ABSTRACT
Latinx immigrants experience substantial disparities in mental health treatment access, particularly for posttraumatic stress disorder (PTSD). The availability of brief, flexible interventions in Spanish may assist in reducing these disparities. Written Exposure Therapy (WET) is a five-session PTSD intervention that appears as effective as longer, gold-standard interventions, but has yet to be tested among Latinx immigrants. To test the acceptability and preliminary effectiveness of WET, 20 Spanish-speaking, Latinx immigrants conducted structured interviews at pretreatment, were offered WET, and completed posttreatment structured interviews. Open thematic coding of pre- and posttreatment interview questions examined perceived barriers and benefits of WET. Quantitative components examined symptom change across PTSD (PCL-IV-C) and depression (PHQ-9). Quantitative results indicated clinically meaningful and statistically significant change in PTSD symptoms using intent-to-treat analyses (Mdiff = 17.06, SDdiff = 9.97, range = 0-29, t(15) = 6.84, p < .001). Open thematic coding identified four barrier-related themes and three benefit-related themes at pretreatment. At posttreatment, three barrier-related themes and two benefit-related themes were identified. Qualitative results largely suggested that perceived barriers were common to other PTSD interventions (e.g., exposure components). Only one participant identified barriers specific to WET. Results suggested WET may reduce PTSD symptoms among Latinx immigrants. WET also appeared to be acceptable and primarily viewed as beneficial among this population. WET is a promising intervention with Latinx immigrants and warrants further testing larger trials, including testing implementation strategies that may improve access to care.
ABSTRACT
Migrant farmwork is often characterized by harsh working conditions that carry significant physical and mental health consequences. Using a learned helplessness framework, the current study examined the extent to which discrimination, immigration legal status difficulties, and adverse childhood experiences moderated the effects of harsh working conditions on depression and anxiety. The study also examined the extent to which harsh working conditions mediated the effects of discrimination, immigration legal status difficulties, and adverse childhood experiences on depression and anxiety. Participants were 241 migrant farmworkers recruited in the Midwest. Participants completed interviews consisting of the Migrant Farmworker Stress Index (MFWSI), Adverse Childhood Events scale (ACEs), Everyday Discrimination Scale, the Centers for Epidemiology Scale for Depression (CES-D), and the seven item Generalized Anxiety Disorder scale (GAD-7). Tests of indirect effects suggested, working conditions mediated the effects of ACEs, immigration legal status fears, and discrimination on CES-D and GAD-7 scores (p-values < .05). Higher ACEs and discrimination also appeared to be associated with larger effects of harsh working conditions on depression and anxiety (p-values < .05), while legal status fears did not significantly moderate the effect of harsh working conditions on either outcome (p-values > .05). Likely through different mechanisms, adverse childhood experiences, discrimination and immigration legal status are associated with higher risk of harsh working conditions and subsequently these conditions account for much of the relations between these three stressors with depression and anxiety. Additionally, discrimination and adverse childhood experiences appear to then enhance the effects of working conditions.
El trabajo de agrícolas migrantes se caracteriza por condiciones severas que incrementanel riesgo de enfermedades médicas y de salud mental. Nuestro estudio examinó qué tantola discriminación, el miedo por el estado legal, y las experiencias adversas durante la niñez (ACEs) aumentaron el efecto de condiciones laborales severas en la depresión y ansiedad. El estudio también examinó si las condiciones laborales explican los efectos de discriminación, el miedo del estado legal, y ACEs en la depresión y ansiedad. Participantes eran 241 trabajadores migrantes agrícolas Latinos del medioccidente (midwest) de los Estados Unidos. Participantes completaron entrevistas de Migrant Farmworker Stress Index (MFWSI; una medida de estrés por trabajadores agrícolas), escala de ACEs, Everyday Discrimination Scale (medida de discriminación), Centers for Epidemiology Scale for Depression (CES-D: medida de síntomas de depresión) y Generalized Anxiety Scale (GAD-7; medida de síntomas de ansiedad). Una serie de modelos de ecuaciones estructurales examinaron ACEs, miedo por estado legal y condiciones laborales severas como predictores de CES-D y GAD-7. Pruebas de efectos indirectos indicaron que las condiciones laborales explicaron parte de los efectos de discriminación, ansiedad y miedo por estado legal en la depresión y ansiedad. También, ACEs y discriminación aumentaron los efectos de las condiciones laborales en los síntomas de depresión y ansiedad (p < .05) pero el miedo por el estado legal no cambió estos efectos (p > .05). Probablemente por mecanismos diferentes, ACEs, discriminación y miedo por el estado legal predicen condiciones laborales severas y estas condiciones incrementan el riesgo de síntomas de depresión y ansiedad. Además, la discriminación y ACEs quizás incrementan los efectos de las condiciones laborales.
