When it comes to depression, individual and collective backstories matter. Those of many Puerto Ricans may include the impact of colonialism and acculturation.

For more than 3 decades, reports have indicated high rates of depression for Puerto Ricans. This is particularly so for people living on the mainland.

Research from 1990 and 2014 backs this statement, although there aren’t many other studies on the subject. In fact, the lack of more recent and comprehensive research in this area could be proof of the marginalization often experienced by this community.

What is the root of these mental health experiences for Puerto Ricans and how can change happen?

What the research on depression in Puerto Ricans says:

According to research from 2019,

  • People from Puerto Rico tend to have higher rates of major depressive disorder than the general population in the United States (9.6% vs. 7.6%).
  • Although not statistically significant, Puerto Ricans living in the United States experience a slightly higher rate of symptoms of mood disorders than Puerto Ricans living on the Island (11.2% vs. 9.9%).
  • Puerto Ricans living on the island report receiving more social support than Puerto Ricans on the mainland.
  • The Puerto Rican community has the highest rates of deaths from substance overdose compared to other Latin American communities, according to research from 2021.

Over the course of the COVID-19 pandemic,

  • Over one third (37.1%) experienced moderate or severe symptoms of depression and anxiety during the pandemic, according to a 2021 report published by the National Urban League.
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Cristalís Capielo-Rosario PhD, researcher and assistant professor in the department of counseling and psychology at Arizona State University, has observed the following factors as contributors to symptoms of depression in Puerto Ricans:

  • poverty
  • segregation
  • racism
  • ethnic discrimination
  • forced migration
  • migration-related stressors (language barriers, difficulty finding employment commensurate to one’s training and experience)
  • challenging working conditions
  • trauma associated with natural disasters

Capielo-Rosario says other factors also often impact the mental health of people in the community:

  • colonial mentality: Colonial mentality refers to internalized oppression; it’s the belief that your ethnic or cultural group is inferior to others or to the culture that colonized your territory.
  • circular migration: Circular migration refers to having to move back and forth from Puerto Rico to the United States, a process that can impact mental health, job opportunities, and family relationships, among others.

The impact of acculturation

Research from 2005 with Puerto Ricans living on the mainland highlights a strong relationship between acculturation and depression.

Acculturation refers to the cultural, social, and psychological changes you go through when moving from one culture to another. It may require understanding, adapting, and negotiating new social rules and customs, from what you eat to what you wear to the language you speak and how you interact with others.

Acculturative stress means you find the acculturation process particularly challenging and this may impact your mental health.

In the 2005 study, researchers found that low acculturation led to lower mood, and specifically in men, higher acculturation meant more symptoms of depression.

“Acculturative stress can be experienced as discrimination and racism […] being stereotyped, and having to disconnect from family and friends in Puerto Rico,” says Capielo-Rosario.

Further research is needed to contextualize the unique experiences of Puerto Ricans living both on the island and on the mainland that may lead to acculturative stress.

1. Culturally competent care

The inclusion of cultural elements may be essential for mental health care interventions.

In fact, research from 2013 indicates that, for ethnic minority clients, treatment outcomes and satisfaction may be directly linked to cultural aspects.

For example, having a professional who belongs to your ethnic group, discusses race and ethnicity, or understands prejudice and discrimination, may lead you to feel more satisfied with the service.

Understanding the particular circumstances of the people of Puerto Rico is essential.

Ivette Gomez, a licensed mental health counselor based in Naples, Florida, explains that, when Puerto Rico transitioned from the Spanish empire to the United States, there was likely a “split in the Puerto Rican psyche.”

Gomez attributes mental health disparities to that split.

The split refers to suddenly facing opposing and overwhelming thoughts, realities, or beliefs. Are you Puerto Rican, Spanish, or “American”?

Gomez says therapists working with Puerto Ricans on the mainland may benefit from discussing aspects such as the loss of identity. She also recommends that the mental health community consider the following:

  • training more psychotherapists and counselors in multiculturalism
  • training counselors to better understand Puerto Rico’s unique culture and experience
  • expanding access to mental health centers that have Spanish-speaking therapists
  • making an effort to offer psychoeducation about the benefits of psychotherapy to Puerto Ricans

Gomez also says narrative therapy and art therapy hold particular promise for Puerto Ricans who face mental health challenges.

“[Narrative therapy] would allow the person to tell their stories and also re-script the stories of their families and experiences,” Gomez says. “[Art therapy] would really tap into the cultural values, expressiveness of our culture, especially music and visual arts. Art therapy then is a bridge to the inner world of the Puerto Rican client.”

Gomez suggests the following approaches to help treat depression in Puerto Ricans:

2. Reparations

“Psychological interventions that aim to eradicate depression disparities must include advocacy actions that also seek to eliminate systemic racism and support economic reparations,” says Capielo-Rosario.

She advocates for the following:

  • return of land property, and restoration of occupied land
  • decolonization and sovereignty reconciliation to improve solidarity
  • psychological liberation

“​​Helping clients explore and challenge colonial logics that lead to inequality, intergroup conflicts, and psychological distress can, in turn, allow clients to experiment with new ways and patterns of thinking, feeling, and behaving,” she explains.

“Mental health professionals can partner with Puerto Rican community organizations that are actively engaging in resistance against laws and institutions that foment settler colonialism in Puerto Rico,” adds Capielo-Rosario.

Acknowledgment can also be an important aspect of healing.

Once interventions are in place, Gomez stresses the importance of constantly looking out for signs of growth and healing.

Puerto Ricans living on the mainland face higher rates of depression compared to other Latin American communities and to Puerto Ricans living on the island.

Acculturation and colonialism may be, in part, important contributing factors to these numbers.

Improving culturally relevant care and reparation processes can help.