According to Centers for Disease Control and Prevention (CDC) data, Latinos/Hispanics not only experience significant health disparities overall but also have a much higher risk for COVID-19 infection. Among the health disparities that increased during the COVID-19 pandemic, one that is rarely discussed is the fact that Hispanics have been experiencing disproportionately high rates of depression when compared to other populations. Indeed, they are 59% more likely to be depressed (40.3%) compared to non-Hispanic whites (25.3%) and report four times more suicidal thoughts/ideation compared to African-Americans.
Prior to the pandemic, Hispanics tended to seek and be offered less mental health services than other groups but were not necessarily at higher risk for depression compared to others. Factors associated with increased mental health issues during the pandemic are reportedly mostly associated with psychosocial stressors relating to social determinants of health. Lifestyle interventions led by community health workers or promotores (who happen to be experts in social determinants of health) have been well-received among Latinos and therefore could help mitigate the effects of COVID-19 related stressors on this population. In this context, we sought to assess the results of a lifestyle-based intervention with mental health components and the promotion of behaviors linked to mental health improvement.
Participants (N=63) were Latinas—mostly of Mexican descent—living in the Inland Empire who completed an 8-week long lifestyle-based program led by promotoras. The program emphasized weight management, high-fiber consumption, physical activity, and stress-management techniques based on the Community Resiliency Model (CRM)®—all behaviors that have been associated with improved mental health.
Demographic data, mental health assessments, and biometric measurements were collected at baseline, immediately after the last session and six weeks after the intervention. Another set of data was collected six weeks into the pandemic. Additionally, participants were asked to select among the following a reason they were grateful for during the pandemic: more time with family, health, free time for extracurricular activities, not having to go out and be exposed to COVID-19, more time to sleep, more time to prepare healthy meals, more time to exercise, and being able to see the world and their community unite. They were also asked to share what they felt helped them cope. All data were analyzed using SPSS, v. 25.
We found that participants had lower depression scores—a decrease from 5.47 (±4.61) to 3.97 (±4.95), p=.02 (Cohen's d = 0.47)—following the program. At the three-month follow up, which happened to include the beginnings of the COVID-19 pandemic, we found that depression levels had gone up compared to immediate post-levels (5.93±5.36, p=.04).
However those who expressed gratitude for having more time to prepare healthy meals, to engage in extracurricular activities, or to exercise had a downward trend towards less depression after the intervention in spite of the pandemic (from 5.08±5.58 to 4.42±2.94, p=.26, from 4.00±5.43 to 2.88±2.95, p=.26, and from 4.43±5.47 to 3.14±2.04, p=.24, respectively).
Those who did not express gratitude for any of these three categories reversed to depression levels even higher than at baseline (from 3.22±4.49 to 6.94±6.38, p=.001, from 3.95±4.90 to 7.05±5.65, p=.004, and from to 3.83±4.91 to 6.78±5.79, p=.004, respectively).
Additional analyses also revealed a positive correlation between change in daily amount of time spent sitting down (compared with pre-COVID-19 time period) and pandemic depression scores (rs=0.45, p=.01).
Lastly, when asked what they used to neutralize the stress and overcome the distress experienced during the pandemic, only 10% mentioned physical activity. More than half of all participants responded prayer/worship (57%) and reading (54%), and 32% mentioned the use of CRM stress-reducing techniques.
While our results suggest several factors at play, we feel that, during this pandemic, encouraging individuals to engage in moderate physical activity such as walking or doing some activities such as Zumba or stretching and dancing with friends or family by Zoom or alone should be emphasized, especially in this vulnerable population.
This study was funded by the Ardmore Institute of Health.
Maud Joachim-Célestin, DrPH is an assistant research professor at the Loma Linda University School of Behavioral Health and adjunct faculty at the School of Medicine whose primary professional interests include translational research in chronic disease prevention among underserved populations. She has provided counseling, program planning and health education to Latino communities in California, New York, and abroad. More recently, she co-developed and oversaw a culturally-tailored diabetes prevention program implemented by community health workers serving Latinos living in the Inland Empire.