by Agustín Durán. This article originally appeared in Spanish in La Opinión. Para leer en español, haga clic aquí.

Elders stay active at the PACE program’s adult day health center at AltaMed in Los Angeles. (Agustín Durán)

Since her daughter Clara died, Gladys, 58, has barely participated in family celebrations; she is constantly sick, and her appearance seems very fragile.

She says that everything is fine, that they are the ailments of her age. She refuses to see a therapist and affirms she is not crazy. Gladys blames her sadness and lack of desire to do anything as pure figments of her children’s imaginations.

The truth is that 14 years have gone by since Clara died, but Gladys gives those she meets the impression that her daughter just died yesterday. Still, the immigrant from Guadalajara, Mexico, denies her suffering and says, “Everything will be okay–it is just a matter of time.”

“She says that everything is normal and all her health problems are attributed to her age,” says Josefina, her eldest daughter. Like her mother, she prefers not to use her surname, because she says, these issues are only spoken with family members. “They are not meant to be aired in public,” she added.

A study by María P. Aranda, PhD, of the Edward R. Roybal Institute of Aging at the University of Southern California indicates that 30% of Latino patients age 55 or older show symptoms of depression during appointments with their general medicine doctors, but they do not know it or they refuse to accept that diagnosis. Those who did accept it discovered that it’s not easy to find a therapist who speaks Spanish.

Untreated Depression Can Worsen

The study, titled “The Role of Culture and Language in Depression Care Experiences Among Older Latinas/os and Health Care Providers,” (Innovation in Aging, Oxford University Press, November 2019) also found high rates of chronic medical conditions and functional disabilities, compared to other racial or ethnic groups.

One problem is that untreated depression during old age can lead to deterioration in general health, increased disability, illness and mortality, including from suicide. Only one in ten older adults with depression receive adequate care, the report notes.

Aranda led the study, which included 259 Latino participants, most who spoke Spanish as their first language. She indicated that clinical depression has been a psychiatric disorder that manifests in different indicators, such as problems with concentration, lack of energy or will to live, sleeping disorders, lack of appetite and very low levels of self-esteem, among other symptoms.

Speaking at the Gerontological Society of America Annual Scientific Meeting in Austin, Texas, in November, Aranda said these problems are more present in the elderly Latino community because culturally the group is not used to being treated by psychologists. Also, those visiting a therapist would face a negativity about mental illnesses and would fear people saying they must be “crazy.”

Aranda emphasized another aspect that may intensify the problem of treating clinical depression among Latinos is poor access to healthcare programs. It is not uncommon to find older people without medical insurance, particularly because of their difficult economic or legal status.

Also, she explained, even non-Latino doctors who have mastered Spanish tend to be unfamiliar with the Mexican or other Latino cultures and cannot grasp social aspects that may be key to understanding clinical depression in their group.

A Third of California Elders Are Immigrants

In 2017, the California Public Policy Institute (PPIC) indicated that 34% of the total (5,401,149) seniors in the state have been born outside the United States. That is, more than 1.8 million seniors did not speak English as their first language.

Vilma Turcios lost two children in El Salvador in the late 1970s as a result of the civil war. She spent 20 years looking for them without success. Since then, she knows she has suffered from depression, but it was not until a few years ago that she was finally able to find a program that would help her get beyond it.

She said that her doctor “has helped me a lot. He listens to me in Spanish and gives me a lot of confidence to share my things. He gives me suggestions to know how to deal with my problem.” She attends sessions two or three times a week at the AltaMed Program for All-Inclusive Care of the Elderly in downtown Los Angeles. Turicos, age 80, said many people she knows think depression is madness or that it is a thing of the devil. She stressed, “I do not. I have come to understand that depression is a very dangerous disease.”

Her physician, Alfonso Sánchez, MD, said that the Spanish-speaking monolingual population has a hard time accepting that they are suffering from depression due to the belief that only “crazy” people go to the psychologist.

When the patient’s resistance is strong he recommends talking to a pastor or priest. Doing so can help them understand that their experience is common to many people and that they don’t have to suffer extreme mental illness to seek relief from a therapist. In addition, patients who benefit from positive treatment results may share that information with family and friends, thus bringing more confidence among other people in seeking help.

Stress or Age Only Two Possible Factors

Aranda indicated that, for some people, the fact of developing some type of clinical depression is not always caused by stress as it is often evaluated. Among other factors are genetics; a change in the brain due to dementia; or a dramatic change or transition in life, such as an accident, the loss of a loved one, or even a change in work can cause or intensify the condition.

A common mistake, said Aranda, is that older people or health providers attribute such problems or symptoms to a person’s age. She emphasized the importance of talking to a doctor regularly to get help, such as a prescription for anti-depressant medication, or referral to an emotional counseling program for older adults.

Some try to hide the symptoms of depression beneath an upbeat attitude, while other seniors may become so depressed they do not want to leave their home, often justifying their need to stay indoors. Although these elders do not appear to be ill, their isolation over time can lead to depression.

Aranda said that regardless of the type of depression one might have, it is always important to see a physician, who may offer treatment before the condition gets worse. She said that currently antidepressant medications help a great deal and, in many situations, she has seen positive changes in people.

She also stressed the need for a communication campaign to improve the public’s understanding that visiting a mental health therapist is an normal option to improve one’s health, not only one for those with extreme mental illness. Catching treatable depression early, often prevents problems from becoming severe. Aranda added that the mental health profession needs to increase the number of bilingual professionals and ensure that all medical insurance offers a bilingual system understandable to the Spanish-speaking community.

Agustín Durán, Metro Editor of La Opinión in Los Angeles, wrote this article supported by a a journalism fellowship from The Gerontological Society of America, the Journalists Network on Generations and the Silver Century Foundation.

The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.