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Article Excerpt
Census predictions indicate that by 2020 Latinos/as will constitute 15% of the U.S. population (U.S. Census Bureau, 2000). As of the 2000 Census, Latinos/as represented approximately 12.5% of the U.S. population, moving them ahead of African Americans as the largest ethnic minority population in the United States (Grieco & Cassidy, 2001). Furthermore, Latinos/as make up even larger portions of the population in some states. For example, in California, as of 2000, Latinos/as (primarily Mexican Americans) composed 32.2% of the population (U.S. Census Bureau, 2000). Although Latinos/as encompass various ethnic backgrounds, approximately 64% of the Latinos/as in the United States are of Mexican origin (Falicov, 1998), with the highest concentration in the southwestern United States (Gloria & Segura-Herrera, 2004; Santiago-Rivera, Arredondo, & Gallardo-Cooper, 2002). These figures may actually underestimate the number of Mexican Americans, given that undocumented immigrants often do not show up in U.S. Census Bureau data (Rogler, Malgady, & Rodriguez, 1989).
* Underuse of Counseling Services
Psychologists are aware that such an increase in the Mexican American population, by way of immigration and high birth rate, will produce a greater need for mental health services for this group. In addition to population increase, other factors experienced by Mexican Americans may also influence the need for more services. It is well documented that the Latino/a population experiences psychological stress from immigration (Falicov, 1998), poverty (Comas-Diaz, 1990; Gloria & Segura-Herrera, 2004), and acculturation (Abreu & Sasaki, 2004; Berry & Annis, 1974; Menas, Padilla, & Maldonado, 1987; Padilla, Alvarez, & Lindholm, 1986; Padilla, Wagatsuma, & Lindholm, 1985). The cumulative psychological distress from the various sources can be overwhelming, increasing the risk for mental health problems.
Considering the psychological distress that results from immigration, poverty, and acculturation, it is not surprising that psychiatric epidemiology studies indicate that Latinos/as experience more mental health problems than does any other ethnic population (Rogler et al., 1989; Williams & Harris-Reid, 1999). Moreover, such risk factors experienced by Mexican Americans may produce a greater need for mental health services to alleviate psychological distress and reduce mental illness for Mexican Americans. Nevertheless, despite the apparent need for services, there is evidence to suggest that Mexican Americans underuse mental health services (Abreu & Sasaki, 2004; Atkinson, Jennings, & Liongson, 1990; Castro, Coe, Gutierres, & Saenz, 1996; Keefe & Casas, 1978; Leong, Wagner, & Tata, 1995; Matin, Marin, Padilla, & De La Rocha, 1983; Reeves, 1986; Rogler et al., 1989; Zane, Hatanaka, Park, & Akutsu, 1994). Of those who do use mental health services, many do not return after the initial visit (Cheung & Snowden, 1990).
In their review of mental health practices among ethnic minorities, Leong et al. (1995) identified three explanations for underuse of mental health services. One hypothesis is that Mexican Americans have a lower incidence of mental illness. Epidemiological data cited by Rogler et al. (1989), however, contradict this hypothesis. The second factor identified in the literature as influencing help-seeking behaviors is institutional barriers. Structural incongruities that result in barriers include (a) lack of Spanish-speaking counselors, (b) inadequate financial resources, (c) location of mental health clinics outside of Latino/a communities, (d) culturally irrelevant therapeutic approaches, and (e) lack of ethnically similar counselors. These factors not only impede persistence in counseling but also may inhibit initial help-seeking intentions.
The third explanation identified by Leong et al. (1995), and the focus of the current study, is cultural barrier theory. This theory posits that various aspects of Latino/a culture predispose members to not seek professional services. These factors were identified as alternative resources, lack of acculturation, and traditional Mexican values. Examples of alternative resources include family (Rogler et al., 1989) and spiritual or folk healers (Zea, Quezada, & Belgrave, 1994). The current study focused on the relationship between the latter two components of cultural barrier theory, acculturation and traditional Mexican values, with willingness to use mental health services.
* Acculturation
Leong et al. (1995) identified a lack of acculturation as an intrapersonal cultural barrier to seeking mental health services. Some researchers have hypothesized that highly acculturated individuals express more positive attitudes related to use of mental health services than do less acculturated individuals (Keefe, 1982; Sanchez & Atkinson, 1983; Sanchez & King, 1986). Sanchez and Atkinson, in an attempt to determine the relationship between cultural commitment and preference for counselor ethnicity, found that strong cultural commitment to the Mexican culture produced less favorable attitudes toward using professional counseling services. Sanchez and King also found evidence of a direct relationship between acculturation and attitudes related to use of mental health services. These findings suggest that highly acculturated individuals approximate the values and beliefs of the American (dominant) culture, which generally encourages seeking mental health services for personal problems. Nevertheless, other studies using Mexican Americans and other ethnic samples have produced mixed findings, casting doubt on the cultural barrier theory of underuse of mental health services (Atkinson, Lowe, & Matthews, 1995; Gim, Atkinson, & Whiteley, 1990; Keefe & Casas, 1978; Ponce & Atkinson, 1989; Ramos-Sanchez, Atkinson, & Fraga, 1999; Ruelas, Atkinson, & Ramos-Sanchez, 1998).
Gim et al. (1990) found an inverse relationship between acculturation and attitudes related to use of mental health services among Asian Americans. The least acculturated participants reported a greater willingness to see a counselor for academic/career, financial, and personal concerns than did more acculturated participants. Findings by Ramos-Sanchez et al. (1999) and Ruelas et al. (1998) also seem to contradict previously held assumptions by the cultural barrier theory for underuse of professional services. Ramos-Sanchez et al. reported that less acculturated Mexican Americans rated the counselor more positively than did more acculturated Mexican Americans. Ruelas et al. found that Mexican Americans rated counselors more positively than did European Americans and that their ratings were associated with their involvement in the Mexican culture. More specifically, Mexican Americans who adhered to traditional Mexican values and beliefs rated the counselor as more credible than did those who did not. Combined, these findings seem to suggest that the loss of Mexican culture was associated with lower ratings of perceived credibility for the counselor. To the extent that perceived credibility is related to help-seeking intentions, these findings suggest that adherence to Mexican culture may actually encourage positive attitudes toward help seeking for Mexican Americans. The current study attempts to directly examine the relationship between helping-seeking intentions and adherence to the Mexican culture.
* Traditional Mexican Values
Traditional Mexican values have also received attention in the theoretical literature regarding help seeking (Cuellar, Arnold, & Gonzalez, 1995; Gloria & Peregoy, 1996; John, Resendiz, & De Vargas, 1997; Sandoval & De La Roza, 1986; Zinn, 1982). Cultural barrier theory assumes that adherence to cultural values, such as familism, machismo, folk illness, religiosity, and fatalism, may preclude Latinos/as from using counseling services. This assumption is based on the notion that values inherent in the Latino/a culture conflict with values inherent in psychotherapy. For example, revealing problems outside of the family would go against the value of familism because, according to familism, all problems should be kept within the familial structure to avoid bringing shame on the family. Similarly, for Latino men, asking for help may be construed as a sign of weakness, the opposite of the value of machismo. No empirical research to date, however, has investigated the relationship between Mexican values and attitudes toward using mental health services. The lack of empirical studies on values and help-seeking intentions underscores the importance of further examining these relationships.
The following prominent traditional Mexican values...
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