Caregiving In Context: Psychological Distress and Discrimination Among Latinx Families Caring for Loved Ones with Psychiatric Disabilities

Background: Latinx family caregivers of people with psychiatric disabilities (PWPD) contend with multiple stressors beyond those related to caregiving, such as discriminatory experiences, that can contribute to cumulative disadvantage and poor mental health. Most studies examining caregiver mental health have focused on individual and interpersonal stress and coping factors, rather than contextual factors. Informed by the sociocultural stress and coping framework, which considers sociocontextual factors such as discrimination in caregiving and its impact on well-being, we examined individual, interpersonal, and sociocontextual factors associated with Latinx caregiver psychological distress. We hypothesized that contextual factors such as discrimination would be associated with increased psychological distress among Latinx family caregivers of PWPD beyond individual and interpersonal factors.

Methods: Data came from a mixed-methods study examining sociocultural factors associated with stress and coping among 88 Latinx family caregivers and their loved ones with serious mental illness (i.e., schizophrenia spectrum, bipolar, major depression) recruited from outpatient psychiatric and community settings. Pearson bivariate correlation analyses examined whether relationships between variables were significant to develop a parsimonious model for primary analyses. Measures included Behavior and Symptom Identification Scale-24, Brief Symptom Inventory-18, Family Burden Interview Schedule, Religious Background and Behavior, and Everyday Discrimination Scale, including a question on reasons for discrimination. Using hierarchical linear regression, we tested the study hypothesis in steps: individual (caregiver age, PWPD symptom severity), interpersonal (burden, religiosity and spirituality), and contextual (everyday discrimination) variables. Semistructured interviews were conducted with a subset of families to examine stress and coping processes including discrimination and analyzed using thematic analysis.

Results: Family caregivers’ average age was 48 years, and most were mothers (n = 40, 46%); PWPD’s average age was 38 years. Most interviews were conducted in English with caregivers (n = 62, 71%) and PWPD (n = 76, 86%), although on average, caregivers (M = 3.24) reported equal preference for English and Spanish (5-point scale) and PWPD (M = 3.68) preferred English most of the time. Discrimination due to race, ethnicity, and color was reported by 50% of caregivers. Correlations indicated significant relationships among variables of interest. Regression analysis for the final model significantly predicted increased caregiver psychological distress, F(5, 82) = 7.81, p < .001, R² = .32 and adjusted R² =.28, indicating our model predicted almost 30% of the variability in psychological distress (individual variables: 9%, interpersonal variables: 15%, contextual variables: 8%). Specifically, higher burden (β = .31, p = .002), lower religiosity and spirituality (β = -.21, p = .04), and greater discrimination (β = .31, p = .003) remained significant predictors in the final model. Thematic analysis of discrimination experiences revealed three main themes: discrimination due to immigration policies, intragroup discrimination due to acculturation, and discrimination when leaving ethnic enclaves.

Conclusions and Implications: Psychological distress associated with caregiving responsibilities and experiences of discrimination can negatively affect Latinx caregivers’ mental health, with broader implications for family well-being, including PWPD. Therefore, beyond addressing caregiving-related challenges, it is critical that family-based interventions also consider contextual stressors like discrimination and support coping resources that promote well-being.