COVID-19, the Latinx community, and mental health: An interview with Gabriela Nagy, PhD

Friday, May 1, 2020
By William Alexander
G Nagy

Even before the COVID-19 epidemic Latinx immigrants were a vulnerable population. Now, they are among those hardest hit, with a greater likelihood to have jobs that are insecure or increase their likelihood of exposure, and reduced access to health care or accurate information about how to protect themselves.

The research of Gabriela Nagy, PhD, assistant professor in the Department of Psychiatry and Behavioral Sciences, focuses on the mental health needs of this group. In this interview, we talk to her about her many responsibilities at Duke and the impact the epidemic is having on the Latinx population. Nagy also talks about how to find quality mental health resources, and how individuals and institutions can help this community and ourselves.

What are your roles and responsibilities within the School of Medicine?
I am an Assistant Professor in the Department of Psychiatry and Behavioral Sciences in the School of Medicine and a Clinical Assistant Professor in the School of Nursing. I am also a faculty co-lead for the SALUD high school pipeline program. Most of my time is focused on research and I am one of the investigators in the SER Hispano project (based out of the School of Nursing). In addition, I teach classes in various training programs and mentor trainees on individual research projects.

How has your work been affected by the coronavirus outbreak? How are you and your colleagues working around these challenges?

The COVID-19 virus has been quite disruptive to our operations. From a research perspective, the hardest challenge has been trying to figure out how to continue data collection virtually rather than meeting in person. We have been forced to be really creative in how we continue to engage our research participants while many of them are really disproportionately affected by this public health crisis.

What are some of the previously existing barriers that prevent Latinx individuals from receiving quality mental health care?
The Latinx community faces many challenges when it comes to receiving quality mental health care. First, many Latinx individuals are underinsured or uninsured, and thus the cost to get mental health care may be too high to seek out care. There are also shortages of mental health care providers who fluently speak Spanish and/or themselves identify as Latinx. This problem becomes more pronounced for individuals living in rural areas where there are greater shortages of mental health care providers.

Second, Latinx individuals are underrepresented in clinical research, so we don’t know how generalizable the existing body of research is to Latinx individuals. This is especially true for recent immigrants. The clinical research that does exist in some cases may not be culturally or contextually relevant.

How is the ongoing COVID-19 epidemic affecting this population in particular, and what further effects are they likely to experience?
This pandemic is affecting the Latinx community in many ways. This population is vulnerable from an economic and public health perspective. Many members of our community work in jobs that have either been lost or put on hold for the foreseeable future, such as in restaurants or hotels. Latinx individuals who still have jobs are more likely to work in positions where they have to interface with the public, often without protective equipment, and risk exposure to COVID-19 for themselves and the people they live with. There has been a lot of concern from the Latinx community about how they will be able to survive in the coming months, especially in light of a looming recession.

The pandemic has had other consequences for the Latinx community. Some individuals may put off necessary medical care out of fear of obtaining COVID-19 through the health system or for fear that their undocumented status may be disclosed. And it is challenging to ensure that Latinx individuals, members of the immigrant community in particular, have access to telehealth. Access may be especially hard for individuals who don’t have Internet access at home or unlimited data plans on their phones or even insurance.

Finally, there has also been a lag in translating into Spanish official recommendations regarding how to prevent the spread of COVID-19. Thus many Latinx individuals may be learning about the pandemic informally from their loved ones, the Internet, or through social media. These avenues are often inaccurate and don’t allow Latinx individuals the chance to adequately protect themselves.

What resources are available to help Latinx individuals (or others) improve their mental health and well-being?
Like everyone else, members of the Latinx community are experiencing stress, depression, burnout, or anxiety that were either created or made worse by the pandemic.

If you or someone you know needs is interested in seeking mental health care, there is no need to wait until this is over. Locations at Duke Health, community clinics, or private practices are now taking new patients. Anyone interested could call our general Duke Psychiatry Hub at 919-684-0100. Another community-based option is Durham’s El Futuro clinic: (919) 688-7101

Many locations now let you have a confidential visit through phone or video calls on your phone, tablet or computer. There are existing evidence-based treatments and robust scientific evidence supporting strategies to support individuals experiencing low mood, anxiety, and burnout, among others.

For people who don’t think that formal services are for them, there are many other strategies to maintain emotional wellbeing. These include working out, meditating, connecting with loved ones, reading, journaling, gardening, etc. There are also many resources online and through apps that can be helpful during this time.

What can individuals or organizations do to help?
The lasting economic and health impacts of COVID-19 on the Latinx community will be a real challenge. It will likely take a committed, coordinated effort on a large scale to adequately address them.

To address gaps in translating and disseminating information, many Latinx health stakeholders across the Duke Health system, in neighboring organizations, and in the community are synergizing efforts to ensure that we can produce and disseminate high-quality public service announcements and share resources. Many of these efforts are being led by Dr. Viviana Martinez-Bianchi, MD, (Family Medicine and Community Health) and Dr. Gabriela Maradiaga Panayotti, MD (Pediatrics).

There are many local organizations working with the Latinx community. Among them is El Centro Hispano who are accepting donations to provide emergency food assistance to families in need.

To offset access-related challenges, many providers are using either telephone or video calls to increase access.

As members of the community at large we ensure that we don’t put essential workers at risk by limiting the amount of time and number of people that leave our homes and ensuring that when we do go out we use personal protective gear (e.g., gloves, face masks).

What are some things that have helped you personally during this crisis?
I have found a few things that have been helpful during this time. First, it is absolutely normal to experience fear and grief, or to worry about worst-case scenarios. In order to make space for those really hard emotions, I have personally been increasing the frequency which I meditate. There are a lot of really good free resources that may be helpful for people who are newly interested in getting connected, such as freemindfulness.org. I would encourage others who are struggling with tough emotions and thoughts around this public health crisis to listen to recorded meditations as podcasts or in other formats.

Second, I would also encourage others to find ways to still practice their hobbies during this time. For example, I love to run and I have now had the time to run and do other exercise daily which has been a really helpful way to reduce stress.

If you are feeling lonely, as many of us are, I would encourage you to take small steps to maintain or rekindle connections to loved ones. In seeing the silver linings during this time, I have been able to reconnect with friends I haven’t talked to in years during this crisis. This will be a really hard moment in our history, but I do see it as an opportunity to connect with others even when we’re physically apart.

What passions or hobbies do you have outside of Duke?
Outside of work, I try to find balance by gardening and cooking. I have a special talent of finding things I have in my fridge and making creative dishes. I also love going salsa dancing with friends. And, though this sounds so cliché, I also enjoy the privilege of getting to travel and see new areas.