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Articles   |    
Impact of a Culturally Focused Psychiatric Consultation on Depressive Symptoms Among Latinos in Primary Care
C. Andres Bedoya, Ph.D.; Lara Traeger, Ph.D.; Nhi-Ha T. Trinh, M.D., M.P.H.; Trina E. Chang, M.D., M.P.H.; Charlotte D. Brill, B.A.; Katherine Hails, B.A.; Patrick N. Hagan, B.A.; Katherine Flaherty, Sc.D.; Albert Yeung, M.D., Sc.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300088
View Author and Article Information

Dr. Bedoya, Dr. Traeger, Dr. Trinh, Dr. Chang, and Dr. Yeung are with Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Ms. Brill, Ms. Hails, and Mr. Hagan are with Massachusetts General Hospital. Dr. Flaherty is with Abt Associates Inc., Cambridge, Massachusetts. Send correspondence to Dr. Bedoya (e-mail: abedoya@mgh.harvard.edu). The findings were presented at the annual meeting and scientific sessions of the Society of Behavioral Medicine, San Francisco, March 20–23, 2013.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  A culturally focused psychiatric (CFP) consultation service was implemented to increase engagement in mental health care and reduce depressive symptoms among adult Latino primary care patients. The aim of this study was to assess preliminary efficacy of the CFP consultation service to reduce depressive symptoms.

Methods  In a randomized controlled study, primary care clinics were randomly selected to provide either the two-session CFP intervention or enhanced usual care. For CFP intervention participants, study clinicians (psychologists or psychiatrists) provided a psychiatric assessment, psychoeducation, cognitive-behavioral tools, and tailored treatment recommendations; primary care providers were provided a consultation summary. Depressive symptoms (as measured by the Quick Inventory of Depressive Symptomatology–Self Rated [QIDS-SR]) were assessed at baseline and six-month follow-up. Multiple regression analysis was conducted to evaluate whether CFP intervention participants showed greater improvement in depressive symptoms at follow-up, with control for baseline depression, clinic site, and significant covariates.

Results  Participants (N=118) were primarily Spanish-monolingual speakers (64%). Although depressive symptoms remained in the moderate range for both groups from baseline to six months, symptom reduction was greater among CFP intervention participants (mean±SD change in QIDS-SR score=3.46±5.48) than those in usual care (change=.09±4.43). The final multiple regression model indicated that participation in the CFP intervention predicted lower depressive symptoms at follow-up (unstandardized beta=−3.09, p=.008), independent of baseline depressive symptoms, clinic site, age, gender, and employment status.

Conclusions  Results suggest that Latinos experiencing depressive symptoms may benefit from a short-term CFP consultation. Findings also support the integration of psychiatric interventions for Latinos in the primary care setting.

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Table 1Baseline characteristics of Latino primary care patients with depressive symptoms, by treatment group
Table Footer Note

a As measured by the Patient Health Questionnaire–2. A score of ≥2 (out of a total of 6) indicates likely depression.

Table Footer Note

b As measured by the Quick Inventory of Depressive Symptomatology–Self Rated. Possible scores range from 0 to 27, with higher scores indicating more severe symptoms.

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Table 2Multiple regression model of change in depressive symptoms from baseline to six months among Latino patients in two treatment groupsa
Table Footer Note

a Change was measured from baseline to six-month follow-up. QIDS-SR, Quick Inventory of Depressive Symptomatology–Self Rated; CFP, culturally focused psychiatric consultation. Final nonimputed model: R2=.49, F=12.00, df=7 and 89, p<.001

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References

 Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision .  Washington, DC,  American Psychiatric Association, 2000
 
Marcus M, Yasamy MT, van Ommeren M, et al: Depression: A Global Public Health Concern. Geneva, World Health Organization, 2012. Available at www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf
 
Ebmeier  KP;  Donaghey  C;  Steele  JD:  Recent developments and current controversies in depression.  Lancet 367:153–167, 2006
[CrossRef] | [PubMed]
 
Van Voorhees  BW;  Walters  AE;  Prochaska  M  et al:  Reducing health disparities in depressive disorders outcomes between non-Hispanic whites and ethnic minorities: a call for pragmatic strategies over the life course.  Medical Care Research and Review 64(suppl):157S–194S, 2007
[CrossRef] | [PubMed]
 
Stockdale  SE;  Lagomasino  IT;  Siddique  J  et al:  Racial and ethnic disparities in detection and treatment of depression and anxiety among psychiatric and primary health care visits, 1995–2005.  Medical Care 46:668–677, 2008
[CrossRef] | [PubMed]
 
Ennis  SR;  Rios-Vargas  M;  Albert  NG:  The Hispanic Population: 2010 .  Washington, DC,  United States Census Bureau, 2011
 
Critical Disparities in Latino Mental Health: Transforming Research Into Action. Washington, DC, National Council of La Raza, 2005
 
González  HM;  Vega  WA;  Williams  DR  et al:  Depression care in the United States: too little for too few.  Archives of General Psychiatry 67:37–46, 2010
[CrossRef] | [PubMed]
 
Menselson  T;  Rehkopf  DH;  Kubzansky  LD:  Depression among Latinos in the United States: a meta-analytic review.  Journal of Consulting and Clinical Psychology 76:355–366, 2008
[CrossRef] | [PubMed]
 
Lewis-Fernández  R;  Das  AK;  Alfonso  C  et al:  Depression in US Hispanics: diagnostic and management considerations in family practice.  Journal of the American Board of Family Practice 18:282–296, 2005
[CrossRef] | [PubMed]
 
Wells  K;  Klap  R;  Koike  A  et al:  Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care.  American Journal of Psychiatry 158:2027–2032, 2001
[CrossRef] | [PubMed]
 
Olfson  M;  Mojtabai  R;  Sampson  NA  et al:  Dropout from outpatient mental health care in the United States.  Psychiatric Services 60:898–907, 2009
[PubMed]
 
Cabassa  LJ;  Zayas  LH;  Hansen  MC:  Latino adults’ access to mental health care: a review of epidemiological studies.  Administration and Policy in Mental Health and Mental Health Services Research 33:316–330, 2006
[CrossRef] | [PubMed]
 
Pingitore  D;  Snowden  L;  Sansone  RA  et al:  Persons with depressive symptoms and the treatments they receive: a comparison of primary care physicians and psychiatrists.  International Journal of Psychiatry in Medicine 31:41–60, 2001
[CrossRef] | [PubMed]
 
Lagomasino  IT;  Dwight-Johnson  M;  Miranda  J  et al:  Disparities in depression treatment for Latinos and site of care.  Psychiatric Services 56:1517–1523, 2005
[CrossRef] | [PubMed]
 
Bhui  K;  Bhugra  D;  Goldberg  D  et al:  Cultural influences on the prevalence of common mental disorder, general practitioners’ assessments and help-seeking among Punjabi and English people visiting their general practitioner.  Psychological Medicine 31:815–825, 2001
[CrossRef] | [PubMed]
 
Cohen  CI;  Magai  CR;  Yaffee  R  et al:  Comparison of users and non-users of mental health services among depressed, older, urban African Americans.  American Journal of Geriatric Psychiatry 13:545–553, 2005
[CrossRef] | [PubMed]
 
Roberts  RE:  Manifestation of depressive symptoms among adolescents: a comparison of Mexican Americans with the majority and other minority populations.  Journal of Nervous and Mental Disease 180:627–633, 1992
[CrossRef] | [PubMed]
 
Alegría  M;  Canino  G;  Ríos  R  et al:  Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites.  Psychiatric Services 53:1547–1555, 2002
[CrossRef] | [PubMed]
 
Alegría  M;  McGuire  T:  Rethinking a universal framework in the psychiatric symptom-disorder relationship.  Journal of Health and Social Behavior 44:257–274, 2003
[CrossRef] | [PubMed]
 
Sleath  B;  Rubin  RH;  Wurst  K:  The influence of Hispanic ethnicity on patients’ expression of complaints about and problems with adherence to antidepressant therapy.  Clinical Therapeutics 25:1739–1749, 2003
[CrossRef] | [PubMed]
 
Karasz  A;  Watkins  L:  Conceptual models of treatment in depressed Hispanic patients.  Annals of Family Medicine 4:527–533, 2006
[CrossRef] | [PubMed]
 
Cooper  LA;  Gonzales  JJ;  Gallo  JJ  et al:  The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients.  Medical Care 41:479–489, 2003
[PubMed]
 
Van Voorhees  BW;  Fogel  J;  Houston  TK  et al:  Beliefs and attitudes associated with the intention to not accept the diagnosis of depression among young adults.  Annals of Family Medicine 3:38–46, 2005
[CrossRef] | [PubMed]
 
Interian  A;  Ang  A;  Gara  MA  et al:  Stigma and depression treatment utilization among Latinos: utility of four stigma measures.  Psychiatric Services 61:373–379, 2010
[CrossRef] | [PubMed]
 
Hinton  L;  Apesoa-Varano  EC;  González  HM  et al:  Falling through the cracks: gaps in depression treatment among older Mexican-origin and white men.  International Journal of Geriatric Psychiatry 27:1283–1290, 2012
[CrossRef] | [PubMed]
 
Kirmayer  LJ;  Groleau  D;  Guzder  J  et al:  Cultural consultation: a model of mental health service for multicultural societies.  Canadian Journal of Psychiatry 48:145–153, 2003
 
Kirmayer  LJ;  Thombs  BD;  Jurcik  T  et al:  Use of an expanded version of the DSM-IV outline for cultural formulation on a cultural consultation service.  Psychiatric Services 59:683–686, 2008
[CrossRef] | [PubMed]
 
Trinh  NT;  Bedoya  CA;  Chang  TE  et al:  A study of a culturally focused psychiatric consultation service for Asian American and Latino American primary care patients with depression.  BMC Psychiatry 11:166, 2011
[CrossRef] | [PubMed]
 
Kroenke  K;  Spitzer  RL;  Williams  JBW:  The Patient Health Questionnaire–2: validity of a two-item depression screener.  Medical Care 41:1284–1292, 2003
[CrossRef] | [PubMed]
 
Yeung  A;  Trinh  NH;  Chang  TE  et al:  The Engagement Interview Protocol (EIP): improving the acceptance of mental health treatment among Chinese immigrants.  International Journal of Culture and Mental Health 4:91–105, 2011
[CrossRef] | [PubMed]
 
Kroenke  K;  Spitzer  RL;  Williams  JBW  et al:  The Patient Health Questionnaire somatic, anxiety and depressive symptom scales: a systematic review.  General Hospital Psychiatry 32:345–359, 2010
[CrossRef] | [PubMed]
 
Rush  AJ;  Trivedi  MH;  Ibrahim  HM  et al:  The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression.  Biological Psychiatry 54:573–583, 2003
[CrossRef] | [PubMed]
 
Bernstein  IH;  Rush  AJ;  Carmody  TJ  et al:  Clinical vs self-report versions of the Quick Inventory of Depressive Symptomatology in a public sector sample.  Journal of Psychiatric Research 41:239–246, 2007
[CrossRef] | [PubMed]
 
Rush  AJ;  Carmody  TJ;  Ibrahim  HM  et al:  Comparison of self-report and clinician ratings on two inventories of depressive symptomatology.  Psychiatric Services 57:829–837, 2006
[CrossRef] | [PubMed]
 
Lesser  I;  Rosales  A;  Zisook  S  et al:  Depression outcomes of Spanish- and English-speaking Hispanic outpatients in STAR*D.  Psychiatric Services 59:1273–1284, 2008
[CrossRef] | [PubMed]
 
Trinh  NT;  Hagan  PN;  Flaherty  K  et al:  Evaluating patient acceptability of a culturally focused psychiatric consultation intervention for Latino Americans with depression.  Journal of Immigrant and Minority Health  (Epub ahead of print Oct 2013)
 
Butler  M;  Kane  RL;  McAlpine  D  et al:  Does integrated care improve treatment for depression? A systematic review.  Journal of Ambulatory Care Management 34:113–125, 2011
[CrossRef] | [PubMed]
 
Chin  MH;  Walters  AE;  Cook  SC  et al:  Interventions to reduce racial and ethnic disparities in health care.  Medical Care Research and Review 64(suppl):7S–28S, 2007
[CrossRef] | [PubMed]
 
Hails  K;  Brill  CD;  Chang  T  et al:  Cross-cultural aspects of depression management in primary care.  Current Psychiatry Reports 14:336–344, 2012
[CrossRef] | [PubMed]
 
Areán  PA;  Ayalon  L;  Hunkeler  E  et al:  Improving depression care for older, minority patients in primary care.  Medical Care 43:381–390, 2005
[CrossRef] | [PubMed]
 
Areán  PA;  Ayalon  L;  Jin  C  et al:  Integrated specialty mental health care among older minorities improves access but not outcomes: results of the PRISMe study.  International Journal of Geriatric Psychiatry 23:1086–1092, 2008
[CrossRef] | [PubMed]
 
Interian  A;  Lewis-Fernández  R;  Dixon  LB:  Improving treatment engagement of underserved US racial-ethnic groups: a review of recent interventions.  Psychiatric Services 64:212–222, 2013
[CrossRef] | [PubMed]
 
Vera  M;  Perez-Pedrogo  C;  Huertas  SE  et al:  Collaborative care for depressed patients with chronic medical conditions: a randomized trial in Puerto Rico.  Psychiatric Services 61:144–150, 2010
[CrossRef] | [PubMed]
 
Mischoulon  D;  McColl-Vuolo  R;  Howarth  S  et al:  Management of major depression in the primary care setting.  Psychotherapy and Psychosomatics 70:103–107, 2001
[CrossRef] | [PubMed]
 
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