Cognitive Behavioral Therapy in the Rural Latino Population

Brain Injury / Head Injury

By Arthur D. Leritz

September 18, 2018

A brain injury can be devastating and can often pose all sorts of challenges: social, familial, and personal. One of most significant challenges any brain injury survivor can face is post-traumatic depression, or an aggravation of pre-existing depression as a result of a brain injury. These challenges are made much more difficult for those living in rural communities where access to treatment is minimal and long distances must be traveled to get needed care. And it is an unfortunate truth that these challenges are greater still for underrepresented and underserved populations within those rural areas, such as the Latino community.

Recently, an article published by the American Psychiatric Association explored the concept of telephone-based cognitive behavioral therapy specifically for Latino patients in rural areas. According to the study, although the need for depression treatment is similar across ethnic groups, Latinos have lower rates of care and quality of treatment, which results in the Latino community bearing a greater burden of disability from depression. Among the greater Latino population, Mexican-Americans, immigrants, and non-English speakers are most unlikely to receive depression care. This is particularly true for men in these groups. Since Mexican-Americans account for two-thirds of the Latino population in the US, this is a significant public health issue.

The study focused on 101 participants in rural Washington State who met the criteria for major depression. The participants were randomly assigned to either cognitive behavioral therapy (CBT) sessions over the telephone, or enhanced usual care, which consisted of treating with a primary care provider and the prescription of anti-depressants. The CBT method consisted of eight phone sessions, with each session focused on a chapter in a patient workbook translated to Spanish, and content examples modified to use Latino names and reflect situations relevant to rural Latinos. The CBT sessions typically lasted 45 to 50 minutes, but actual sessions varied according to clinical need and patient preference. The telephone sessions were conducted by Spanish-speaking therapists, ranging in experience from a student working towards a master’s degree in social work to an experienced therapist with an M.S.W.

While the study was small, the results were interesting:

  • 84% of patients who received CBT completed six month assessments, compared to 70% of patients in enhanced usual care;
  • Over the six month follow up period, patients randomly assigned to CBT showed greater reductions in depression scores when compared to those in the enhanced care group;
  • Patients in the CBT group had greater follow through and more contact with a provider than those in the enhanced care group.

While this was a small pilot study, the results indicate that telephone-based CBT has the potential to enhance access to mental health services in an underserved Latino population which would otherwise have little access to mental health services.

The attorneys at Adler Giersch understand the importance of access to care and its challenges, and the critical importance in getting your patient on the proper road to recovery. We have a team of staff members who speak fluent Spanish and are happy to provide guidance to any of your Spanish-speaking patients who are struggling with challenges of a brain injury or other injuries that occurred as a result of the negligence of another person.