Prevalence of depressive symptoms among Hispanic/Latino ethnic subgroups during the COVID-19 pandemic

Hispanic/Latino populations experienced disproportionate exposure to depression risk factors during the COVID-19 pandemic. While aggregated data confirm the risks of depressive symptoms among Hispanic/Latino individuals, little research uses disaggregated data to investigate these risks based on ethnic subgroups. Using the “Understanding the Impact of the Novel Coronavirus (COVID-19) and Social Distancing on Physical and Psychosocial (Mental) Health and Chronic Diseases” survey, which was distributed nationally between May 13, 2021, and January 9, 2022 (N = 5413), we estimated the prevalence of depressive symptoms among Hispanic/Latino ethnic subgroups during the pandemic. We performed descriptive analysis on a 116-item survey, which collected disaggregated data from Hispanic/Latino individuals aged ≥ 18 years (n = 1181). About one-third of the participants reported depressive symptoms (31.3%), with those who self-identified as other Hispanic/Latino/Spanish origin (40.2%) reporting the highest depressive symptom prevalence. Among participants who reported depression treatment before the pandemic, the highest reports of treatment were among Puerto Rican (81.8%) participants. More than one-third of participants receiving prior depression treatment (38.7%) reported treatment interference by the pandemic, mostly among Central American individuals (50.0%). This study highlights the need for integrating more disaggregated data into public health approaches which seek to target population subgroups and reduce racial/ethnic mental health disparities.


Abbreviations
The COVID-19 pandemic has increased (and continues to increase) stress in many populations, affecting their mental health.Evidence suggests that pandemics increase the risk of developing mental disorders and poor mental well-being 1 .The percentage of United States (US) adults with symptoms of anxiety or depressive disorder increased from 36.4% to 41.5% between August 2020 and February 2021 2 .In particular, compared to prepandemic, the prevalence of depressive symptoms and major depressive disorder has risen since the COVID-19 pandemic began [3][4][5] .Depression is one of the most common mental health disorders 6 .It is characterized by persistently low or depressed mood, decreased interest in pleasurable activities, feelings of guilt or worthlessness, poor concentration, sleep disturbances, or thoughts of suicide 7 .Therefore, the rise in depression during the COVID-19 pandemic is a major concern that needs to be further evaluated by identifying the population subgroups most likely to be affected in a similar situation.Overall, most of the participants (74.0%) reported good and very good/excellent general mental health (33.4 and 40.6%, respectively).South American (50.4%),Central American (49.2%), and Cuban/Cuban American (48.8%) participants reported the highest proportions of very good/excellent mental health, followed by other Hispanic/Latino/Spanish origin (40.4%),Mexican/Mexican American (37.8%),Puerto Rican (37.4%), and Dominican (32.8%) participants.About 7% of the total participants reported poor general mental health, and Mexican/Mexican Americans had the highest prevalence (8.3%) within individual subgroups.This was followed by Puerto Rican (7.5%), other Hispanic/Latino/Spanish origin (6.7%),South American (5.0%),Central American (4.9%),Dominican (4.5%), and Cuban/Cuban American (2.4%) participants.

Discussion
The COVID-19 pandemic has exacerbated mental health disorder symptoms in the US population, especially in Hispanic/Latino individuals.However, there is limited information on mental health disorder symptoms among Hispanic/Latino ethnic subgroups to identify and delineate group differences to enhance tailoring public health messages and interventions.We disaggregated data to conduct descriptive analyses and estimate the prevalence of depressive symptoms among Hispanic/Latino ethnic subgroups during the COVID-19 pandemic using a sample surveyed from across the US.
We found that about one-third of the participants reported experiencing depressive symptoms.However, only 6.8% of total participants reported poor mental health.This may be indicative of stigma, prejudice, discrimination, mental health perspectives and implicit biases against individuals who struggle with mental health 26 .Past research has found that while Hispanic/Latino individuals are at high risk of depression, unmet mental health needs are often predicated on stigma, which impacts how individuals view themselves and others [26][27][28] .Therefore, while a tendency towards social desirability bias may have influenced how participants reported general mental health status, responses to PHQ-2 revealed that there may be a discrepancy in individual perceptions of mental health vs. individual experiences of depressive symptoms.This has important implications for overall population health when considering the comorbidities of depression, such as diabetes, cancer, and heart disease, which are among the leading causes of death among the Hispanic/Latino population 11,29 .Additionally, within the US population, Hispanic/Latino prevalences of distress, anxiety, and depression were among the highest of any racial/ethnic minority group during the COVID-19 pandemic 12,30,31 .Subsequently, there is a need for more research using disaggregated data to unravel between-and within-population subgroup mental health disparities.www.nature.com/scientificreports/By specifically exploring how the Hispanic/Latino (sub)population may be disparately exposed to and impacted by depression risk factors, effective steps can be taken to mitigate such risk factors and more equitably serve the respective subgroups.Among all individual ethnic subgroups, other Hispanic/Latino/Spanish origin and Puerto Rican participants reported the highest prevalence of depressive symptoms.These findings are consistent with other studies which have found Puerto Ricans to have a higher prevalence of psychological distress and depression when compared with other Hispanic/Latino ethnic subgroups 32,33 .This finding highlights the need to create interventions that target increased depressive symptoms within specific Hispanic/Latino subgroups, as some subgroups might be at higher risks for psychological distress and depression with the advent of large-scale societal disruptions/ stressors such as the pandemic.Furthermore, the prevalence of depressive symptoms among participants of other Hispanic/Latino/Spanish origin, who may have identified as natives of various countries and/or territories, underscores the importance of data disaggregation and oversampling when exploring health disparities among minority populations.Future studies should take these considerations into account to create a more holistic understanding of the unique experiences of different Hispanic/Latino ethnic subgroups, and how their needs can be most effectively met.
The highest reports of poor general mental health were observed among Mexican/Mexican American and Puerto Rican participants.Though very limited literature has compared mental health between Hispanic/Latino subgroups, our finding regarding Mexican/Mexican Americans contrasts with literature that found them to have lower odds of psychiatric disorders than other Latino subgroups 34 .On the other hand, South American and Cuban/Cuban Americans had the highest reports of good and very good/excellent general mental health.These results may be associated with socioeconomic status and related outcomes.The 2020 US Census found that Cubans lived in households with median net worths almost double those of Mexican/Mexican Americans and Puerto Ricans 35 .More research should analyze relationships between socioeconomic statuses and related indicators (i.e., educational attainment, employment status, etc.), as well as their impacts on mental health risk exposure and resource access across Hispanic/Latino subpopulations.
More than 1 in 3 Hispanic/Latino individuals who were receiving depression treatment before the pandemic reported treatment interference due to COVID-19.While Central American individuals reported the highest rates of depression treatment interference, this subpopulation was followed closely by Puerto Rican and Mexican/ Mexican American individuals.These mental health disparities, compounded by the fact that Puerto Rican and Mexican/Mexican American persons reported the highest rates of depression treatment pre-pandemic [36][37][38] as well as the highest rates of poor general mental health, are troubling.The treatment interference among Hispanic/ Latino persons is concerning because mental health treatment has not decreased in the general US population.One study found that between 2015 and 2019, there were widespread increases in depression across the US, though commensurate increases in treatment were not observed 39 .However, after the onset of the pandemic in 2021, the Centers for Disease Control and Prevention (CDC) reported that the percentage of US adults receiving mental health treatment increased from 19.2 to 21.6% 40 .This implies that the observed increase in treatment occurred despite COVID-19-related interferences experienced by Hispanic/Latino individuals, highlighting the extent of disparities in mental health and access to treatment.Thus, while treatment for depressive symptoms may serve as an indicator of healthcare access, it may be a less accurate indicator of mental health burden.For instance, while Cuban participants reported the lowest rate of poor mental health, they had the third highest prevalence for depression treatment before COVID-19.Conversely, although Dominican participants reported the fourth highest rate of depressive symptoms during the pandemic, they had the lowest prevalence of depression treatment before COVID-19.These findings emphasize an increased need not only to allocate mental health resources for the Hispanic/Latino population overall but also to enhance access and outreach efforts targeting more vulnerable subpopulations.
The aforementioned findings related to Puerto Rican and Mexican/Mexican American mental health and treatment utilization (and interference) dovetail with findings related to acculturation.For all the Hispanic/Latino ethnic subgroups in our study, most participants reported living in the US for more than 10 years.The Mexican/ Mexican American and Puerto Rican subgroups had the highest proportions of participants who lived in the US for more than 10 years.Reports of poor general mental health despite high levels of acculturation align with past research findings indicating that as length of stay in the US increases, immigrant health decreases [41][42][43] .Furthermore, while length of stay may increase assimilation and access to resources such as mental health treatment 44 , past research has found that underutilization is still common within immigrant communities.Immigrants often face barriers such as stigma, and low linguistic proficiency, and rely more on religious and social supports instead of more formal mental health treatments 38,[45][46][47] .Previous research has also found that mental health treatment access is limited by higher rates of poverty and lower rates of insurance among Hispanic/Latino populations compared to non-Hispanic White individuals 48 .These disparities may have been exacerbated during the pandemic.Therefore, in examining potential associations between years lived in the US and prevalence of depressive symptoms among Hispanic/Latino ethnic subgroups, future research should consider cultural differences and stigma that may impact mental health treatment utilization, despite increased assimilation and access to resources over time.Accounting for such considerations in future longitudinal studies could provide additional insights into depression treatment utilization among Hispanic/Latino subgroups and support the development of more tailored mental health interventions.
Additionally, past research has found that interventions based on Western concepts of mental health conditions can lead to poorer engagement and outcomes among ethnic minorities [49][50][51] .Nonetheless, culturally tailored, adaptable mental health interventions are associated with greater symptom improvements among ethnic minority groups [49][50][51] .In the case of Hispanic/Latino populations, such adaptations have taken the form of language-matching and training therapists in values such as respeto (obedience to authority) and familismo (the concept that both nuclear and extended family are central to and more important than the individual) 50 .While such adaptations have been observed to improve outcomes, further developments in research and public health interventions should evolve to ensure that the nuanced cultural backgrounds of various ethnic subgroups can be understood and catered to in the pursuit of mental health across populations ranging from Hispanic/Latino to Asian, African, and beyond 52,53 .
There are some limitations to our study.Though our study is exploratory in nature and provides disaggregated data on Hispanic/Latino groups to aid in hypothesis-generation, the majority of the participants were Mexican/ Mexican American individuals (45.1%).Thus, the results of this study are not representative or generalizable across all Hispanic/Latino subgroups in the US.Secondly, the ethnic subgroups of South American and Central American participants represent multiple countries which are not disaggregated within our results, and other ethnic subgroups had very limited survey participants.This highlights a need for oversampling of underrepresented Hispanic/Latino ethnic subgroups.Finally, the survey was only administered online and in English, potentially hindering participation based on English literacy and access to technology.

Conclusion
Overall, this study, which relied on disaggregated data, revealed a higher prevalence of depressive symptoms among Hispanic/Latino ethnic subgroups during the COVID-19 pandemic than might have been deduced from aggregated datasets.Whereas mental health treatment received by US adults increased in general over the course of the pandemic, this study presents evidence that such treatment was largely interfered with among the Hispanic/ Latino population and within more vulnerable ethnic subgroups (e.g., reporting higher prevalence of depressive symptoms and/or poor general mental health).Considering the study's findings, further research is warranted to better understand the mental health experiences of respective ethnic subgroups within the Hispanic/Latino community.This consideration can support more effective examination and execution of culturally protective strategies, health communication, and interventions.It will be crucial to support not only the general population but also the Hispanic/Latino ethnic subgroups with the resources to mitigate mental health disorder risks and factors that may lead to depression and its comorbidities.The results of our study can be used to encourage further research on disaggregated Hispanic/Latino ethnic subgroups and increase oversampling of underrepresented populations in addressing mental health disparities in population subgroups.
AbbreviationsDF Degrees of freedom IRB Institutional Review Board NIH National Institutes of Health PHQ-2 Patient Health Questionaire-2 SES Socioeconomic status US United States (24.8%).Most of the sample reported being in the US for 10 years or more (76.5%)and speak English well/very well (86.9%).When asked about COVID-19 vaccination status, the majority reported being vaccinated (67.1%).