Urgent revisions suggested for Spanish-language mental health materials

Spanish-language medical information given to Latino/a patients about depression treatment often contains confusing terminology that could decrease comprehension and adherence to treatment recommendations, according to a University of Michigan study.

The research, published in the journal Health Education Research, assessed the comprehension and perceived usefulness of selected sections from patient education handouts on depression and antidepressants, as well as medication information sheets for the antidepressant sertraline, among 30 Latino/a adults who prefer to speak and read in Spanish.

While most participants said the overall information seemed useful and applicable to them, over half reported that at least one section included words or phrases they found confusing or unfamiliar. Specific terms that caused confusion included "chemical substances," "electric shocks" and "formulation."

More concerning, some participants stated they misunderstood certain sentences as affirming negative stereotypes about mental illness and antidepressant use—the opposite of the intended meaning.

"Ten percent of participants misunderstood some sentences to be reinforcing stigma instead of diminishing it for a population that may already feel stigmatized because of their ethnicity or preferred language," said study lead author Beatriz Manzor-Mitrzyk, assistant professor at the U-M College of Pharmacy.

One section stated: "Depression is a medical illness caused by changes in the natural chemicals in your brain. It is not a character flaw, and it does not mean that you are a bad or weak person. It does not mean that you are going crazy."

"What I didn't like very much is what it says about it being a person who is bad or weak … or that a person is going crazy," said one participant interviewed for the study.

Another participant recommended revising that language entirely, saying: "I would clarify more explicitly that it is not weakness; it is not a lack of will, it is not a lack of character."

The study outlined other examples where participants found wording confusing or asked for additional context to be included.

Based on their findings, Manzor-Mitrzyk and colleagues call for revisions to these commonly provided written materials to improve comprehension and usefulness and remove stigmatizing language for the non-English language preference.

"The seriousness of the organizational health literacy-based issues identified in this and previous studies require that government and health service organizations make necessary and timely revisions to address them," Manzor-Mitrzyk said.

"We strongly encourage health professionals to use guideline-recommended patient education techniques that assess comprehension and give opportunity for clarification, such as the teach-back method or asking patients to share what they will do with the information provided when they get home."