Abstract
BackgroundImmigrants and refugees to the United States have a higher prevalence of depression compared to the general population and are less likely to receive adequate mental health services and treatment. Those with limited English proficiency (LEP) are at an even higher risk of inadequate mental health care. Collaborative care management (CCM) models for depression are effective in achieving treatment goals among a wide range of patient populations, including patients with LEP. The purpose of this study was to assess the utilization of a statewide initiative that uses CCM for depression management, among patients with LEP in a large primary care practice.MethodsThis was a retrospective cohort study of patients with depression in a large primary care practice in Minnesota. Patients who met criteria for enrollment into the CCM [with a provider-generated diagnosis of depression or dysthymia in the electronic medical records, and a Patient Health Questionnaire-9 (PHQ-9) score ≥10]. Patient-identified need for interpreter services was used as a proxy for LEP. Rates of enrollment into the DIAMOND (Depression Improvement Across Minnesota, Offering A New Direction) program, a statewide initiative that uses CCM for depression management were measured. These rates were compared between eligible patients who require interpreter services versus patients who do not.ResultsOf the 7561 patients who met criteria for enrollment into the DIAMOND program during the study interval, 3511 were enrolled. Only 18.2 % of the eligible patients with LEP were enrolled into DIAMOND compared with the 47.2 % of the eligible English proficient patients. This finding persisted after adjustment for differences in age, gender and depression severity scores (adjusted OR [95 % confidence interval] = 0.43 [0.23, 0.81]).ConclusionsWithin primary care practices, tailored interventions are needed, including those that address cultural competence and language navigation, to improve the utilization of this effective model among patients with LEP.
Highlights
Immigrants and refugees to the United States have a higher prevalence of depression compared to the general population and are less likely to receive adequate mental health services and treatment
This observation warrants attention given that interpreter services (IS) patients are more likely to seek and receive mental health services in primary care practices, rather than in specialty clinics [36, 37], and mental health Collaborative care management (CCM) embedded in primary care practices have been shown to be highly effective among patients with limited English proficiency (LEP) [28]
These results suggest that mental health CCMs may run the risk of further widening existing disparities in mental health access and outcomes among these vulnerable populations
Summary
Immigrants and refugees to the United States have a higher prevalence of depression compared to the general population and are less likely to receive adequate mental health services and treatment. Those with limited English proficiency (LEP) are at an even higher risk of inadequate mental health care. The collaborative care management (CCM) model for depression is one such multicomponent, health care system-level intervention that uses case managers to link patients seen by their primary care providers with mental health specialists [21] This approach has led to higher utilization rates of anti-depressant medications and disease remission, compared to usual care, among both the general population and ethnic/racial minority groups [22,23,24,25]. It potentially may even ameliorate disparities in depression management among this group [26]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
