Abstract
BackgroundEthnic minorities with depression are more likely to seek mental health care through primary care providers (PCPs) than mental health specialists. However, both provider and patient-specific challenges exist. PCP-specific challenges include unfamiliarity with depressive symptom profiles in diverse patient populations, limited time to address mental health, and limited referral options for mental health care. Patient-specific challenges include stigma around mental health issues and reluctance to seek mental health treatment. To address these issues, we implemented a multi-component intervention for Asian American and Latino American primary care patients with depression at Massachusetts General Hospital (MGH).Methods/DesignWe propose a randomized controlled trial to evaluate a culturally appropriate intervention to improve the diagnosis and treatment of depression in our target population. Our goals are to facilitate a) primary care providers' ability to provide appropriate, culturally informed care of depression, and b) patients' knowledge of and resources for receiving treatment for depression. Our two-year long intervention targets Asian American and Latino American adult (18 years of age or older) primary care patients at MGH screening positive for symptoms of depression. All eligible patients in the intervention arm of the study who screen positive will be offered a culturally focused psychiatric (CFP) consultation. Patients will meet with a study clinician and receive toolkits that include psychoeducational booklets, worksheets and community resources. Within two weeks of the initial consultation, patients will attend a follow-up visit with the CFP clinicians. Primary outcomes will determine the feasibility and cost associated with implementation of the service, and evaluate patient and provider satisfaction with the CFP service. Exploratory aims will describe the study population at screening, recruitment, and enrollment and identify which variables influenced patient participation in the program.DiscussionThe study involves an innovative yet practical intervention that builds on existing resources and strives to improve quality of care for depression for minorities. Additionally, it complements the current movement in psychiatry to enhance the treatment of depression in primary care settings. If found beneficial, the intervention will serve as a model for care of Asian American and Latino American patients.Trial RegistrationClinicalTrials.gov: NCT01239407
Highlights
Ethnic minorities with depression are more likely to seek mental health care through primary care providers (PCPs) than mental health specialists
Patients themselves are reluctant to seek treatment; Asian Americans may experience higher levels of perceived stigma related to seeking mental health treatment, from their families [7]
To evaluate the cultural components of the study, a number of qualitative interviews will be conducted with participants in the intervention and usual care arms, and with members of the target population who did not participate in the study
Summary
Ethnic minorities with depression are more likely to seek mental health care through primary care providers (PCPs) than mental health specialists Patient-specific challenges include stigma around mental health issues and reluctance to seek mental health treatment To address these issues, we implemented a multi-component intervention for Asian American and Latino American primary care patients with depression at Massachusetts General Hospital (MGH). Goals of the project are to facilitate a) primary care providers’ ability to provide appropriate, culturally informed care of depression in adult Asian American and Latino American patients, and b) patients’ knowledge of and resources for receiving treatment for depression This intervention focuses on the primary care setting, as ethnic minorities with depression are much more likely to be cared for by primary care physicians (PCPs) than by specialists in mental health [1]. Latino Americans may have had fewer helpful mental health treatment experiences than nonLatino Caucasians, which may make them less willing to seek treatment in the future [8]
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