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Developing a clinical tool to treat depression in Spanish-speaking Latin American immigrants in Canada : applying a global mental health perspective for improved mental health outcomes Vidal, Bertha Carolina


This dissertation considers the implications of applying of global health perspective to guide the development of culturally appropriate mental health services in Canada. Recognizing that forces of globalization can both affect determinants of health that vulnerable populations face and the kind of mental health services that are available, I focus on the situation of immigrants in the Greater Toronto Area, a population that has been prioritized for increased access to equity-driven health services, drawing on my personal and professional positionality with the issues examined. This study specifically examines Latin American immigrants, a group that has been identified as a high-growth population at-risk for mental health difficulties. An extensive and comprehensive review of social determinants of health as it relates to the mental health of Latin American immigrants in Canada is conducted, and the availability and effectiveness of patient-centred care for Latin American populations is also reviewed, with particular attention to the standard delivery versus the cultural adaptation of cognitive behavioural therapy – currently regarded as the ‘gold standard’ in psychotherapeutic treatment. Clinical, service delivery, and social policy issues that may arise in providing culturally appropriate, patient-centred care are exemplified in the findings of a secondary qualitative analysis of focus groups that were conducted for a feasibility study for a culturally adapted cognitive behavioural therapy (CA-CBT) for Latin American immigrants in Canada. A key contribution of this work is the synthesis of the foregoing evidence to conclude that the provision of culturally adapted mental health services is necessary but not sufficient to promote the health equity of Latin American immigrant population in Canada. Recommendations for policy, future research, and changes to the philosophy of psychiatric practice are discussed, and the findings are related to debates on the concept of “global mental health” that are currently underway.

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