OBJECTIVES

We examined the relationship between preferred English, Spanish, or an Asian language for mental health services and adherence to treatment with antipsychotic medication and Medi-Cal beneficiaries with schizophrenia in San Diego, California.

METHODS

Data included 31,560 person-years from 1999–2004. Pharmacy records were analyzed to assess adherence to antipsychotic medication, based on the medication possession ratio (MPR). Clients were defined as nonadherent (MPR<0.5), partially adherent (0.5<=MPR<0.8), adherent (0.8<=MPR<=1.1), or as an excess filler (MPR>1.1). Regression models were used to examine adherence, hospitalization, and costs by race/ethnicity and language status.

RESULTS

Limited English proficient Latinos were more likely to be adherent to antipsychotic medications than English proficient Latinos (40.8% vs. 35.9%, P<0.001). Limited English proficient Latinos were less likely to be excess fillers than English proficient Latinos (15.1% vs. 20.4%, P<0.001). Limited English proficient Asians were less likely to be adherent than English proficient Asians (40.1% vs. 45.1%, P=0.034). Compared to English proficient Asians, limited English proficient Asians were more likely to be nonadherent (28.7% vs. 22.0%, P<0.001) and less likely to be excess fillers (12.5% vs. 17.4%, P=0.004). Controlling for adherence and comorbidities, limited English proficient clients had lower rates of hospitalization and health care costs than English proficient and white clients.

CONCLUSIONS

Adherence to antipsychotic medications varies among and within ethnic groups by English proficiency. Policies supporting the training of bilingual and multicultural ethnic minority providers, and interventions that capitalize on existing social support networks, may improve adherence to treatment among linguistically diverse populations.

This study examined caregiver preferences in the event of hip fracture between Mexican-American and non-Latino White elders. The differential effects of ethnicity and a cultural factor were also examined to elucidate the role of culture on caregiver preference. Data came from a cross-sectional survey of 89 Mexican-American and 30 non-Latino White elders. Hierarchical binary logistic regression was used to examine the differential impact of ethnicity and a cultural factor on caregiver preference. Fewer Mexican-American elders than non-Latino White elders preferred to rely on a formal/professional helper, and a greater proportion of Mexican-Americans than non-Latino Whites would turn to informal caregivers when faced with care needs following a hip fracture. The cultural factor significantly mediated the ethnic effect on caregiver preference. The need for culturally-relevant services based on caregiver preference for long-term care is discussed in addressing health disparities for ethnically diverse elders.

Fifty-nine Latino participants diagnosed with persistent psychotic disorders were assigned to either a culturally tailored skills-training intervention (n = 21), an equivalent non-tailored intervention (n = 15), or a community-based support group (n = 23). Participants completed a number of skills-based performance assessments (e.g., UCSD performance-based skills assessment; UPSA) and a well-being measure prior to and immediately post-treatment. Compared to those in the non-tailored intervention, participants receiving the tailored intervention showed significant improvement in several outcomes. These results indicate that Latino individuals with persistent psychotic disorders benefit from interventions which consider cultural values and mores.

The purpose of this study was to examine the relationship between scores on the UCSD Performance-based Skills Assessment (UPSA), a performance-based measure of functional capacity, and level of patient community responsibilities (i.e., work for pay; volunteer work; attend school; household duties) in a Latino sample. Participants were 58 middle-aged and older Latinos of Mexican origin (mean age = 48.8 years) with a diagnosis of schizophrenia or schizoaffective disorder. We conducted an analysis of covariance (ANCOVA), controlling for age, symptoms of psychosis, and participant language, to determine if greater participation in community responsibilities was associated with higher functional capacity, as measured by the UPSA. Results indicated significant group differences in UPSA scores (F = 5.11, df = 2,51; p = .009), with patients reporting only a single community responsibility having significantly higher UPSA scores than those reporting zero community responsibilities (p = .016) and those reporting two responsibilities scoring significantly higher than those reporting zero community responsibility (p = .008). There were no differences found between those reporting one and those reporting two community responsibilities (p= .256). In contrast, no group differences were observed on the Dementia Rating Scale, a global measure of cognitive functioning (F = 2.14, df = 2,51; p = .128). These results provide initial support for the validity of the UPSA in Latino patients of Mexican origin, and suggest that improvement in functional capacity (i.e., UPSA scores) may be associated with increased capacity for greater community involvement in this population.