









































Vol. 1, Issue 1


Vol. 1, Issue 1 

 

 

ENGAGE! 2019 Vol. 1 No. 1 https://doi.org/10.18060/22817 

Copyright © 2019 Author(s). 

 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. 

A MIXED-METHODS, COMMUNITY-BASED STUDY TO IDENTIFY PREDICTORS OF 
DEPRESSION IN LATINO ADOLESCENTS BY GENDER 

SILVIA M. BIGATTI, VIRNA DIAZ, KATRINA K. CONRAD, MICHELLE RAMIREZ, AND TESS D. 
WEATHERS

ABSTRACT 

Latino adolescent depressive symptoms are a 

growing national problem. In this mixed-method, 

community-based participatory research study we 

quantitatively examined predictors of depression 

known to impact adolescent mental health that are 

amenable to interventions. Concurrently, we 

qualitatively assessed parents’ perceptions of mental 

health problems in children, their causes and potential 

solutions. The data from parents (n = 108) was 

obtained in focus groups led in Spanish, and the data 

from the majority of adolescents (n = 86) was obtained 

in English language surveys. Among the adolescents 

there was an even representation of males (47.7%) and 

females (52.3%), Mage = 15.24 (SD = 1.97). Nearly half 

(47.7%) of the adolescents were experiencing minor 

depression and one in ten (10.5%) were experiencing 

major depression according to their scores on the 9-

item Patient Health Questionnaire (PHQ-9).  

Adolescent participants reported low 

acculturative stress, average social support, and high 

mastery, as well as highly functional families. Males 

reported higher self-mastery than females and lower 

acculturative stress. Predictors of depression differed 

by gender. For males, self-mastery predicted lower 

depressive symptoms; for females acculturative stress 

predicted higher depressive symptoms. The focus 

groups with parents supported and expanded 

quantitative findings. The parents demonstrated a 

keen awareness of depression in teens and their own 

contributions to the problem, including their efforts to 

maintain their culture of origin, which may contribute 

to their teens’ acculturative stress.  Parents also 

reported difficulties knowing what steps to take and 

finding resources. The additional dimension of 

parental voice is often missing from studies of 

adolescents, and here it clarified many of the issues 

identified in the teens. These findings suggest the need 

to focus on mental health in this population, 

potentially developing differential interventions by 

gender and taking a family systems approach.  

 

Keyword: Depression, acculturative stress, self-

mastery, Latino Adolescents, gender. 

INTRODUCTION 

In the United States, more than four-in-ten 

Latinos can be found in 10 metropolitan areas, six of 

which are located in California and Texas (Brown & 

Lopez, 2013). However, the Latino population has been 

establishing roots in other communities across the 

country. From the year 2000 to 2011, among the 60 

https://doi.org/10.18060/22817
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ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 86 

metropolitan areas with the largest growth in Latino 

population, Indianapolis, Indiana saw the highest 

increase at 197% - this represents a growth from 33,290 

to 84,466 in that decade alone (Brown & Lopez, 2013). 

Many of those that arrived in Indiana during those 

years settled in the state and started families. Among 

the then 426,000 individuals who identified as Latino 

in the whole state, 32% were foreign born, and 76% 

were of Mexican origin, 8% Puerto Rican, 6% Central 

American, 2% Cuban/Dominican, 2% South American, 

and 6% Other (Strange, 2013).  The average age of the 

foreign born subgroup was 36, and the average age of 

the US born was 16 (Pew Research Center, 2014). These 

Latino parents are now facing the challenges of raising 

adolescents in a culture and environment different 

from their own, and far from extended family support. 

In these newer migration destinations for the Latino 

population, Latino parents cannot depend on the 

resources and connections present in communities 

with long-established Latino populations, and are 

more likely to have unmet needs, especially parenting 

support. This is a problem given the mental health 

needs identified in Indiana teens, and Latino teens in 

particular. 

Specifically, compared to the US as a whole 

(11.9%), a higher percentage of Indiana youth (14.6%) 

experienced a major depressive episode in 2014 

(SAMHSA, 2015). A 2015 report from the Youth Risk 

Behavior Survey (YRBS) identified higher rates of 

suicide attempts in Latino youth (15.5%) in the 

previous year compared to their non-Hispanic White 

peers (8.7%) (CDC, 2015). These data point to a serious 

problem for Latino youth, one that VD, the community 

partner, and SB and her team, the academic partners, 

decided to explore jointly given their shared interests 

in the wellbeing of this population. 

We sought to identify predictors of depression 

in Latino youth, as a first step in developing 

community-based prevention programs. We examined 

intrapersonal factors (acculturative stress, mastery) 

and interpersonal factors (social support, family 

functioning) known to impact adolescent mental 

health in general and to be amenable to interventions.  

Acculturative stress may contribute to depressive 

symptoms among the teens who are themselves 

immigrants or have immigrant parents (Lawton & 

Gerdes, 2014; Lorenzo-Blanco, Unger, Baezconde-

Garbanai, Ritt-Olson, & Soto, 2012; Roche & 

Kuperminc, 2012). Acculturative stress is the stress 

experienced as individuals go through the process of 

acculturation and adjustment between their native 

cultural values and customs and the mainstream 

American customs and cultural values (Lawton & 

Gerdes, 2014; Stein, Gonzalez & Huq, 2012). For these 

teens, acculturation to the US may happen more 

quickly than for their parents, potentially causing 

problems at home (Cox Jr., Zapata Roblyer, Merten, 

Shreffler & Schwerdtfeger, 2013; Lawton & Gerdes, 

2014).  

Latino parents cannot depend on the 
resources and connections present in communities 
with long-established Latino populations, and are 
more likely to have unmet needs, especially 
parenting support. This is a problem given the 
mental health needs identified in Indiana teens, 
and Latino teens in particular. 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 87 

Teens experiencing acculturative stress may be 

at risk for depression; yet a well-functioning family, as 

well as self-mastery and social support, may be 

protective (Kuperminc, Wilkins, Roche & Alvarez-

Jimenez, 2009; Lorenzo-Blanco et al., 2012). A family 

that is strong and cohesive will not only protect against 

stress and depression, but may be less likely to 

contribute to stress, especially acculturative stress 

(Dillon, De La Rosa & Ibañez, 2013). Teens high in self-

mastery are more likely to see stressors as temporary 

events that they will be able to overcome, and are less 

likely to experience depression. Social support is 

instrumental to mental health and protective against 

depression for youth (Rueger, Malecki, Pyun, Aycock & 

Coyle, 2016). Low peer, family and school social 

support are associated with suicidal ideation and 

attempts in youth (Miller, Esposito-Smythers & 

Leichtweis, 2015).  

During adolescence especially, females face 

higher risk for depressive symptoms than males overall 

(Mojtabai, Olfson & Han, 2016). Moreover, adolescent 

Latina females are more likely to suffer from more 

severe depressive symptoms than their male 

counterparts, and are more likely to attempt suicide 

than any other race and ethnicity (Lorenzo-Blanco et 

al., 2012), thus gender is an important factor to 

investigate when considering the mental health 

outcomes of Latino adolescents (Lorenzo-Blanco et al., 

2012).       

Therefore, in the present study we examined 

depressive symptoms among Latino teens in an 

emerging Latino community, focusing on gender 

differences, acculturative stress, and protective factors, 

such as family support. We assessed parents because 

parental perceptions are key to understanding youth 

mental health issues (Miller, Esposito-Smythers & 

Leichtweis, 2015). 

METHODS 

COMMUNITY-BASED PARTICIPATORY 

RESEARCH (CBPR) 

The present study was conducted using a 

Community-Based Participatory Research (CBPR) 

approach. CBPR “equitably involves all partners … with 

a research topic of importance to the community with 

the aim of combining knowledge and action for social 

change to improve community health and eliminate 

health disparities” (Wallerstein & Duran, 2010, p. S40).  

We employed several key principles of 

community-based research as described by Israel and 

colleagues (1998). First, we developed the study 

collaboratively after discussing the challenges that 

Indiana Latinos face. Once the study was developed, 

the entire team built upon the strengths of the 

community partner in terms of knowledge about the 

community and their existing cadre of community 

contacts for recruitment purposes. Throughout the 

duration of the study, both the community partner and 

the academic partners were actively engaged and 

included in all phases of research. Both the community 

partner and academic partners conceptualized and 

wrote this manuscript. 

The study described here was the first 

collaboration of this community-university 

partnership. The academic partners (SB, KC & TW) 

shared with IMHC their interest in focusing on Latino 

youth mental health after exploring statistics regarding 

this health disparity. The Indiana Minority Health 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 88 

Coalition (IMHC) facilitated the connection with the 

Latino Health Organization. Once we were introduced, 

we began to jointly explore the literature and decide 

on the focus and methodology of the study, which was 

funded by IMHC.  

DESIGN 

The study employed a concurrent mixed-

methods research design with different participants for 

each method of data collection. Quantitative data were 

obtained from adolescent participants via several 

survey instruments, while at the same time 

complementary qualitative data were collected from 

parents in focus group sessions. These adolescent and 

parent study sessions were held simultaneously. The 

academic partners and the community partner were 

involved in data collection. 

RECRUITMENT 

Following university IRB approval, the 

community partner initiated recruitment. Self-

identified Latino adolescents and their parent(s) living 

in the Indianapolis metropolitan area were eligible to 

participate. Phone calls were made and/or letters were 

sent to clients of the community partner with 

adolescent children, requesting that only one 

adolescent per family participate, chosen by the 

parent. The community partner also sent flyers and 

letters to community centers or churches where she 

has pre-existing ties and approval. Families who 

learned about the study through the flyers or letters 

and were interested in participating called the 

community partner and signed up for the study. Eight 

meetings were planned and held in community 

locations in two counties, one urban, one suburban, 

over a time period of four months. Each session lasted 

60-90 minutes.

CONSENT AND ASSENT

The study was thoroughly explained in Spanish 

to parents and adolescents. Opportunity was given to 

all potential participants to ask questions. A study 

information sheet was available for their convenience. 

It was made clear to both parents and adolescents that 

the responses that each gave would be treated as 

confidential and anonymous by the study team. A 

process of implied or passive assent/consent was 

employed; attendees who did not wish to participate 

following the study explanation were given the 

opportunity to leave the event. At this point, parents 

and adolescents were separated into different rooms in 

the facility to conduct the separate assessments. To 

participate, at least one parent and one teen per family 

had to voluntarily consent to be part of the study; 

however, in some cases both parents participated in 

the focus groups. 

STUDY PROCEDURES 

Adolescents 

 No identifying information was collected from 

any participant, primarily to encourage adolescents to 

answer honestly without worry that their parents may 

discover how they answered. The researchers offered 

to each adolescent participant 1) written surveys in 

English or Spanish, whichever they preferred, or 2) the 

option to have the survey questions read out loud 

(privately) in the case that there were any participants 

who had trouble reading or writing. Eight (4 girls and 4 

boys) completed surveys in Spanish; none asked to 

have the surveys read to them. They were informed 

that they could ask any questions if needed, and also 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 89 

stop if they felt tired or uncomfortable. On average, it 

took approximately 60-75 minutes to complete the 

questionnaires and participants received a $10 gift card 

for their time. KC managed the adolescent data 

collection with the help of research assistants. 

Parents 

At the same time the adolescents were 

completing their questionnaires, parents participated 

in a focus group session. More than one parent per 

child could, and sometimes did, participate. Members 

of the group were asked a variety of questions in 

Spanish to explore their perspectives on the overall 

study theme of stress and sadness among Latino 

adolescents.  

Parents were asked to think of adolescents in 

general, including their own children and their 

children’s friends, to reduce fear of personal disclosure. 

Questions included: 

1) How much stress do you think adolescents

are under, and why?

2) What does this stress look like in

adolescents? (eg.: he/she cries frequently,

sleeps too much, is not hungry, does not

socialize)

3) What do you think is causing stress in

adolescents?

4) What might parents do that causes more

stress to their adolescent child?

5) What can parents do to help their

adolescent child deal with stress?

6) How sad do you think adolescents are in

general, and why?

7) How worried are you about the behavior of

adolescents in their daily life environment,

and why?

8) What specifically are adolescent children

doing that worries you, and why?

9) How much do you think the new culture is

related to the stress in Latino adolescent

children, and why?

These focus group discussions were co-led in 

Spanish-only by SB and VD. The choice of Spanish-

only was based on the community partner’s knowledge 

that adults in the Latino community she serves are 

mostly limited English proficient. She informed 

parents of the language of the focus groups when she 

recruited them. Mean number of parents per focus 

group was 13.5 (median = 13), with a low of 11 parents in 

one of the groups and a high of 15 parents in two of the 

groups. Parents were told that they could stop 

participation at any time if they felt uncomfortable, 

and none were required to answer any of the 

questions. No identifying information or demographics 

were collected from parents on advice from the 

community partner (VD), to encourage participation, 

increase their comfort level with participation, and 

confirm the anonymous nature of participation. With 

participants’ consent, the discussions were audio-

recorded for subsequent transcription. Upon 

conclusion of each focus group, each parent received a 

$10 gift card as a token for participation.  

MEASURES (FOR ADOLESCENTS)  

Demographics. The demographic form 

included age, gender, immigrant status (immigrant, 

first, or second generation), language most spoken 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 90 

with friends, language most spoken with family, and 

proportion of Latino friends.  

Depression. To measure depression levels, the 

PHQ-9 (Kroenke & Spitzer, 2002) was utilized. The 

PHQ-9 is a 9-item instrument that measures different 

manifestations of depressive symptoms and has been 

validated in several languages, including Spanish. The 

answers selected (on a 4-point scale) range from 0 = 

Not At All to 3 = Nearly Every Day. Sample items 

include: “little interest or pleasure in doing things,” 

“feeling down, depressed, or hopeless,” and “feeling 

tired or having little energy.” Scores range from 0 to 27 

when computing raw scores. There are also cut-offs for 

depressive severity diagnostic categories. Scores from 0 

to 4 suggest minimal or no depression, 5 to 9 suggest 

mild depression, 10 to 14 suggest moderate depression, 

15 to 19 suggest moderately severe depression, and 

scores from 20 to 27 suggest severe depression. In the 

literature, the PHQ-9 has been shown to be reliable. In 

a study of Hispanic American women, the reliability 

was α = .84 in the sample who chose the English 

version and α =.85 in the sample who chose the 

Spanish version (Merz, Malcarne, Roesch, Riley, & 

Sadler, 2011). Reliability in the present sample was α = 

.87 for the English version. 

Acculturative Stress. The Social, Attitudinal, 

Familial, and Environmental (SAFE) scale (Mena, 

Padilla & Maldonado, 1987) was utilized to measure 

acculturative stress. The SAFE scale is a 24-item survey 

rated on a 5-point scale from 1 = Not Stressful to 5 = 

Extremely Stressful. Sample items include: “It bothers 

me that family members I am close to do not 

understand my new values,” “It bothers me that I 

cannot be with my extended family,” and “I don’t feel 

at home in this country.” A ‘does not apply’ response 

option was also available, with a score of 0. Thus, 

possible scores ranged from 0 to 120. In the literature, 

the SAFE scale has been shown to be reliable with α = 

.89 (Mena et al, 1987). VD, SB and MR translated the 

SAFE into Spanish. Reliability in the present sample 

was α = .90 for the English version. 

Social Support. The Child and Adolescent 

Social Support Scale (CASSS) (Malecki, Demaray & 

Elliot, 2000) was utilized to measure perceived support 

from family and school. The CASSS consists of 60 

items that may be broken down into five subscales of 

12 items rated on a 6-point scale from 1 = Never to 6 = 

Always. Subscales measure perceived social support 

from parents, teachers, class, school, and close friends. 

The full scale ranged from 60 to 360, with each 

subscale ranging from 12 to 72. Sample items include: 

“My close friends understand my feelings,” “My 

teachers make sure I have what I need for school,” and 

“My parents show they are proud of me.” In the 

literature, the CASSS has been shown to be reliable 

with α = .96 (Malecki & Demaray, 2003). We used the 

full scale in the present study to preserve statistical 

power and to capture the totality of available support 

from all sources. VD, SB and MR translated the CASSS 

into Spanish.  Reliability in the present sample was α = 

.97 for the English version. 

Self-Mastery. In order to measure self-mastery, 

Pearlin and Schooler’s (1978) Self-Mastery Scale was 

utilized. The Self-Mastery Scale is 7 total items that are 

scored on a 5-point scale from 1 = Strongly Disagree to 

5 = Strongly Agree. Scores had possible ranges from 7 

to 35. Sample items include: “I have little control over 

the things that happen to me,” “I often feel helpless in 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 91 

dealing with the problems of my life,” and “What 

happens to me in the future mostly depends on me.” In 

the literature, the Self-Mastery Scale has been shown 

to be reliable with α = .74 -.75 (Scheier, Carver, & 

Bridges, 1994). Reliability for the Spanish version has 

been reported at α = .74 (Rini, Wadhwa & Sandman, 

1999).  Reliability in the present sample was α = .80 for 

the English version.  

Family Functioning. The Family APGAR 

(Smilkstein, 1978) was utilized to measure perceived 

family functioning.  The Family APGAR consists of 5 

items that are scored on a 5-point scale ranging from 1 

= Always to 5 = Never. Scores had possible ranges from 

0 to 10. Sample items include: “I am satisfied with the 

way my family and I share time together,” “I am 

satisfied that my family accepts and supports my 

wishes to take on new activities or directions,” and “I 

am satisfied that I can turn to my family for help when 

something is troubling me.” In the literature, the 

Family APGAR has shown to be reliable with α = .77 

(Gómez & Ponce, 2010). The Spanish version has 

shown reliability of α = .84 (Bellon-Saameno, Delgado-

Sanchez, Luna del Castillo, & Lardelli-Claret, 1996). 

Reliability in the present sample was α = .86 for the 

English version.   

DATA ANALYSIS PLAN 

After each collection session, surveys were 

taken back to the academic team’s office where the 

results were securely entered into statistical software 

(IBM® SPSS® Statistics). Our first step was to describe 

the sample and the variables of interest, and determine 

relations among them. For this purpose, descriptive 

and bivariate analyses were completed for each 

collected measure. Our second step was to determine 

what factors may explain depression and whether 

these differed by gender. For this purpose, regression 

analyses were used to examine predictors of depression 

and multivariate analyses of variance to compare males 

and females. A power-analysis for the regressions with 

G*Power, alpha = .05, power = .80, four predictors 

indicated a needed sample size of 84 (Faul, Erdfelder, 

Buchner & Lang, 2009). 

Focus groups were analyzed following a 

thematic approach (Boyatzis, 1998). Audiotaped focus 

group discussions were transcribed and translated 

verbatim by one of the authors (MR). Independently, 

MR and SB identified themes, and then met to discuss 

the themes and reach agreement on the set of themes 

to be used.  They each then coded the transcripts 

according to the themes. Once the transcripts were 

coded, VD and KC verified the results. Cross-

comparisons of focus group results for consistency 

with findings from adolescent surveys are detailed 

below. 

RESULTS 

DEMOGRAPHICS 

Our study sample consisted of 86 Latino 

adolescents (Mage = 15.24, SD = 1.97), and 108 parents.  

Demographics were not collected from parents 

participating in focus groups at the recommendation 

of the community partner to increase participation and 

facilitate disclosure. The responses from adolescents 

show that all but 3 parents were foreign-born (see 

Table 1). Among the adolescent participants, there was 

even representation of males (47.7%) and females 

(52.3%).  See Table 1 for additional adolescent 

demographic information by gender; Chi-square 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 92 

analyses showed no differences by gender in any of 

these demographic variables.  

Proxy measures of acculturation among the 

demographics, such as language spoken outside the 

home (English was between 82.2% and 91.1% of the 

sample in the present study) and choice of friends 

(Mostly or All Hispanic, between 57.7% and 68.3%), 

suggest that overall, this sample of adolescents was 

already acculturated. This is noteworthy given that 

most of the adolescents were foreign-born (68.9% for 

females, and 56.1% for males).   

Table 1: Demographic information by gender 

Females (n=45) Males (n=41) 

Age Mean=15.20 (SD=2.19) Mean=15.29 (SD=1.72) 

Immigrant status ¹ 

    I was born outside US 68.9% 56.1% 

    I was born inside US 28.9% 39% 

    My parents and I were 

born in US 

2.2% 4.9% 

Ethnicity of friends ² 

    Mostly Hispanic 53.3% 61% 

    Mostly not Hispanic 35.6% 24.4% 

    All Hispanic 4.4% 7.3% 

    All not Hispanic 6.7% 7.3% 

Language for survey 

    English 91.1% 90.2% 

    Spanish 8.9% 9.8% 

Language with friends 

    English 82.2% 90.2% 

    Spanish 17.8% 9.8% 

Language with family 

    English 4.4% 4.9% 

    Spanish 95.6% 95.1% 

Notes: 
¹Coded as born in US vs. Not for analyses 
²Coded as all or most Hispanic or Not for analyses 

No statistically significant differences by gender on any of 
these variables. 

DESCRIPTIVE AND BIVARIATE ANALYSIS 

Means and standard deviations for study 

variables by gender can be found in Table 2. When 

examining cut-off scores for the PHQ-9, nearly half 

(47.7%) were experiencing minor depression and 10.5% 

were experiencing major depression. As a group, 

participants reported low acculturative stress, average 

social support and high mastery; they also reported 

highly functional families. Boys and girls differed in 

self-mastery, F(1,84) = 6.89, p = .011, with boys scoring 

higher than girls. They also differed in acculturative 

stress, F(1,84) = 6.68, p = .010, with girls scoring higher 

than boys. 

Table 2: Correlations and Means (SD) among Study Variables by 
Gender 

FEMALES 

PHQ-9 SAFE CASS MAST APGAR 

PHQ-9 Depression 

(raw score) 

♦ .679** -.306* -.302* -.268 

SAFE – Acculturative 

Stress 

♦ -.281 -.459** -.399** 

CASSSS – Social 

Support 

♦ .069 .247 

MAS – Self-Mastery ♦ .061 

APGA – Family 

Functioning 

♦

Mean 7.8 37.33 129 24.26 7.58 

SD 5.48 20.28 20.54 4.68 2.32 

Minimum 0 2 71 14 1 

Maximum 25 80 180 32 10 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 93 

MALES 

Note. *p < .05; **p < .01 
Statistically significantly different means by gender: self-mastery (p = 
.011) and acculturative stress (p = .010) 

Pearson correlations among variables are 

shown in Table 2, separated by gender. In general, 

correlations were low to moderate for all variables; 

however, it is noteworthy that correlations among 

some variables differed in strength by gender. In order 

to determine whether the differences in correlations 

were statistically significant, we used Fisher r-to-z 

transformation. With this approach we found that the 

correlations between depression and self-mastery were 

statistically significantly different by gender (z = 2.04, p 

= .04), as were the correlations between social support 

and family functioning (z = -2.72, p = .007).  

We also examined demographic variables and 

their relationship to depression. Age was moderately 

correlated to depression (r = .32, p = .003); closer 

examination showed scores in depression ranged from 

a low of M = 3.44 (SD = 1.02) at age 12, to a high of M = 

12.78 (SD = 2.59) at age 18, with fluctuating scores 

across ages. One-way analyses of variance examined 

differences in depression by gender, immigration 

status, and ethnicity of friends. Females reported 

higher scores in depression than males, F(1,84) = 4.172, 

p = .044. When we examined males and females by 

severity of depression based on cut-off scores, females 

were more likely to be at least minimally depressed 

than males (73.3% compared to 41.5%; see  Table 3). 

There was no difference in PHQ-9 scores between 

those born in the US and those born outside the US, 

nor among those whose friends are mostly or all 

Hispanic or not (p > .05). 

Table 3: PHQ-9 Depression Diagnostic Categories by Gender 

Diagnostic Category Female  

n (%) 

Male 

n (%) 

Minimal or no depression (score ranges 0-4) 12 (26.7) 24 (58.5) 

Mild depression (score ranges 5-9) 19 (42.2) 8 (19.5) 

Moderate depression (score ranges 10-14) 9 (20) 5 (12.2) 

Moderately severe (score ranges 15-19) 4 (8.9) 2 (4.9) 

Severe depression (score ranges 20-27) 1 (2.2) 2 (4.9) 

MAIN QUANTITATIVE ANALYSES 

In order to examine the combined relationship 

of all predictor variables with depression, we ran 

regression analyses. Separate regression analyses were 

run examining predictors of depression for each 

gender to examine strengths of association and 

prediction values between groups. For both males and 

females, depressive symptoms (total PHQ-9 scores), 

the dependent variable, were regressed onto the 

various predictors: acculturative stress (SAFE), social 

support (CASSS Total Scores), self-mastery, and family 

functioning (Family APGAR). The regression for 

females was statistically significant, F(4,40) = 9.09, p < 

PHQ-

9 

SAFE CASS MAST APGAR 

PHQ-9 Depression 

(raw score) 

♦ .485** -.430** -

.646** 

-.498** 

SAFE – 

Acculturative Stress 

♦ -.250 -.671** -.273 

CASSSS – Social 

Support 

♦ .416** .697** 

MAS – Self-Mastery ♦ .397* 

APGA – Family 

Functioning 

♦

Mean 5.29 27.51 123.01 27.07 7.29 

SD 5.91 14.07 22.66 5.27 3.08 

Minimum 0 4 60 16 0 

Maximum 21 61 183 35 10 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 94 

.01. The full model explained a total of 42.4% of the 

variance in depression. Only acculturative stress 

showed enough strength to enter the regression 

equation (β = .656, p < .001), with higher stress 

predicting higher depression. The regression for males 

was also statistically significant, F(4,36) = 8.69, p < .01. 

The full model explained a total of 49.1% of the 

variance in depression. Only self-mastery showed 

enough strength to enter the regression equation (β = -

.467, p = .010), with lower mastery predicting higher 

depression. These findings suggest that although all 

predictors as a whole played a role in male and female 

depression, there was one specific variable in each 

group (stress for females and self-mastery for males) 

that stood out. 

QUALITATIVE FINDINGS FROM PARENT 

FOCUS GROUP  

Five major themes emerged from the eight 

focus group with parents (n = 108). These were: 

1) Parents’ awareness and worry about depression

in their children

2) Parents’ awareness that their own behaviors

and emotions impact their children

3) Parents’ lack of resources to deal with stress in

the family

4) Minority/immigrant status is both a cause of

depression and a barrier to solutions

5) Conflicts between parents and teens are caused

by cultural adaptation differences.

THEME 1: 

This first theme addressed the focus of the 

present study, i.e. the depressive symptoms in Latino 

teens. Parents were asked several questions about this 

topic, and were informed that this was the focus of the 

study. It is therefore not surprising that describing 

teens’ depressive symptoms was a major component of 

parent responses. The teens’ externalizing and 

internalizing behavior made it clear to parents that 

something problematic was happening. Some of the 

comments of parents that indicated problematic 

changes in behavior included:  

“They do not want to talk, so one can tell that 

something is going on whether it be in school, 

with friends, at home.” 

“She was so depressed she would go into the 

closet and cover herself with a blanket, and 

that scared me.” 

“They get into a bad mood. They also 

demonstrate it with anger...you can tell by 

their facial expressions…it worries me a lot.” 

“…my son will isolate himself, lock himself in 

his room—he does not want to come out.”  

“With the story of the girl [the cutting], I 

wanted to mention it to my children because I 

worry a lot. …”  

THEME 2: 

Throughout the focus group meetings, parents 

showed insight into their own contributions to their 

children’s mental health. These were demonstrated by 

comments such as: 

“We do not always express it, but sometimes 

the teens will hear us talking about our 

economic situation, about not being able to 

pay the rent, to buy food.”  

“Sometimes there are conflicts between a 

couple…a lack of money and family problems 

so they find out and I think that is a cause of 

great stress for them.”  



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 95 

“We are living in an age where the Latino is 

persecuted because of the migratory situation. 

So if the parents are feeling affected, it is to be 

expected that the adolescents feel it as well.”  

“…sometimes parents make it so that the kids 

are embarrassed of their background. So we 

cannot do that because they do not know 

what or who they are, if they are from here or 

from there, although they were born here.” 

THEME 3: 

However, in spite of recognizing the problem 

and potential causes, parents often reported feeling 

helpless to find solutions because of various 

limitations.  

Some of the parents’ limitations were financial: 

“There are support centers but those are not 

accessible. … sometimes our income is not 

enough to send our teens to a good 

psychologist or support group.”  

“…I do not have any other family here to help 

me take care of them or to give me advice on 

how to help them. This is difficult for me.” 

Other times the limitations were related to free time: 

“…he does not confide because he says, ‘You 

work too much and come home tired and if I 

tell you my problems…’”  

“So if they are happy and want to do things 

but I am not, I am stressed with work and 

bills, all that, I cannot give them the quality of 

time that they need. So they become stressed 

and lock themselves in their room, separate 

themselves from us.” 

Mostly parents reported limitations in terms of not 

knowing what to do: 

“As a parent, one feels powerless/helpless. 

They are at that age where one does not know 

what to do…we do not want to make them feel 

worse.” 

“One does not know how to talk to the girls 

…what do I do to take her out of that place to 

make her understand that I need to be with 

her and she needs to be with me? I have not 

been able to achieve that, I do not know how.”  

“They do not know how to communicate with 

us and we do not know how to be with them. 

… I do not know how to go about doing that.” 

THEME 4: 

Parents reported that minority/immigrant 

status was a barrier because of language and cultural 

differences, interpersonal problems, or legal issues. 

Examples include: 

“…the culture influences them as well because 

migrating to another country as an 

adolescent is difficult because they want to go 

out but it is hard because it is another 

language.” 

“[The Latino adolescents] do not identify with 

the [American teens] because of the language 

and the school and they do not identify with 

us because we are in a new country and we do 

not have our culture, our people.”  

 “My son has talked to me about how he has 

heard how teens make fun of students that 

have arrived from other countries so that 

causes stress.”  

“…we do not have documents; they cannot get 

driver’s licenses, all that perturbs them. So all 

that causes them to constantly think about all 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 96 

those stresses and how we are going to pay for 

college when we do not have a social security 

number to be able to keep studying…”  

THEME 5: 

In this theme parents address the effects on 

the family of the process of adaptation to the new 

culture.  

Parents evidenced pain at watching their children 

adapt and possibly lose their culture of origin, and at 

times understanding that this may be a necessary step 

for adaptation. Comments included: 

 “I impress upon her that she can be American 

because she was born here but she has our culture. 

So I have always told her that she has to embrace 

her culture. That she has Hispanic parents, that she 

looks Hispanic, that she does not look American, so 

she has to know that it is her culture, it is her roots 

and that she should not forget that.” 

“We as parents are never going to lose our culture. 

But we also need to understand that they are living 

in another culture. So for them, many times it is 

difficult. It provokes stress. So sometimes there is no 

identification with them because we teach them one 

thing, but they live in a different culture. And 

sometimes as parents we close ourselves off; we are 

also at fault for that.” 

“Even in the language, they come home talking in 

English and one tells them to speak Spanish because 

it would be terrible to be a Mexican that does not 

speak Spanish.”  

TRIANGULATION OF QUANTITATIVE AND 

QUALITATIVE FINDINGS 

We found that the focus groups with parents 

informed and explained the quantitative data from the 

youth surveys.  Our quantitative findings identified 

various levels of depressive symptoms in the 

adolescents. These were described by parents as a 

variety of behaviors, both internalizing and 

externalizing, in Theme 1.  

Furthermore, the quantitative findings 

suggested that factors within the family contributed to 

depressive symptoms.  Specifically, our assessment of 

family functioning using the Family APGAR scale, and 

of social support with the CASSS correlated with 

depression in boys. The CASSS, but not the Family 

APGAR, correlated with depression in girls. Theme 2 

from the focus groups, where parents recognized that 

some of their behaviors and emotions contributed to 

the depressed mood in their children, clarified what 

sorts of couple and family issues might be leading to 

the observed correlations.  

Theme 4, where parents reported language and 

cultural differences, interpersonal problems, and legal 

issues related to minority status, may partially inform 

why acculturative stress, as measured with the SAFE, 

correlated with depression among teens. Acculturative 

stress is the stress experienced as one adapts to a new 

culture, and the issues identified by parents might be 

The pain some parents experience as they 
see their children become Americanized may 
cause strain in the family. Although parents 
report understanding the need for their 
children to integrate, they expressed 
difficulty with the process.  



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 97 

interrupting the teens’ integration, or making it more 

challenging. 

Theme 5 may be the most interesting and 

informative for future interventions.  In this theme, 

parents address the effects of acculturation on the 

family.  Parents explain how the process of 

acculturation and its associated stress (SAFE) relate to 

family functioning (APGAR). In the quantitative 

analyses, among females, family functioning correlated 

with acculturative stress, which was the only 

statistically significant variable in the regression 

predicting depression scores in girls. Among boys, 

family functioning correlated, at similar strength, with 

mastery, which was the only statistically significant 

variable predicting depression scores in boys. The pain 

some parents experience as they see their children 

become Americanized may cause strain in the family. 

Although parents report understanding the need for 

their children to integrate, they expressed difficulty 

with the process.  

DISCUSSION 

The results from the quantitative data gathered 

from the adolescents are consistent with the findings 

from other studies. In the present study Latino 

adolescent females reported higher rates of depression 

than their male counterparts, which matches extant 

literature (Lorenzo-Blanco et al., 2012; García, 

Manongdo & Ozechowski, 2014). Importantly, we 

found different predictors of depression among males 

and females, with girls’ depression predicted by higher 

acculturative stress, and boys’ by lower self-mastery. 

Social support from friends, family and school, and 

self-mastery correlated with lower depression for girls, 

but in the presence of higher acculturative stress, did 

not reach significance in the regression, suggesting 

that the negative impact of acculturative stress was 

stronger than the positive impact of social support and 

self-mastery. For boys, higher social support from 

friends, family and school, lower acculturative stress, 

and higher family functioning correlated with 

depression, but in the presence of self-mastery did not 

reach significance in the regression, suggesting that 

the positive impact of self-mastery was stronger than 

the positive impact of social support and family 

functioning and the negative impact of acculturative 

stress.  

Latino cultural norms show large differences in 

how parents raise Latino girls and boys. Traditional 

Latino cultural norms set expectations that female 

outside-the-home activities will be more restricted 

than males’ (Lui, 2015; Roche et al, 2018) and that 

within the home they will perform household activities 

and be submissive to the rest of the family (Cupito, 

Stein & Gonzalez, 2014). These norms differ from the 

cultural norms in the US, which do not make such 

marked differences by gender (Raffaelli & Ontai, 2004). 

It may not be surprising then that immigrant girls 

acculturate at a faster rate than their male 

counterparts, possibly attracted to the greater freedom 

experienced by adolescent girls in the US (Céspedes & 

Huey, 2008; Lorenzo-Blanco et. al, 2012), a freedom 

that immigrant boys are not denied within their own 

culture. Unfortunately, this process threatens 

adolescent girls’ mental health (Cupito, Stein & 

Gonzalez, 2014). Furthermore, parents who arrive in 

the US may be struck by the cultural differences in 

behavior, dress, and freedom for girls. These 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 98 

differences may cause them to enforce their own 

cultural norms even more strictly than they would 

otherwise. These different cultural norms and rates of 

acculturation may explain why acculturative stress was 

the most powerful predictor of depression among the 

girls.  

For boys, who in our sample did not experience 

as much acculturative stress as girls, the experience of 

adapting to the new culture may not be as impactful. 

Instead, the confidence and ability to deal successfully 

with stressors plays a more salient role. Self-mastery 

has been consistently found to protect from depression 

in adolescents (Gilster, 2014; Watkins, Hudson, 

Caldwell, Siefert & Jackson, 2011). It is important to 

note that self-mastery correlated with depressive 

symptoms at the bivariate level for the girls in our 

sample as well. Programs that increase self-mastery 

may help Latino teens, especially first or second 

generation or those whose parents have yet to 

acculturate. 

Although the focus groups asked parents about 

teens in general and did not match the parental reports 

with the children’s data, the mixed methods findings 

suggest other factors that relate to depression as well. 

Family functioning is invariably impacted by the 

experience of immigration and adaptation to a new 

country and culture (Lawton & Gerdes, 2014). In the 

focus groups held with the Latino immigrant parents, 

conflict related to cultural differences they experience 

with their children was often reported. As parents 

strived to maintain their cultural identity, their 

children seemed to strive to assimilate, or at least this 

was what parents perceived. Parents perceived danger 

in this, as they saw their culture and its values as 

sources of strength for themselves and potentially for 

their children. As the children acculturate, they may 

not readily adopt, or may even reject, family traditional 

cultural values, causing even more family conflict and 

less family cohesion (Lorenzo-Blanco et al., 2012; Lui, 

2015). Efforts to solidify family relations in Latino 

families may reduce family conflict. Familismo, a 

Latino cultural value of loyalty, respect and obedience 

to family, is protective of mental health in youth and 

may be diminished during the process of acculturation 

(Stein, Gonzalez, Cupito, Kiang & Supple, 2015). 

Interventions aimed at parents that explain the process 

of integration as an adaptive one may help them 

maintain familismo while at the same time allowing 

their children to integrate effectively into their new 

culture.  

This decrease in family functioning may be 

especially difficult for girls. Although family 

functioning was not related to depression in girls, it 

was related to acculturative stress suggesting a 

potential indirect effect of family functioning for girls. 

Latino girls’ acculturation may be accompanied by the 

deterioration of family cohesion and functioning due 

to the loss of Latino cultural values believed to 

discourage family conflict (Lorenzo-Blanco et. al, 2012). 

Because Latino adolescent females have greater 

sensitivity to interpersonal difficulties than their male 

counterparts, they may have more difficulty with 

family conflict, which places them at higher risk for 

depression (Lorenzo-Blanco et. al, 2012).  

Our findings also highlight the importance of 

social support from various sources for these teenagers. 

Support from friends, family, teachers and school, the 

universe of relations for teenagers, were related to 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 99 

lower depressive symptoms in both girls and boys. 

These findings are not surprising, as the relation 

between social support and mental health is well 

understood, and has been previously examined among 

Latino teens in general (Gonzales, Fabrett & Knight, 

2009; Kuperminc, Wilkins, Roche & Alvarez-Jimenez, 

2009; Potochnick, Perreira & Fuligni, 2012) and 

immigrant Latino youth (Blanco-Vega, Castro-Olivo & 

Merrell, 2008). These findings do, however, suggest 

further avenues for addressing depressive symptoms in 

this population. These include strengthening the 

available support systems and finding new avenues to 

address the growing concerns over these teens’ mental 

health.  

Strengthening teens’ social support systems 

become especially important when considered in light 

of the main findings from the parent focus groups. 

Theme 4 from the focus groups presents both an 

explanation for the frustrations of parents and a course 

of action if interventions are to be tailored to parents 

or to changes in policies at the local, state, or national 

level. Because of their challenges with language and 

cultural adaptation, parents felt helpless when faced 

with mental health problems in their children, and 

unable to find professional help in their community. 

Although at several of the focus groups parents 

demonstrated interest in seeking help from mental 

health professionals, this was not always the case. 

Difficulties with getting Latino parents to seek mental 

health care for their children is well documented in the 

literature (McCord, Draucker & Bigatti, 2018; Stafford, 

Aalsma, Bigatti, Oruche & Draucker, 2019). This 

combination of reports from parents and extant 

literature suggest they are not likely to provide their 

teens with professional help unless it comes to them in 

the form of community-serving organizations that 

focus on mental health. Therefore, strengthening the 

available support systems, and finding new ones, is one 

way in which we can address the growing concerns 

over these teens’ mental health; these support systems 

should include mental health professionals culturally 

competent to work with this population.  

Our unique mixed methods approach, 

collecting quantitative data from adolescents and 

qualitative data from parents, was a strength of the 

study.  It allowed for triangulation of data, and 

demonstrated that what happens within the home, 

what their parents perceive and how they behave, are 

important to understand adolescent depression and 

adaptation. The additional dimension of parental voice 

is often missing from studies of adolescents, and in the 

study reported here clarified many of the issues 

identified in the teens. It suggests a family-focused 

approach to interventions directed at this problem. 

Such an approach includes family therapy, parental 

training, and other approaches that consider the family 

unit as important when addressing problems in 

children and adolescents (Carr, 2014). There is 

evidence that this approach may be more effective 

than focusing on the individual child. A recent study of 

Because of their challenges with language 
and cultural adaptation, parents felt 
helpless when faced with mental health 
problems in their children, and unable to 
find professional help in their community. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289137/#R6
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289137/#R6
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289137/#R12
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289137/#R12


ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

 100 

family-focused therapy for depression in children, with 

a sample that was 15% Latino, found that it resulted in 

better depression outcomes for the children and more 

satisfaction among families in all demographics 

included (Thompson, Sugar, Langer & Asarnow, 2017).  

The study presented here was a cross sectional, 

correlational, CBPR study, and as such, had inherent 

limitations. No conclusions can be drawn regarding 

causation among the variables. It is possible that 

depressive symptoms in the teens lead to problems in 

the variables we identified as predictors. It is also 

possible parental behaviors are caused by teen 

depression, and not the other way around. Although 

the triangulation of the teen’s data with parental 

reports suggested explanations of one by the other, 

neither parents nor teens were privy to the others’ 

data. Therefore, our conclusions are speculative and 

need to be confirmed in future research. Only studies 

that follow families over time, preferably upon arrival 

to the US or even earlier, would clarify causation. Of 

course, such studies are difficult with newly-

immigrated and low-income populations. Our survey 

instruments as well as our focus group questions 

sought to determine mostly what was happening, 

much more than why or how it was happening. This 

was purposeful, as it was a first step in understanding 

the needs of the community.  

Furthermore, our study was focused mainly on 

the teens, their parents, and their immediate 

surroundings. The experiences these families may have 

with the larger community within Indiana and at the 

national level were not explored. Future research that 

explores the impact of national immigration policies 

and the increased discrimination occurring toward this 

population needs to be conducted. Research focused 

on parents suggests high psychological distress 

associated with immigration actions and national news 

(Roche, Vaquera, White & Rivera, 2018). Convenience 

sampling most likely resulted in a biased sample, 

especially given that our community partner 

conducted the recruitment. However, in CBPR 

research it is the needs of the partner’s constituents 

that are the focus of the collaboration, presenting both 

a limitation and strength of this type of research. These 

limitations related to CBPR, however, are 

counterbalanced by the importance of, and the ability 

to, reach a sample that seldom is represented in 

research. 

In spite of these limitations, the quantitative 

data from the adolescents in the present study helps to 

understand factors associated with depression in 

Latino youth, and the qualitative data with parents 

clarified many of the dynamics between Latino teens 

and their parents during the difficult and uneven 

process of acculturation in these families.  It suggests 

further avenues for research into this important 

problem and informs potential interventions at both 

the individual, family and community level. 



ENGAGE! / Vol. 1, Issue 1 Bigatti / Latino Adolescent Depression 

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	Abstract
	INTRODUCTION
	METHODS
	RESULTS
	DISCUSSION
	References

