Understanding treatment barriers for Major Depressive Disorder in the Latino community: A qualitative study stratified by language preference.

Abstract

This qualitative study explores barriers to accessing treatment for Major Depressive Disorder (MDD) among Latino adults in the United States, with a novel focus on how these barriers were described based on participants' preferred language. Fifty Latino individuals (n = 24 primarily Spanish-speaking; n = 26 primarily English-speaking) participated in Zoom interviews and completed a demographic survey and the patient health questionnaire-9 MDD self-report measure in their preferred language. Thematic analysis of interview data identified barriers across three levels: individual (e.g., stigma, service literacy, treatment readiness, caretaking responsibilities), provider (e.g., language barriers, cultural humility, perceived care quality), and clinic (e.g., cost, time constraints, waitlists, geographical access). While many challenges were shared across groups, key differences emerged. Spanish-speaking participants emphasized the importance of bilingual providers and described feelings of mistrust, communication fears, and concerns about emotional safety when language concordance was absent. English-speaking participants described prioritizing working with bicultural providers who demonstrated cultural humility and a nuanced understanding of possible intergenerational and structural stressors. Structural barriers, such as cost and scheduling, were often compounded by emotional experiences such as shame and mistrust, underscoring the need for both system-level and culturally responsive solutions. These findings reinforce the need for equity-informed strategies that attend to the intersection of language, culture, and structural barriers to MDD treatment.