18
100.0%
56.3%
56.3%
32
100.0%
100.0%
100.0%
Education Level and Understanding Mental Health
Education level and knowledge on location of services. This analysis compared
the reported level of education with the respondents’ agreement/disagreement with the
statement: “If someone asked me where they could find a therapist to talk to, I know
where I could send them.” Half (50%) of the respondents agreeing with this statement
were high school graduates or had some college. Four-fifths (80%) of the participants that
disagreed that they knew where to send someone to a therapist had less than a high school
65
education (Table 12). Chi-square testing indicated that there is no statistically significant
relationship between these two variables.
Table 12
Education Level and Where to Find Services
Education Level
Count
% within Services
% within Education Level
% of Total
Disagree Count
% within Services
% within Education Level
Less than
High School
11
50.0%
57.9%
34.4%
8
80.0%
42.1%
High School
Graduate or
Some
College
Total
11
22
50.0% 100.0%
84.6% 68.8%
34.4% 68.8%
2
10
20.0% 100.0%
15.4% 31.3%
% of Total
Count
% within Services
% within Education Level
% of Total
25.0%
19
59.4%
100.0%
59.4%
6.3% 31.3%
13
32
40.6% 100.0%
100.0% 100.0%
40.6% 100.0%
Where to Find Agree
Mental Health
Services
Total
Education level and knowledge of mental health symptoms. This analysis
compared the reported level of education with the respondents’ agreement/disagreement
with the statement: “I know what symptoms would describe or indicate a mental health
illness.” Two-fifths (40%) of the respondents agreeing with this statement were high
school graduates or had some college education. More than half (58.8%) of the
participants that disagreed that they knew would know which symptoms indicated mental
66
illness had less than a high school education (Table 13). Chi-square testing indicated that
there is no statistically significant relationship between these two variables.
Table 13
Education Level and Recognizes Symptoms of Mental Illness
Education Level
Recognizes
Agree
Symptoms of
Mental Illness
Total
Count
High School
Less than Graduate or
High
Some
School
College
9
6
Total
15
% within Symptoms
% within Education Level
% of Total
Disagree Count
% within Symptoms of
% within Education Level
% of Total
Count
60.0%
47.4%
28.1%
10
58.8%
52.6%
31.3%
19
40.0% 100.0%
46.2% 46.9%
18.8% 46.9%
7
17
41.2% 100.0%
53.8% 53.1%
21.9% 53.1%
13
32
% within Symptoms
% within Education Level
% of Total
59.4%
100.0%
59.4%
40.6% 100.0%
100.0% 100.0%
40.6% 100.0%
Education level and understanding of mental health disorders. This analysis
compared the reported level of education with the respondents’ agreement/disagreement
with the statement: “I have a clear understanding of mental health disorders.” Almost half
(43.8%) of the respondents agreeing with this statement were high school graduates or
had some college education. Almost two-thirds (62.5%) of the participants that disagreed
that they knew would know which symptoms indicated mental illness had less than a high
67
school education (Table 14). Chi-square testing indicated that there is no statistically
significant relationship between these two variables.
Table 14
Education Level and Understands Mental Health Disorders
Understands
Mental
Health
Disorders
Total
Agree
Count
% within Understands
% within Education Level
% of Total
Disagree Count
% within Understands
% within Education Level
% of Total
Count
% within Understands
% within Education Level
% of Total
Education Level
High School
Less than Graduate or
High
Some
School
College
9
7
Total
16
56.3%
47.4%
28.1%
10
62.5%
52.6%
43.8%
53.8%
21.9%
6
37.5%
46.2%
100.0%
50.0%
50.0%
16
100.0%
50.0%
31.3%
19
18.8%
13
50.0%
32
59.4%
100.0%
59.4%
40.6%
100.0%
40.6%
100.0%
100.0%
100.0%
Time in the U.S. and Perceived Stigma
Time in the U.S. and family accepts therapy. The variables that were examined
in this descriptive analysis were the reported amount of time the participant had been
living in the United States and the respondents’ agreement/disagreement to the statement:
“I believe that my family accepts therapy as a common and acceptable practice for
anyone to use, including me.” Over half (55.6%) of the participants agreeing that their
68
family accepted therapy had been living in the United States for over than 10 years. Twofifths (40% ) of those respondents that disagreed that their family viewed therapy as an
acceptable practice had been in the United States for under 10 years (Table 15). Chisquare testing between these variables did not result in any statistically significant
findings.
Table 15
Time Lived in the U.S. and Family Accepts Therapy
Family Accepts
Therapy
Agree
Disagree
Total
Time Lived In The U.S.
Less than 10 years or
10 years
more
Count
8
10
% within Family
44.4%
55.6%
% within Time In U.S.
57.1%
52.6%
% of Total
24.2%
30.3%
Count
6
9
% within Family
40.0%
60.0%
% within Time In U.S.
42.9%
47.4%
% of Total
18.2%
27.3%
Count
14
19
% within Family
42.4%
57.6%
% within Time In U.S.
100.0%
100.0%
% of Total
42.4%
Total
18
100.0%
54.5%
54.5%
15
100.0%
45.5%
45.5%
33
100.0%
100.0%
57.6% 100.0%
Time in the U.S. and boss accepts therapy. The variables that were examined in
this descriptive analysis were the reported amount of time the participant had been living
in the United States and the respondents’ agreement/disagreement to the statement: “I
believe that my boss accepts therapy as a common and acceptable practice for anyone to
69
use, including me.” Over two-thirds (70%) of the participants that agreed with the
statement that their boss viewed therapy as an acceptable practice had lived in the U.S.
for more than 10 years. Similarly, close to two-thirds (63.6%) of those that disagreed that
their boss accepts therapy had lived in the U.S. for less than 10 years (Table 16). The
Chi-square test was approaching significance (p=.069); however, one cell had an
expected count less than 5.
Table 16
Time Lived in the U.S. and Boss Accepts Therapy
Time Lived In The U.S.
Boss Accepts Agree
Therapy
Total
Count
% within Boss Accepts
% within Time In U.S.
% of Total
Disagree Count
% within Boss Accepts
% within Time In U.S.
% of Total
Count
% within Boss Accepts
% within Time In U.S.
% of Total
Less than 10 years or
10 years
more
6
14
30.0%
70.0%
46.2%
77.8%
19.4%
45.2%
7
4
63.6%
36.4%
53.8%
22.2%
22.6%
12.9%
13
18
Total
20
100.0%
64.5%
64.5%
11
100.0%
35.5%
35.5%
31
41.9%
100.0%
58.1%
100.0%
100.0%
100.0%
41.9%
58.1%
100.0%
Time lived in U.S. and friends accept therapy. The variables that were
examined in this descriptive analysis were the reported amount of time the participant
had been living in the United States and the respondents’ agreement/disagreement to the
70
statement: “I believe that my friends accept therapy as a common and acceptable practice
for anyone to use, including me.” Almost two-thirds (61.9%) of the participants agreeing
that their friends accepted therapy had been living in the United States for more than 10
years. Half (50% ) of those respondents that disagreed that their friends viewed therapy
as an acceptable practice had been in the United States for less than 10 years (Table 17).
Chi-square testing between these variables did not result in any statistically significant
findings.
Table 17
Time Lived in the U.S. and Friends Accept Therapy
Time Lived In The U.S.
Less than 10 years or
10 years
more
Friends Accept Agree
Count
8
13
Therapy
% within Friends
38.1%
61.9%
% within Time In U.S.
57.1%
68.4%
% of Total
24.2%
39.4%
Disagree Count
6
6
% within Friends
50.0%
50.0%
% within Time In U.S.
42.9%
31.6%
% of Total
18.2%
18.2%
Total
Count
14
19
% within Friends
42.4%
57.6%
% within Time In U.S.
100.0%
100.0%
% of Total
42.4%
Total
21
100.0%
63.6%
63.6%
12
100.0%
36.4%
36.4%
33
100.0%
100.0%
57.6% 100.0%
71
Time in the U.S. and Perceived Cultural Competency
Time in the U.S. and therapists speak Spanish. The variables that were
examined in this descriptive analysis were the reported amount of time the participant
had been living in the United States and the respondents’ agreement/disagreement to the
statement “There are many therapists in the community that speak Spanish.” Over half
(55.6%) of the participants agreeing that there are therapists in the community that speak
Spanish had been living in the United States for less than 10 years. Almost three-fourths
(73.3%) of those respondents that disagreed with this notion had been in the United
States for over 10 years (Table 18). Chi-square testing between these variables did not
result in any statistically significant findings.
72
Table 18
Time Lived in the U.S and Therapists Speak Spanish
Time Lived In The U.S.
Therapists That Agree
Speak Spanish
Total
Count
Less than 10 years or
10 years
more
10
8
Total
18
% within Therapists
% within Time In U.S.
55.6%
71.4%
44.4%
42.1%
100.0%
54.5%
% of Total
Disagree Count
% within Therapists
% within Time In U.S.
% of Total
Count
% within Therapists
% within Time In U.S.
% of Total
30.3%
4
26.7%
28.6%
12.1%
14
42.4%
100.0%
42.4%
24.2%
11
73.3%
57.9%
33.3%
19
57.6%
100.0%
57.6%
54.5%
15
100.0%
45.5%
45.5%
33
100.0%
100.0%
100.0%
Time in the U.S. and therapists understand religion. This analysis compared
the amount of time the participant reported living in the United States with the
respondents’ agreement/disagreement with the statement: “In my community, there are
therapists that understand my religion and how it relates with the Mexican culture.” More
than half (55.6%) of the respondents agreeing with this statement had lived in the United
States less than 10 years. Over three-fifths (69.2%) of the participants disagreeing with
this statement regarding therapists understanding religion had been living in the United
States for more than 10 years (Table 10). Chi-square analysis found no statistically
significant findings.
73
Table 19
Time Lived in the U.S. and Therapists Understand Religion
Therapists That
Understand
Religion and
Mexican Culture
Total
Time Lived In The
U.S.
Less than 10 years
10 years or more
Agree
Count
10
8
% within Therapists
55.6%
44.4%
% within Time In U.S.
71.4%
47.1%
% of Total
32.3%
25.8%
Disagree Count
4
9
% within Therapists
30.8%
69.2%
% within Time In U.S.
28.6%
52.9%
% of Total
12.9%
29.0%
Count
14
17
% within Therapists
45.2%
54.8%
% within Time In U.S.
100.0% 100.0%
% of Total
45.2%
54.8%
Total
18
100.0%
58.1%
58.1%
13
100.0%
41.9%
41.9%
31
100.0%
100.0%
100.0%
Time in the U.S. and therapists understand the woman’s role. This analysis
compared the amount of time the participant reported living in the United States with the
respondents’ agreement/disagreement with the statement: “In my community, there are
therapists that understand the role and responsibilities of a woman in the Mexican
culture.” More than half (57.1%) of the respondents agreeing with this statement had
lived in the United States less than 10 years. Nearly four-fifths (83.3%) of the participants
disagreeing with this statement regarding therapists understanding the woman’s role had
been living in the United States for more than 10 years (Table 20). The Chi-square test
74
revealed that there was a statistically significant association between these two variables
(X²=5.122; df=1; p=.024).
Table 20
Time Lived in the U.S. and Therapists Understand Role
Time Lived in the U.S.
Therapists Agree
Understand
Role
Disagree
Total
Count
% within Therapists
% within Time in U.S.
% of Total
Count
% within Therapists
% within Time in U.S.
% of Total
Count
% within Therapists
% within Time in U.S.
% of Total
Less than 10
10 years or
years
more
12
9
57.1%
42.9%
85.7%
47.4%
36.4%
27.3%
2
10
16.7%
83.3%
14.3%
52.6%
6.1%
30.3%
14
19
42.4%
100.0%
42.4%
57.6%
100.0%
57.6%
Total
21
100.0%
63.6%
63.6%
12
100.0%
36.4%
36.4%
33
100.0%
100.0%
100.0%
Level of English and Woman’s Role in the Mexican Culture
Level of English and Mexican woman’s emotions. This analysis compared the
respondents’ reported level of spoken English with the respondents’
agreement/disagreement with the statement: “A Mexican woman must always act strong
and not show emotions.” Almost three-fifths (58.8%) of the respondents agreeing with
this statement spoke no English. Exactly three-fourths (75%) of the participants
disagreeing with this statement spoke some English or more (Table 21). The Chi-square
75
test revealed that there was a statistically significant association between these two
variables (X²=3.860; df=1; p=.049). One cell had an expected count of less than 5.
Table 21
Level of English and Mexican Woman’s Emotions
Level of Spoken English
Mexican Woman's
Emotions
Agree
Count
% within Emotions
% within English Level
7
Total
17
58.8%
71.4%
41.2% 100.0%
36.8% 51.5%
30.3%
4
21.2%
12
% within Emotions
% within English Level
25.0%
28.6%
75.0% 100.0%
63.2% 48.5%
% of Total
Count
12.1%
14
36.4%
19
% of Total
Disagree Count
Total
No English
10
Some
English or
More
% within Emotions
% within English Level
% of Total
42.4%
100.0%
42.4%
51.5%
16
48.5%
33
57.6% 100.0%
100.0% 100.0%
57.6% 100.0%
Level of English and Mexican woman’s focus. This analysis compared the
respondents’ reported level of spoken English with the respondents’
agreement/disagreement with the statement: “A Mexican woman should be more focused
on her responsibilities in the home and workplace and not take time to go to therapy.”
Almost three-fourths (72.7%) of the respondents agreeing with this statement spoke no
English. Similarly, nearly three-fourths (72.7%) of the participants disagreeing with this
76
statement spoke some English or more (Table 22). The Chi-square test revealed that there
was a statistically significant association between these two variables (X²=6.203; df=1;
p=.013). One cell had an expected count of less than 5.
Table 22
Level of English and Mexican Woman’s Focus
Level of Spoken
English
Mexican
Woman's Focus
Total
Agree
Count
Some
No
English or
English
More
8
3
Total
11
% within Woman's Focus
% within Level of English
% of Total
72.7%
57.1%
24.2%
27.3%
15.8%
9.1%
100.0%
33.3%
33.3%
Disagree Count
% within Woman's Focus
% within Level of English
% of Total
Count
6
27.3%
42.9%
18.2%
14
16
72.7%
84.2%
48.5%
19
22
100.0%
66.7%
66.7%
33
% within Woman's Focus
% within Level of English
% of Total
42.4%
100.0%
42.4%
57.6%
100.0%
57.6%
100.0%
100.0%
100.0%
Level of English and Mexican woman asking husband/partner. This analysis
compared the respondents’ reported level of speaking English with the respondents’
agreement/disagreement with the statement: “A Mexican woman should ask her
husband/partner before talking to a therapist.” Almost two-thirds (64.3%) of the
77
respondents agreeing with this statement spoke no English. Nearly four-fifths (73.7%) of
the participants disagreeing with this statement spoke some English or more (Table 23).
The Chi-square test revealed that there was a statistically significant association between
these two variables (X²=4.758; df=1; p=.029).
Table 23
Level of English and Mexican Woman Asking Husband/Partner
Level of Spoken
English
No
English
Mexican Woman Agree
Asking
Husband/Partner
Total
Count
% within Woman Ask
% within Level of English
% of Total
Disagree Count
% within Woman Ask
% within Level of English
% of Total
Count
9
64.3%
64.3%
27.3%
5
26.3%
35.7%
15.2%
14
% within Woman Ask
% within Level of English
% of Total
42.4%
100.0%
42.4%
Some
English or
More
5
35.7%
26.3%
15.2%
14
73.7%
73.7%
42.4%
19
Total
14
100.0%
42.4%
42.4%
19
100.0%
57.6%
57.6%
33
57.6% 100.0%
100.0% 100.0%
57.6% 100.0%
Level of English and Perceived Stigma
Level of English and family accepts therapy. This analysis compared the
respondents’ reported level of speaking English with the respondents’
agreement/disagreement with the statement: “I believe that my family accepts therapy as
78
a common and acceptable practice for anyone to use, including me.” Over three-fifths
(61.1%) of the respondents agreeing with this statement spoke no English. Exactly fourfifths (80%) of the participants disagreeing with this statement spoke some English or
more (Table 24). The Chi-square test revealed that there was a statistically significant
association between the level of English the participant spoke and whether they believed
their family accepts therapy (X²=5.661; df=1; p=.017).
Table 24
Level of English and Family Accepts Therapy
Family Accepts Agree
Therapy
Total
Count
Level of Spoken English
Some
No
English or
English
More
11
7
Total
18
% within Family Accepts
% within Level of English
% of Total
Disagree Count
% within Family Accepts
% within Level of English
% of Total
Count
61.1%
78.6%
33.3%
3
20.0%
21.4%
9.1%
14
38.9% 100.0%
36.8% 54.5%
21.2% 54.5%
12
15
80.0% 100.0%
63.2% 45.5%
36.4% 45.5%
19
33
% within Family Accepts
% within Level of English
% of Total
42.4%
100.0%
42.4%
57.6% 100.0%
100.0% 100.0%
57.6% 100.0%
Level of English and boss accepts therapy. This analysis compared the level of
English the participant reported speaking with the respondents’ agreement/disagreement
with the statement: “I believe that my boss accepts therapy as a common and acceptable
79
practice for anyone to use, including me.” More than half (55%) of the respondents
agreeing with this statement spoke no English. Just over four-fifths (81.8%) of the
participants disagreeing with this statement regarding their boss accepting therapy spoke
some English or more (Table 25). The Chi-square test revealed that there was a
statistically significant association between the amount of English the participant spoke
and whether they believed their boss accepted therapy (X²=3.951; df=1; p=.047). One
cell had an expected count less than 5.
Table 25
Level of English and Boss Accepts Therapy
Boss Accepts Agree
Therapy
Count
% within Boss Accepts
% within Level of English
% of Total
Disagree Count
% within Boss Accepts
% within Level of English
Total
% of Total
Count
% within Boss Accepts
% within Level of English
% of Total
Level of Spoken English
Some
English or
No English
More
11
9
Total
20
55.0%
84.6%
45.0% 100.0%
50.0% 64.5%
35.5%
2
29.0%
9
18.2%
15.4%
81.8% 100.0%
50.0% 35.5%
6.5%
13
29.0%
18
64.5%
11
35.5%
31
41.9%
58.1% 100.0%
100.0%
41.9%
100.0% 100.0%
58.1% 100.0%
Level of English and friends accept therapy. This analysis compared the level
of English the participant reported speaking with the respondents’
80
agreement/disagreement with the statement: “I believe that my friends accept therapy as a
common and acceptable practice for anyone to use, including me.” More than half
(52.4%) of the respondents agreeing with this statement spoke no English. Three-fourths
(75%) of the participants disagreeing with this statement regarding their friends accepting
therapy spoke some English or more (Table 26). The Chi-square test revealed no
significance between the respondent’s level of English and beliefs about participants’
friends accepting therapy.
Table 26
Level of English and Friends Accept Therapy
Friends Accept Agree
Therapy
Total
Count
% within Friends Accept
% within Level of English
% of Total
Disagree Count
% within Friends Accept
% within Level of English
% of Total
Count
Level of Spoken English
Some
English or
No English
More
11
10
Total
21
52.4%
78.6%
33.3%
3
25.0%
21.4%
9.1%
14
47.6% 100.0%
52.6% 63.6%
30.3% 63.6%
9
12
75.0% 100.0%
47.4% 36.4%
27.3% 36.4%
19
33
% within Friends Accept
42.4%
57.6% 100.0%
% within Level of English
% of Total
100.0%
42.4%
100.0% 100.0%
57.6% 100.0%
81
Summary
This chapter reviewed the research question and examined the results of the study
on Mexican immigrant women and their perceptions of mental health services. The
independent variables were explained through an examination of frequency distributions.
The dependent variables likelihood of seeking services and discrimination were examined
through frequency distributions. The re-coding of any measurement of variables was
discussed. The survey responses to the demographic characteristics (independent
variables) were analyzed in comparison with the dependent variables to explore
statistically meaningful relationships and these significant interactions were presented.
The next chapter will discuss these results in-depth and in relation to former and future
research.
82
Chapter 5
DISCUSSION
Introduction
This chapter will summarize the most important findings discovered in the study,
particularly those that were statistically significant and those that approached
significance. Following this summary, a comprehensive discussion will compare these
results with prior research that has been presented similar or contradictory findings.
Limitations of the study will be addressed, and implications of the findings will be
discussed at micro, mezzo, and macro levels of social work practice. The chapter will
conclude with recommendations for further research, and a concluding summary.
Summary
Current research contains little information on the perceived barriers and the
demographic characteristics that exert the most influence over Mexican immigrant
women when seeking mental health services. This study’s purpose was to increase this
knowledge by exploring which of the factors reviewed in the literature are statistically
influenced by which demographic characteristics. There were three independent variables
(demographics) and three dependent variables (barriers) with strong statistical
significance relationships. The major independent variables were: (a) level of English; (b)
time lived in the United States; and (c) level of education. The significant dependent
variables were: (a) beliefs about the woman’s role; (b) perceived social stigma; and (c)
perceived cultural competence of mental health practitioners.
83
The relationship between the level of English spoken and beliefs regarding the
woman’s role had some of the highest significance. Not surprisingly, those that reported
speaking more English also reported that they did not agree with aspects of traditional
Mexican gender roles. This is congruent with the findings that one of the factors that may
indicate acculturation level and the adaptation of Westernized gender roles is language
(Alegria et al., 2002; Folsom et al. 2007).
Another high statistical relationship was the participant’s level of English and their
perception of social stigma regarding mental health services. These findings were similar
to previous findings, as even those that reported speaking more English reported
perceiving social stigma associated with mental health services. This relates to the study
by Lagomasino et al. (2005) where social stigma was one of the main barriers identified
as causing a Latino group to be less than half as likely to seek services as Caucasians, not
necessarily based on language level. It does not explain, however, why those that
reported speaking no English also reported high levels of agreement that their family and
boss accepted therapy, as this result was unexpected.
Another relationship that was discovered was between amount of time in the United
States and the participant’s perceptions that there are therapists in the community that
understand the role of the woman in the Mexican culture. The participants in this study
highly disagreed that there was culturally competent services, even though they had lived
in the U.S. more than 10 years. This is similar to the study by Kanel (2002) who found
that a combined group of acculturated college students and recent immigrant low-skilled
84
workers both believed that there was a lack of culturally sensitive services in the
community. This confirms the idea that the more time spent in the U.S. does not result in
a higher belief of competent services. It does not explain, however, why those that had
lived in the U.S. less than 10 years agreed so greatly that culturally sensitive services
exist in the community.
Lastly, a relationship was established between the education level of participants
and their beliefs regarding the woman’s roles in the Mexican culture. This confirmed the
researcher’s suspicions that those that had a lower education level reported agreeing with
aspects of the traditional female role in the culture. One of the aspects, the woman’s
emotions, was statistically significant when related to education level, while the other two
aspects were approaching statistical significance. This relationship has not been explored
by former research.
Discussion
This study was initiated to explore the perceived barriers of Mexican immigrant
women as they relate to their particular demographic characteristics. This researcher
looked at a variety of identified barriers and demographics to determine if there was any
relationship between these perceptions and a specific set of demographic attributes.
Age and response rate. Of the 51 women asked to participate in the survey
questionnaire, more than half (64%) of the participants completed the survey. Of those
33 female participants, more than half (60.6%) were over the age of 35 years. Both of
these results were surprising to the researcher, as this result is opposite of what Dreby
85
(2006) experienced when asking a similar population to be involved in a study. Instead
of openly participating, those asked responded in fear and refusal, stating that talking
about private matters should not occur with people outside of family or close friends.
This researcher, therefore, expected less women to participate altogether, and of those
that participated to be in the younger age category. This was based on the researcher’s
own assumption that younger adults would acculturate more quickly into a Westernized
culture and not hold on to traditional ideology, such as the previously mentioned notion
about private matters staying in the family.
Similar responses to demographics. Several of the demographic questions were
answered so similarly by participants that valid data was unable to be extracted by
comparing to other variables. Among these similarities were income level, geographic
area of origin in Mexico, relationship status, and religion. The income level of most
participants was less than $20,000 annually. This was congruent with previous studies
that cited low income level (and often lack of health insurance) as being common barriers
to mental health services among this population (Alegria et al., 2002; Cabassa, 2007;
Shattel et al., 2008). The geographical area of origin of over half of the participants was a
“pueblo” or rural area in Mexico. This was interesting information, as this researcher
found no previous studies that analyzed this specific variable within their participants.
Further research on a larger scale is needed to determine to what level this variable truly
influences this population. In terms of relationship status, a slight majority of respondents
were married or in a partnership. This was another variable that very few studies included
86
as a component in their study, with the exception of Kanel (2002) who did include this as
a barrier for Latinos in seeking mental health services. Finally, almost all of the
participants (90.9%) reported that they were members of the Catholic faith. This result
was expected, as religion was a variable cited in several research studies as being an
important element in the Mexican culture (Falicov, 2009; Jurkowski et al., 2010)
especially the Catholic religion, as it influences the woman’s role in this culture and
encourages them to pattern themselves after the Virgin Guadalupe (Dreby, 2006).
Cultural competency in mental health practitioners. These questionnaire items
were included based on the assertion by Wing Sue and Sue (2008) that mental health
practice usually is not culturally sensitive to others except for those who are Caucasian
with a middle-class income level. This study attempted to discover the perceptions of
Mexican immigrant women regarding culturally based services, and also tie in any
specific demographic characteristic. Surprisingly, the only variable connected was the
amount of time the participant had lived in the U.S., and only one of the three questions
was statistically significant. The significant question was regarding the cultural
competency of therapists in understanding the role of the woman in the Mexican culture.
The results found were that those that had lived in the U.S. more than ten years disagreed
that there were therapists that understood the woman’s role in the Mexican culture. While
the other two questions were not statistically significant, they produced similar results
among participants. This suggests that this population’s knowledge concerning services
increases as they continue to live in the United States, and that this understanding is that
87
there are not culturally competent services available for this population. This is congruent
with previous studies that pronounce a deficit in culturally competent services (Derose &
Baker, 2000; Dobalian & Rivers, 2008; Kanel, 2002; Lagomasino et al., 2005; Sisneros &
Alter, 2009; Suarez, 2000).
Social stigma of mental health services. This variable sought to explore the
ideology that traditional Mexican culture looks to supernatural or other folktale
explanation to describe any health or mental health difficulties that a person may be
experiencing (Castro, 2001; Loue, 1999). Most often, these explanations have been
known to be related to witchcraft, bad or evil spirits, and other undesirable experiences
and can cast the same undesirable stigma from others onto the person experiencing them
(Falicov, 2009; Trotter & Chavira, 1997). This stigmatic ideology surrounding mental
health may equate to an increased likelihood that an individual in this culture would
avoid mental health services and would assume that their family is disapproving of such
services. The results of this study indicate, however, that this is not necessarily the case.
A statistical relationship was established between those that spoke less English agreeing
that their boss and family would consider therapy as acceptable. There was no significant
relationship between level of English and friends considering therapy as acceptable.
These results were opposite of what the researcher expected. Since language is often
associated with acculturation level (Alegria et al., 2002; Folsom et al., 2007), it would be
natural to assume that those who spoke less English were less acculturated and held more
traditional Mexican views.
88
Perceptions of the Mexican woman’s role. A significant portion of the
statistically significant results in this study were associated with the perceptions of the
woman’s role in the Mexican culture. The questions regarding this role were based off of
previous studies that described the woman’s role as being submissive (Galanti, 2003),
emotion-less (Villegas et al., 2010) self-sacrificing (Wilson, 2003) and subservient to the
husband (Gonzales-Guarda et al., 2009). This role may be an obstacle to mental health
services, as it would require these women to seek help for themselves, obtain permission
from their husbands, and express emotions in therapy. This not only takes time away
from home and family responsibilities, but it would not be in line with the qualities of a
good Mexican wife. The questions in the survey questionnaire sought to explore which
participants agreed with aspects to this traditional role. There was a statistically
significant relationship between the level of English the participant spoke and whether
they agreed with these aspects. Those that spoke no English agreed more that a Mexican
woman should not show emotions, should not take time away from responsibilities to
attend therapy, and should ask their husbands/partners first before seeking therapy.
Likewise, a statistical relationship was established between the level of education the
respondent had and their acceptance of the notion that a Mexican woman should not
show emotion. Additionally, the other two questions regarding the woman’s role were
approaching significance when compared with the level of education. Just as with the
level of English variable, respondents with less education agreed more with these aspects
of the traditional role. These results lend new information and insight to research, as no
89
prior research was found that connected these demographic variables to these perceptions
of the Mexican woman’s role.
Limitations
This study was limited in that the amount of participants was very small.
Therefore, generalizations about this population cannot be made due to such a small
representation. Additionally, those respondents that participated were located in a facility
that offers mental health services and other community-based services. While the
participants themselves were not attending these services, they were participating in a
recreational support group in these facilities. This would indicate that these respondents
were individuals that were already open to seeking support and help outside the realms of
their own home. Due to the presence of some hesitancy by the subjects to participate this
study and outright refusal from other invited persons, this researcher speculates that the
response rate may have been even lower had the study been performed in the general
community instead of a place where participants already felt a level of trust and comfort.
This study is also limited by its specific focus on Mexican immigrant women.
Research has indicated that the perceptions and struggles experienced with obtaining
mental health services in the United States occur across most races and ethnicities. This
study would need to be replicated among other individuals of other races, countries of
origin, and gender in order to increase its external validity. Such a focus on other
immigrant, racial, or gender groups was not studied in-depth in the duration of this study.
Additionally, this study has the potential to be limited due to the researcher’s
90
differing culture and race. As the researcher is a Caucasian American, research
participants may have felt unprecedented pressure to answer the research questionnaire
based on their interpretation of how the researcher would want them to answer. This
pressure could be supposed out of fear of being judged by the researcher, and may have
skewed the study results.
Lastly, this study is limited by its focus on American expressions of mental
health. This study might have very different results if carried out in another country, such
as Mexico. The perceptions of mental health services that Mexican immigrant women in
other countries experience were also not addressed.
Implications for Social Work Practice and Policy
The results of this study have important implications at the micro, mezzo, and
macro levels of social work practice. At a micro level, social workers can utilize the
results of the study to approach clients that are Mexican immigrant women with an
understanding of their culture and perceptions towards mental health. Specifically, the
results of this study indicate that such clients may need to be educated on the causes of
mental health issues, and speak with a culturally competent mental health professional
that will be able to speak their preferred language and understand their culture.
Additionally, social workers should encourage empowerment and use personal narrative
techniques to promote these clients to seek services if they need/want them regardless of
fear of social stigma, discrimination, or disapproval of family or friends.
91
At a mezzo level of practice, social workers can learn from this study that
education level, English language level, and the amount of time in the U.S. have relate to
their perceptions that Mexican immigrant women have regarding barriers to mental
health services. These were variables that particularly related to these women retaining
the traditional role of Mexican immigrant women. This role can have a big influence on
whether these individuals would ever seek services, regardless of necessity. Assisting a
client in recognizing any oppressive aspects to this role, and then navigating into new
roles as a woman in her culture could influence their family and community positively.
Additionally, interested social workers may find it useful to be involved in efforts to
decrease other barriers in the community (such as community social stigma).
Within a macro level of social work practice, this study emphasizes the need for
increased awareness within the social work community of the existing barriers to this
population. Such awareness will become increasingly important as more Mexican
immigrant women enter the United States and need mental health assistance. More
importantly, this study stresses the deficit of culturally competent services that are
available to this population. This information could be used to gain more culturally
sensitive services in the social work community and mental health agencies, in a variety
of aspects, not just language, but also in religion, immigration experience, and cultural
gender roles as well.
92
Recommendations
For continued research in this area, this researcher suggests several ideas that
could allow practitioners more success in helping this specific population gain mental
health services.

An important addition to the research would be a large-scale study that involves
more participants from throughout the community and with different experiences.
This would provide a more accurate representation of this population.

A research project focusing solely on the likelihood of Mexican women to obtain
services would be a beneficial addition to existing research, especially since the
sample size in this study was too small to measure this aspect.

Another helpful research approach might be to interview Mexican immigrant
women on an individual basis, so as to get a narrative version of their experiences
with barriers to mental health services and their perceptions. This would also
reduce the likelihood of these participants to share opinions and perspectives with
one another during the survey process, thereby eliminating the chance that they
might answer the questions similarly.

A variable addressed in this study that could be addressed more effectively in
future research is the variable of perceived discrimination. Even though three
separate aspects of discrimination were introduced in this study, not all of them
were viewed by the participants as being equally experienced. A more
comprehensive, in-depth study regarding race versus gender and immigration
93
status in the discrimination realm would help explore as to the reasoning behind
these perceptions.

Finally, an additional variable addressed in this study that could be enhanced by
future research is the variable of the level of understanding this population has
concerning mental health symptoms, services, and location of services. A study
that analyzed these things would further enlighten social workers as to the deficit
that this population may be experiencing. This in turn could encourage free public
psycho-educational courses that could educate the community on this subject.
Conclusion
The perception of mental health services that Mexican immigrant women have is
an important topic for social work practitioners. In spite of ever-increasing numbers of
Mexican immigrants who are moving into the United States, a limited amount of research
about women in this population and mental health services exists. The purpose of this
study was to increase this knowledge base and provide practical suggestions for social
workers who are working with Mexican immigrant women. Findings from this study
suggest that several factors can influence the perceptions of mental health services that
these women have. These factors are: 1) their education level, 2) their level of speaking
English, and 3) the amount of time they have lived in the United States. These factors
need to be taken into consideration when referring these clients to services, and should be
understood when administering such services to these clients.
94
The limitations of this study included that there was a small sample size of the
population and that these participants were located in a facility that offered mental health
services. The study was limited as it focused so specifically on Mexican immigrant
women and did not cover the aspects of other immigrants in different races or of a
different gender. The participants that responded in this study may have been influenced
by the fact that the researcher was an American Caucasian, and that the study was carried
out under the expressions of American mental health and its meanings. Had the study
been performed under other circumstances, the results may have been different.
Further study should include exploring these variables with a larger percentage of
this population, and encompassing individuals from throughout the community, and not
just located in one place. A more individual form of gathering information from
participants may be beneficial, such as interviewing one on one using narrative. Future
studies could also include the perspectives of Mexican immigrant women who are
obtaining mental health services and who may have done so against the desires of family
and friends.
Because Mexican immigrant women is one of the fastest growing populations in
California and in the United States, social workers need to inform themselves of the
dynamics involved in obtaining mental health services for this population. Failure to
understand the process and difficulties involved may result in being unprepared to offer
culturally adequate assistance to these clients. The findings of this study need to be
utilized to stimulate more extensive research and distribution of research findings to the
95
field of social work and mental health professionals. Additional research in this area will
assist social workers in helping to dissolve barriers and obstacles that this population
faces in seeking services, as well as having a comprehensive knowledge of their
perceptions and understanding of mental health.
96
APPENDICES
97
APPENDIX A
Consent to Participate in a Study
Purpose
You have been invited to participate in a study conducted by Jana Delgado-Jiménez, a
graduate student seeking a Master’s degree in Social Work at the Division of Social
Work, California State University, Sacramento. The purpose of this study is to investigate
the knowledge level surrounding the perceptions immigrant women from Mexico have
regarding barriers to utilizing mental health services.
Procedures
If you choose to participate in this study, you will be given a survey to complete. This
survey contains a series of questions with multiple choice answers, and also statements to
which you will circle your level of agreement or disagreement. This survey should take
approximately 10-15 minutes to complete. The survey is confidential and will not ask for
your name. At any time you may choose to not answer any specific question(s) or stop
taking the survey altogether.
Risks
There are very low risks associated with this study. The only risks that may be
experienced are recollecting experiences and memories from your life. A list will be
provided of resources in your community (free of charge) that you may contact and
utilize in case any recollection of experiences makes you feel uncomfortable.
Participating or not participating in this survey will have no effect on your eligibility for
services at Dixon Family Services or Yolo Family Resource Center, or any other agency.
Confidentiality
All of the results obtained in this study will remain confidential. All information received
will be maintained in a locked file. Only the aforementioned researcher and project
faculty advisor (Maria Dinis) will have access to these files. All papers and documents
involved in the study will be destroyed immediately after the completion of the study,
which is expected by June of 2011.
Questions or Concerns
If you have any questions, please contact Jana Delgado Jiménez at (xxx) xxx-xxxx. You
may also contact my thesis advisor for this project, Maria Dinis, Ph.D., MSW, at (916)
278-7161.
98
Participation
Your participation in this study is completely voluntary. You are free to decide to
participate or stop at any time. In any moment, you may skip questions, not answer any
particular question that makes you feel uncomfortable, or stop participating altogether.
By signing below, you understand the risks associated with this study and agree to
participate. Your participation in this study will give social workers a better
understanding of the knowledge regarding mental health and mental health service
utilization among the Mexican population. Thank you for your participation in this study.
I consent to participate in this study:
____________________________
_______/_______/_______
Signature of the participant
Date
The following is a list of resources available to you free of charge. Each agency provides
a wide array of services for individuals or families. For example, these services include
support groups, mental health counseling, and food programs. These agencies provide
Spanish speaking services.
Yolo Family Resource Center
828 Court St.
Woodland, CA 95695
(530) 406-7221
Dixon Family Services
155 N. 2nd Street
Dixon, CA 95620
(707) 678-0442
City of Vacaville: Family Services
1000 Ulatis Dr.
Vacaville, CA 95687
(707) 469-6600
99
APPENDIX B
Consentimiento Para Participar en un Estudio
Propósito
Usted ha sido invitada para participar en un estudio conducido por Jana Delgado Jiménez,
quien es estudiante licenciada obteniendo su maestría de trabajo social en la División de
Trabajo Social de la Universidad del Estado de California, Sacramento. El propósito de
este estudio es para investigar el nivel de conocimiento sobre las percepciones mujeres
que son inmigrantes de México tienen sobre los obstáculos en usando servicios de salud
mental.
Procedimiento
Si usted decide participar en este estudio, recibirá una encuesta para cumplir. Esta
encuesta contiene una serie de preguntas. Cada pregunta tiene varias respuestas de las
cuales debe escoger la que más aplica a usted. También hay frases de las cuales usted va
a escoger su nivel de ser de acuerdo o desacuerdo y poner un círculo alrededor de su
respuesta. Esta encuesta debe tomar aproximadamente 10-15 minutos para cumplir.
Esta encuesta es confidencial y no preguntará por su nombre. En cualquier momento
usted puede decidir no contestar alguna(s) pregunta(s) o parar de contestar
completamente.
Riesgos
Hay muy pocos riesgos asociados con este estudio. Los únicos riesgos que posiblemente
se experimenten son los que le haga recordar las memorias y experiencias que ha vivido.
Se le va a proveer una lista de recursos en su comunidad (que son gratis) a los cuales
usted puede recurrir y utilizar en caso de cualquier recuerdo de experiencias le haga sentir
incómoda.
Confidencialidad
Todos los resultados obtenidos en este estudio permanecerán confidenciales. Toda
información obtenida se mantendrá en un archivo que permanecerá bajo llave. Solo la
persona nombrada arriba y aconsejadora del proyecto (María Dinis) tendrán acceso a esta
información. Al final del estudio, todos los papeles obtenidos serán destruidos. El tiempo
esperado de cual esto va a suceder será en el fin de Junio, 2011.
Preguntas o Preocupaciones
Si usted tiene alguna pregunta favor de ponerse en contacto con Jana Delgado Jiménez
por teléfono (xxx) xxx-xxxx. Usted también puede ponerse en contacto con mi
aconsejadora de este proyecto, María Dinis, Ph.D., MSW, por (916) 278-7161.
100
Participación
Su participación en este estudio es completamente voluntaria. Usted es libre de decidir
participar o parar en cualquier tiempo. En cualquier momento, usted puede pasar
preguntas, no contestar una cuestión en particular que le hace sentir incomoda, o dejar de
participar en este estudio. Al firmar abajo, usted entiende los riesgos asociados con este
estudio y está de acuerdo en participar. Su participación en este estudio dará a las
trabajadoras sociales un mejor entendimiento del conocimiento de salud mental y
utilización de servicios de salud mental entre la población Mexicana.
Gracias por su participación en este estudio que será de mucha utilidad para el propósito.
Yo consiento participar en este estudio:
____________________________
Firma del participante
_______/_______/_______
Fecha
Lo siguiente es una lista de servicios que son gratis y disponibles para ayudar. Cada
agencia tiene varios servicios para ayudar individuales o familias. Por ejemplo, estos
servicios incluyen grupos de apoyo, conseguimiento de salud mental, y programas de
comida. Estas agencias ofrecen servicios en español.
Yolo Family Resource Center
828 Court St.
Woodland, CA 95695
(530) 406-7221
Dixon Family Services
155 N. 2nd Street
Dixon, CA 95620
(707) 678-0442
City of Vacaville: Family Services
1000 Ulatis Dr.
Vacaville, CA 95687
(707) 469-6600
101
APPENDIX C
Perceptions of Mental Health Services: A Survey
The first set of questions asks you some information about your demographic
background. Please circle the answer that most appropriately applies to you.
If you would like more clarity on any question, the researcher is available to assist
you.
A. What is your age?
1. 18-34 years
2. 35+ years
B. How would you describe your current relationship status?
1. Single
2. Married/Partnership
3. Widow
4. Separated
5. Divorced
C. What is your religion?
1. Catholic
2. Non-Catholic Christian
3. Atheist/Agnostic
4. Other: Please describe ___________________
102
D. What is your highest level of education completed?
1. No education
2. Less than High School
3. High School Graduate
4. Some College
5. Other: Please describe ___________________
E. What best describes the area of Mexico that you lived in?
1. Rural
2. Suburbs
3. City
F. How long have you been in the United States?
1. 5 years or less
2. 10 years or less
3. More than 10 years
G. How much English do you speak?
1. Not much English at all
2. Some English
3. A lot of English
4. English mixed with Spanish
103
H. What is your annual household income?
1. Less than $20,000
2. $20,000 or more
The next series of questions asks for your level of agreement/disagreement. Please
circle your answer based on the scale provided with each statement. If you would
like more clarity on any statement, the researcher is available to assist you.
I. A Mexican woman must always act strong and not show emotions.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
J. A Mexican woman should be more focused on her responsibilities in the home and
workplace and not take time to go to therapy.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
K. A Mexican woman should talk about family problems to people outside of the family.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
L. A Mexican woman should ask her husband/partner before talking to a therapist.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
104
M. A Mexican woman experiencing problems should talk to a leader in her church or a
leader in her community first, before talking to a therapist.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
N. A woman seeking therapeutic services will be treated differently because of her
gender.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
O. A Mexican seeking therapeutic services will be treated differently because of their
race.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
P. An undocumented immigrant seeking mental health services will be reported to
immigration.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
Q. There are many therapists in the community that speak Spanish.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
105
R. In my community, there are therapists that understand my religion and how it relates
with the Mexican culture.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
S. In my community, there are therapists that understand the role and responsibilities of
a woman in the Mexican culture.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
T. I have a clear understanding of mental health disorders.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
U. I know what symptoms would describe or indicate a mental health illness.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
V. If someone is experiencing extreme stress, sadness, or anxiety, they should speak
with a therapist.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
106
W. If someone asked me where they could find a therapist to talk to, I know where I
could send them.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
X. I would consider speaking to a therapist as an option for me if I felt I wanted or
needed it.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
Y. I believe that my family accepts therapy as a common and acceptable practice for
anyone to use, including me.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
Z. I believe that my boss accepts therapy as a common and acceptable practice for
anyone to use, including me.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
AA. I believe that my friends accept therapy as a common and acceptable practice for
anyone to use, including me.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
107
BB.
I believe that therapy is a common and acceptable practice for anyone to use,
including me.
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
No, I Strongly
Disagree with this
statement
4
CC. If someone has mental health issues, they could be cursed/ possessed by a
supernatural power (a witch, bad spirit, or the devil).
Yes, I Strongly
Agree with this
statement
1
Yes, I Agree with
this statement
No, I Disagree with
this statement
2
3
Thank you for participating in this study!!
No, I Strongly
Disagree with this
statement
4
108
APPENDIX D
Encuesta: Percepciones de los Servicios de Salud Mental
La primera parte de esta encuesta le pregunta información de su historia
demográfica. Circule la respuesta que más aplica a usted.
Si usted quiere más claridad de cualquier pregunta, la investigadora está disponible
para asistir.
A. ¿Cuántos años tiene usted?
1. 18-34 años
2. 35 + años
B. ¿Cómo describiría su estatus civil actual?
1. Soltera
2. Casada/Pareja
3. Viuda
4. Separada
5. Divorciada
C. ¿Cuál es su religión?
1. Católica
2. Cristiana (No Católica)
3. Atea/Agnóstica
4. Otra: Por Favor Describe ________________
109
D. ¿Cuál es el nivel más alto de educación que usted ha completado?
1. No educación
2. Menos que la secundaria
3. Graduada de secundaria
4. La Universidad
5. Otra: Por Favor Describe ________________
E. ¿Cuál de lo siguiente mejor describe el área de México donde usted vivió?
1. Un rancho
2. Un pueblo
3. Una cuidad
F. ¿Por cuánto tiempo ha vivido usted en los estados unidos?
1. 5 años o menos
2. 10 años o menos
3. Más que 10 años
G. ¿Cuánto inglés habla usted?
1. No mucho
2. Un poco inglés
3. Mucho inglés
4. Inglés con español
110
H. ¿Cuál es el ingreso anual de su hogar?
1. Menos que $20,000
2. $20,000 o más
La próxima parte de esta encuesta pregunta si está de acuerdo o desacuerdo con las
siguientes frases. Por favor circule el número indicando su nivel de acuerdo o
desacuerdo siguiendo la escala debajo de las frases.
Si usted quiere más claridad de cualquier frase, la investigadora está disponible
para asistir.
I. Una mexicana necesita mostrar fuerza, y no debe mostrar emociones.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
J. Una mexicana no debe ir a terapia, porque debe estar enfocada en sus
responsabilidades en el hogar y trabajo.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
K. Una mexicana debe hablar de problemas en su familia a personas fuera de la
familia.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
111
L. Una mexicana debe pedir su esposo/pareja antes de hablar con un terapista.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
M. Una mexicana pasando por problemas debe hablar con un líder en su iglesia
primero, antes de hablar con un terapista.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
N. Una mujer obteniendo servicios de salud mental va a ser tratada diferente por ser
mujer.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
O. Un mexicano obteniendo servicios de salud mental va a ser tratado diferente por
su raza.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
112
P. Un inmigrante indocumentado obteniendo servicios mentales va ser reportado a
inmigración.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
Q. Hay muchos terapistas que hablan español en la comunidad.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
R. En mi comunidad, hay terapistas que entienden mi religión y como relata con la
cultura mexicana.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
S. En mi comunidad, hay terapistas que entienden la posición y responsabilidades de
una mexicana en la familia.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
T. Tengo un buen entendimiento de desordenes de salud mental.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
113
U. Yo sé qué síntomas indicarían o describirían una enfermedad mental.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
V. Si alguien está experimentando demasiado estrés, tristeza, o nervios, debe hablar
con un terapista.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
W. Si alguien me pregunta dónde encontrar un terapista, yo sé a dónde puedo
mandarlo.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
X. Yo consideraría hablar con un terapista como una opción para mí, si yo lo gustaría
o si lo necesitaría.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
114
Y. Creo que mi familia acepta terapia como una práctica común y aceptable usar por
cualquier persona, incluyendo a mí.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
Z. Creo que mi patrón acepta terapia como una práctica común y aceptable usar por
cualquier persona, incluyendo a mí.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
AA. Creo que mis amigos aceptan terapia como una práctica común y aceptable usar
por cualquier persona, incluyendo a mí.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
BB. Creo que terapia es una práctica común y aceptable usar por cualquier persona,
incluyendo a mí.
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
115
CC. Si alguien tiene problemas con su salud mental, puede ser el resulto de una
brujería o es una posesión de poderes súper-naturales (una bruja, mal espíritu, o el
diablo).
Sí, estoy totalmente
de acuerdo con esta
frase
Sí, estoy de
acuerdo con esta
frase
No, yo estoy en
desacuerdo con
esta frase
1
2
3
Gracias por participar en este estudio.
No, yo estoy
totalmente en
desacuerdo con
esta frase
4
116
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