Financial Barriers to Health Care Among Mexican Americans With Chronic Disease and Depression or Anxiety in El Paso,Texas

Abstract

Purpose: To determine the barriers to health care access by chronic disease and depression/anxiety diagnosis in Mexican Americans living in El Paso, TX. Design: A secondary analysis was conducted using data for 1,002 Hispanics from El Paso, TX (2009-2010). Logistic regression was conducted for financial barriers by number of chronic conditions and depression/anxiety diagnosis. Interaction models were conducted between number of chronic conditions and depression or anxiety. Results: Depressed/anxious individuals reported more financial barriers than those with chronic conditions alone. There were significant interactions between number of chronic conditions and depression/anxiety for cost, denied treatment because of an inability to pay, and an inability to pay $25 for health care. Conclusion: Financial barriers should be considered to maintain optimal care for both mental and physical health in this population. Implications for Practice: There should be more focus on the impact of depression or anxiety as financial barriers to compliance.

Keywords

cardiovascular disease diabetes Mexican Americans health care barriers

Get full access to this article

View all access options for this article.

References

Agency for Healthcare Research and Quality. (2015). 2014 National Healthcare Quality and Disparities report chartbook on health care for Hispanics (AHRQ Pub. No. 15-0007-11-EF). Rockville, MD: Author.

Adriaanse

M. C.

Dekker

J. M.

Heine

R. J.

Snoek

F. J.

Beekman

A. J.

Stehouwer

C. D.

. . . Pouwer

(2008). Symptoms of depression in people with impaired glucose metabolism or type 2 diabetes mellitus: The Hoorn study. Diabetic Medicine, 25, 843-849.

American Diabetes Association. (2016). Statistics about diabetes data from the 2011 National Diabetes fact sheet. Retrieved from http://www.diabetes.org/diabetes-basics/statistics/?loc=db-slabnav#sthash.74nH1NvR.dpuf

American Psychiatric Association. (2014). APA fact sheet. Mental health disparities: Hispanics/Latinos. Arlington, VA: Author. Retrieved from http://marccr.com/documents/BHS/Fact-Sheet-Latinos.pdf

Bähler

Huber

C. A.

Brüngger

Reich

(2015). Multimorbidity, health care utilization and costs in an elderly community-dwelling population: A claims data based observational study. BMC Health Service Research, 15, 23. doi:10.1186/s12913-015-0698-2

Balcázar

H. G.

de Heer

Rosenthal

Aguirre

Flores

Puentes

F. A.

. . . Schulz

L. O.

(2010). A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, 2005-2008. Preventing Chronic Disease, 7(2), A28.

Billimek

August

K. J

. (2014). Costs and beliefs: Understanding individual and neighborhood-level correlates of medication nonadherence among Mexican Americans with type 2 diabetes. Health Psychology, 33, 1602-1605.

Bouwman

Adriaanse

M. C.

Riet

Snoek

F. J.

Dekker

J. M.

Nijpels

(2010). Depression, anxiety and glucose metabolism in the general Dutch population: The New Hoorn study. PLoS ONE, 5(4), e9971.

Bridges

A. J.

Andrews

A. R.

III Deen

T. L.

(2012). Mental health needs and service utilization by Hispanic immigrants residing in mid-southern United States. Journal of Transcultural Nursing, 23, 359-368.

10.

Budhwani

Hearld

K.R.

Chavez-Yenter

(2015). Depression in racial and ethnic minorities: The impact of nativity and discrimination. Journal of Racial and Ethnic Health Disparities, 2(1), 34-42.

11.

Cené

C. W.

Dennison

C. R.

Powell Hammond

Levine

Bone

L. R.

Hill

M. N.

(2013). Antihypertensive medication nonadherence in black men: Direct and mediating effects of depressive symptoms, psychosocial stressors, and substance use. Journal of Clinical Hypertension, 5, 201-209.

12.

Centers for Disease Control and Prevention. (2011). National diabetes fact sheet, 2011. Retrieved from http://www.cdc.gov//diabetes/pubs/pdf/ndfs_2011.pdf

13.

Chen

Rizzo

(2010). Racial and ethnic disparities in use of psychotherapy: Evidence from U.S. national survey data. Psychiatric Services, 61, 364-372.

14.

Cook

B. L.

Manning

W. G.

(2009). Measuring racial/ethnic disparities across the distribution of health care expenditures. Health Service Research, 44, 1603-1621.

15.

Cooper

L. A.

Gonzales

J. J.

Gallo

J. J.

Rost

K. M.

Meredith

L. S.

Rubenstein

L. V.

. . . Ford

D. E.

(2003). The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Medical Care, 41, 479-489.

16.

De Heer

Salinas

J. J.

Lapeyrouse

L. M.

Heyman

Morera

O. F.

Balcazar

. (2013). Bi-national utilization and barriers to care among Mexican American border residents with diabetes. Pan American Journal of Public Health, 34, 147-154.

17.

Fassin

(2004). Public health as culture: The social construction of the childhood lead poisoning epidemic in France. British Medical Bulletin, 69, 167-177.

18.

Giacco

Matanov

Priebe

(2014). Providing mental healthcare to immigrants: Current challenges and new strategies. Current Opinions in Psychiatry, 27(4), 282-288.

19.

Harman

J. S.

Edlund

M. J.

Fortney

J. C.

(2004). Disparities in the adequacy of depression treatment in the United States. Psychiatric Service, 55, 1379-1385.

20.

Icks

Kruse

Dragano

Broecker-Preuss

Slomiany

Mann

. . . Moebus

(2008). Are symptoms of depression more common in diabetes? Results from the Heinz Nixdorf recall study. Diabetic Medicine, 25, 1330-1336.

21.

Interian

Ang

Gara

M. A.

Link

B. G.

Rodriguez

M. A.

Vega

W. A.

(2010). Stigma and depression treatment utilization among Latinos: Utility of four stigma measures. Psychiatric Service, 61, 373-379.

22.

Interian

Ang

Gara

M. A.

Rodriguez

M. A.

Vega

W. A.

(2011). The long-term trajectory of depression among Latinos in primary care and its relationship to depression care disparities. General Hospital Psychiatry, 33(2), 94-101.

23.

Jimenez

D. E.

Bartels

S. J.

Cardenas

Alegría

(2013). Stigmatizing attitudes toward mental illness among racial/ethnic older adults in primary care. International Journal of Geriatric Psychiatry, 28, 1061-1068.

24.

Kim

Aguado Loi

C. X.

Chiriboga

D. A.

Jang

Parmelee

Allen

R. S.

(2011). Limited English proficiency as a barrier to mental health service use: A study of Latino and Asian immigrants with psychiatric disorders. Journal of Psychiatric Research, 45, 104-110.

25.

Kollannoor-Samuel

Vega-López

Chhabra

Segura-Pérez

Damio

Pérez-Escamilla

(2012). Food insecurity and low self-efficacy are associated with health care access barriers among Puerto-Ricans with type 2 diabetes. Journal of Immigrant and Minority Health, 14, 552-562.

26.

Lapeyrouse

L. M.

Morera

Heyman

J. M.

Amaya

M. A.

Pingitore

N. E.

Balcazar

(2012). A profile of US-Mexico border mobility among a stratified random sample of Hispanics living in the El Paso-Juarez area. Journal of Immigrant and Minority Health, 14, 264-271.

27.

Le Cook

Manning

Alegria

. (2013). Measuring disparities across the distribution of mental health care expenditures. Journal of Mental Health and Policy Economics, 16(1), 3-12.

28.

Lee

Salloum

R.G.

(2016). Racial and ethnic disparities in cost-related medication non-adherence among cancer survivors. Journal of Cancer Survival, 10(3), 534-544.

29.

Livingston

Minushkin

Cohn

(2008). Hispanics and health care in the United States: Access, information and knowledge. Washington, DC: Pew Hispanic Center and Robert Wood Johnson Foundation.

30.

Marquez-Velarde

Grineski

Staudt

(2015). Mental health disparities among low-income US Hispanic residents of a US-Mexico border colonia. Journal of Racial and Ethnic Health Disparities, 2(4), 445-456.

31.

Ngo-Metzger

Sorkin

D. H.

Billimek

Greenfield

Kaplan

S. H.

(2011). The effects of financial pressures on adherence and glucose control among racial/ethnically diverse patients with diabetes. Journal of General Internal Medicine, 27, 432-437.

32.

Poongothai

Anjana

R. M.

Pradeepa

Ganesan

Unnikrishnan

Rema

Mohan

(2011). Association of depression with complications of type 2 diabetes: The Chennai Urban Rural Epidemiology Study (CURES-102). Journal of the Association of Physicians of India, 59, 644-648.

33.

Quiñones

A. R.

Liang

Bennett

J. M.

(2011). How does the trajectory of multimorbidity vary across black, white, and Mexican Americans in middle and old age? Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 66, 739-749.

34.

Ravel

Dhanaraj

Bhansali

Grover

Towari

(2010). Prevalence & determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian Journal of Medical Research, 132, 195-200.

35.

Redmond

Baer

H. J.

Hicks

L. S.

(2011). Health behaviors and racial disparity in blood pressure control in the National Health and Nutrition Examination Survey. Hypertension, 57, 383-389.

36.

Singer

(2009). Introduction to syndemics: A critical systems approach to public and community health. San Francisco: Jossey-Bass.

37.

Salinas

Al Snih

(2013). Border health in the shadow of the Hispanic paradox: Issues in the conceptualization of health disparities in older Mexican Americans living in the southwest. Journal of Cross-Cultural Gerontology, 28(3), 251-266.

38.

Stata Corporation. (2013). STATA 13 SE [Statistical software]. College Station, TX: Author.

39.

Uebelacker

L. A.

Marootian

B. A.

Pirraglia

P. A.

Primack

Tigue

P. M.

Haggarty

. . . Miller

I. W.

(2012). Barriers and facilitators of treatment for depression in a Latino community: A focus group study. Community Mental Health Journal, 48, 114-126.

40.

U.S. Census Bureau. (2011). The Hispanic population in the United States, 2011. Retrieved from http://www.census.gov/population/hispanic/data/2011.html

41.

U.S. Census Bureau. (2015a). Small Area Health Insurance Estimates (SAHIE): 2013 Highlights. Retrieved from http://www.census.gov/did/www/sahie/data/2013/2013highlights.pdf

42.

U.S. Census Bureau. (2015b). Quick Facts, El Paso city, Texas. Retrieved from http://www.census.gov/quickfacts/table/HEA775214/4824000,00

43.

U.S. Department of Health and Human Services. (n.d.). Health Resources and Services Administration (HRSA): Health workforce. Updated designations. http://bhpr.hrsa.gov/shortage/updateddesignations/index.html

44.

Vega

W. A.

Rodriguez

M. A.

Ang

(2010). Addressing stigma of depression in Latino primary care patients. General Hospital Psychiatry, 32, 182-191.

45.

Vijayaraghavan

Jacobs

E. A.

Seligman

Fernandez

(2011). The association between housing instability, food insecurity, and diabetes self-efficacy in low-income adults. Journal of Health Care for the Poor and Underserved, 22, 1279-1291.

46.

Weaver

K. E.

Rowland

J. H.

Bellizzi

K. M.

Aziz

N. M.

(2010). Forgoing medical care because of cost: Assessing disparities in healthcare access among cancer survivors living in the United States. Cancer, 116, 3493-3504.

47.

Weidenbacher

H. J.

Beadles

C. A.

Maciejewski

M. L.

Reeve

B. B.

Voils

C. I.

(2015). Extent and reasons for nonadherence to antihypertensive, cholesterol, and diabetes medications: The association with depressive symptom burden in a sample of American veterans. Patient Preference and Adherence, 9, 327-336.

48.

Wells

Klap

Koike

Sherbourne

(2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. American Journal of Psychiatry, 158, 2027-2032.

49.

K. T.

Borders

T. F.

(2007). Racial and ethnic disparities in the financial burden of prescription drugs among older Americans. Journal of Health and Human Services Administration, 30(1), 28-49.

50.

Zuvekas

S. H.

Fleishman

J. A.

(2008). Self-rated mental health and racial/ethnic disparities in mental health service use. Medical Care, 46, 915-923.