Latino Primary Care Research Articles

A pilot replication of QUIT, a randomized controlled trial of a brief intervention for reducing risky drug use, among Latino primary care patients

BackgroundQUIT is the only primary care-based brief intervention that has previously shown efficacy for reducing risky drug use in the United States (Gelberg et al., 2015). This pilot study replicated the QUIT protocol in one of the five original QUIT clinics primarily serving Latinos. DesignSingle-blind, two-arm, randomized controlled trial of patients enrolled from March-October 2013 with 3-month follow-up. SettingPrimary care waiting room of a federally qualified health center (FQHC) in East Los Angeles. ParticipantsAdult patients with risky drug use (4–26 on the computerized WHO ASSIST): 65 patients (32 intervention, 33 control); 51 (78%) completed follow-up; mean age 30.8 years; 59% male; 94% Latino. Interventions and measuresIntervention patients received: 1) brief (typically 3–4minutes) clinician advice to quit/reduce their risky drug use, 2) video doctor message reinforcing the clinician’s advice, 3) health education booklet, and 4) up to two 20–30minute follow-up telephone drug use reduction coaching sessions. Control patients received usual care and cancer screening information. Primary outcome was reduction in number of days of drug use in past 30days of the highest scoring drug (HSD) on the baseline ASSIST, from baseline to 3-month follow-up. ResultsControls reported unchanged HSD use between baseline and 3-month follow-up whereas Intervention patients reported reducing their use by 40% (p<0.001). In an intent-to-treat linear regression analysis, intervention patients reduced past month HSD use by 4.5 more days than controls (p<0.042, 95% CI: 0.2, 8.7). Similar significant results were found using a complete sample regression analysis: 5.2 days (p<0.03, 95% CI: 0.5, 9.9). Additionally, on logistic regression analysis of test results from 47 urine samples at follow-up, intervention patients were less likely than controls to test HSD positive (p<0.05; OR: 0.10, 95% CI: 0.01, 0.99). ConclusionsFindings support the efficacy of the QUIT brief intervention for reducing risky drug use.

Emotion dysregulation as a mechanism linking anxiety and hazardous drinking among Latinos in primary care.

Research suggests that Latinos experience significantly more mental health and alcohol use problems than non-Latino whites. However, relatively little is known about the mechanisms underlying alcohol use in this population. One factor associated with excessive alcohol use in Latinos is anxiety. A potential explanatory mechanism for this relationship is emotion dysregulation, as emotion dysregulation in the context of anxiety may lead to alcohol use problems/disorders. The aim of the current study was to examine the indirect effect of anxiety, through emotion dysregulation, on drinking severity and probable hazardous drinking in Latinos. Latino adults (N = 264) were recruited from a primary care health clinic as part of a larger ongoing study examining mental health among Latinos in primary care. Participants were interviewed using the MINI and then completed various self-report assessments (in Spanish). Structural equation modeling was used to evaluate model fit. Structural models fit the data well. Additionally, there were statistically significant indirect effects of anxiety via emotion dysregulation on drinking severity and probable screen for hazardous drinking. Anxiety may contribute to alcohol use problems due to an overall tendency to engage in maladaptive attempts to regulate emotions. Targeting emotion dysregulation in the context of anxiety and hazardous alcohol use among Latinos may be one therapeutic strategy to reduce severity of alcohol use (and hazardous drinking). (Am J Addict 2017;26:615-622).

Subjective Social Status and Anxiety and Depressive Symptoms and Disorders among Low Income Latinos in Primary Care: The Role of Emotion Dysregulation

Accumulating evidence suggests that Latinos experience greater anxiety- and depression-related health disparities compared to non-Latino Whites. Perceived social status may help to account for these mental health disparities among Latinos, but the specific mechanisms underlying these relations are still unknown. One possible explanation for this relation is emotion dysregulation. Therefore, the present study sought to test whether emotion dysregulation maintains an explanatory role in the relation between subjective social status and anxiety and depressive symptoms and disorders among low income Latinos. Latino adults (N = 383; M age = 38.9 years, SD = 11.4; 86.2% female) were recruited for this study from a primary care health clinic. As hypothesized, there was a statistically significant indirect association of subjective social status via emotion dysregulation in relation to depressive (B = −0.42, Bootstrapped 95% CI [−0.81, −0.08], completely standardized estimate = −0.07), suicidal (B = −0.04, Bootstrapped 95% CI [−0.10, −0.01], completely standardized estimate = −0.04), social anxiety (B = −0.09, Bootstrapped 95% CI [−0.20, −0.02], completely standardized estimate = −0.05), and anxious arousal symptoms (B = −0.13, Bootstrapped 95% CI [−0.28, −0.02], completely standardized estimate = −0.05), as well as number of depressive and anxiety disorder diagnoses (B = −0.03, Bootstrapped 95% CI [−0.05, −0.004], completely standardized estimate = −0.06). Post-hoc tests evaluated indirect associations of subjective social status via specific facets of emotion dysregulation. Overall, the current study found novel empirical evidence for the explanatory role of emotion dysregulation in the associations between subjective social status and anxiety/depressive symptoms and disorders in a sample of economically disadvantaged Latinos. Future work is needed to develop and evaluate targeted interventions that can modify these constructs to offset anxiety/depressive symptoms and disorders among this population.

Patient Preferences for Discussing Childhood Trauma in Primary Care.

Exposure to traumatic events is common in primary care patients, yet health care professionals may be hesitant to assess and address the impact of childhood trauma in their patients. To assess patient preferences for discussing traumatic experiences and posttraumatic stress disorder (PTSD) with clinicians in underserved, predominantly Latino primary care patients. Cross-sectional study. We evaluated patients with a questionnaire assessing comfort to discuss trauma exposure and symptoms using the Adverse Childhood Experiences (ACE) Study questionnaire and the Primary Care-PTSD screen. The questionnaire also assessed patients' confidence in their clinicians' ability to help with trauma-related issues. Surveys were collected at an integrated medical and behavioral health care clinic. Of 178 adult patients asked, 152 (83%) agreed to participate. Among participants, 37% screened positive for PTSD, 42% reported 4 or more ACEs, and 26% had elevated scores on both measures. Primary Care-PTSD and ACE scores were strongly positively correlated (r = 0.57, p < 0.001). Most patients agreed they were comfortable being asked about trauma directly or through screening questionnaires and did not oppose the inclusion of trauma-related information in their medical record. In addition, most patients perceived their clinician as comfortable asking questions about childhood trauma and able to address trauma-related problems. Screening is acceptable to most primary care patients regardless of trauma exposure or positive PTSD screening. Findings may aid primary care clinicians to consider screening regularly for ACEs and PTSD to better serve the health care needs of trauma-exposed patients.

The Differential Role of Anxiety Sensitivity and its Components in the Relation between Emotional Nonacceptance and Anxiety and Depressive Symptoms and Disorders among Latinos in Primary Care

The present investigation examined anxiety sensitivity (AS) in the relation between emotional nonacceptance (unwillingness to experience unwanted emotions) and mood and anxiety symptoms among Latinos seeking health services at a primary healthcare facility. Participants included 267 adult Latinos (85.4% female; Mage = 38.8 years, SD = 10.7, and 95.9% used Spanish as their first language). Results indicated that emotional nonacceptance was indirectly related to number of mood and anxiety disorders, anxious arousal, social anxiety, and depressive symptoms through AS. The observed effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and negative affectivity. Using a multiple mediation model revealed that the AS cognitive, physical, and social concerns demonstrated unique incremental explanatory effects (above and beyond the other two AS sub-scales) for depressive, anxious arousal, and social anxiety symptoms, respectively. Thus, specific sub-scales of AS were uniquely related with the expression of particular affective symptom domains. Overall, the present findings suggest that there is merit in focusing further scientific attention on the interplay between nonacceptance and AS in regard to better understanding and intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.

The role of negative affect in the relation between subjective social status and mental health among economically disadvantaged Latinos in primary care

Purpose The purpose of this paper is to examine the explanatory role of negative affect in the relation between subjective social status and anxiety/depressive disorders, suicidality symptoms, and disruption in life domains (i.e. disability; work/school, social life, and family life/home responsibilities) among Latinos seeking health services at a primary healthcare facility. Design/methodology/approach An experiment was designed using participants including 205 adult Latinos (Mage=39.2; SD=11.4) with annual incomes of less than $30,000. The sample was mostly female (85.9 percent) with a majority (98.5 percent) indicating Spanish as their first language. Findings Results indicated that subjective social status was indirectly related to the mental health variables through negative affect. Notably, these observed effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, and number of years in the USA. Research limitations/implications The present findings suggest that there is merit in focusing further scientific attention on the interplay between subjective social status and negative affect to better understand and possibly intervene to reduce anxiety/depressive vulnerability and disability among Latinos in primary care settings. Originality/value The current study sheds light on the relationship between social status and negative affect in the Latino population. Elucidating mental health in a minority population such as the Latino population provides insight into the mental health needs among minorities that have yet to be addressed.

Treatment moderators and effectiveness of Engagement and Counseling for Latinos intervention on worry reduction in a low-income primary care sample.

We conducted a secondary analysis of randomized controlled trial data to determine if the Engagement and Counseling for Latinos (ECLA) intervention, a brief, evidence-based, and culturally adapted cognitive-behavioral intervention specifically designed for and effective at treating depression, also reduced co-occurring worry symptoms. We also explored whether delivery modality (telephone, face-to-face) and sociodemographic patient characteristics moderated treatment effectiveness. Between May 2011 and September 2012, low-income Latino primary care patients (N = 257) with depression from Boston and San Juan were randomized to usual care (n = 86), face-to-face ECLA (n = 84), or telephone ECLA (n = 87) and completed a psychosocial assessment at baseline and 4 months after randomization. We used intention-to-treat analyses with linear regression models with change in worry (4 months from randomization) as the primary outcome and treatment condition as the primary predictor. Patients in ECLA experienced significant reductions in worry at 4 months from randomization than those in usual care (PSWQΔ = -3.28, p < .05). Among patients receiving ECLA, those in the telephone condition exhibited greater worry reductions than those in the face-to-face condition (telephone: M = -7.83, SD = 11.45; face-to-face: M = -6.73, SD = 12.23; p < .05). Employment status was the only significant treatment moderator. Unemployed patients did not exhibit any changes in worry irrespective of condition, whereas employed patients exhibited the greatest worry reductions across conditions. Although worry was not a treatment target in ECLA, it also reduced worry among low-income Latinos, which suggests ECLA may have transdiagnostic clinical implications. Telephone-delivered ECLA might hold promise for increasing the uptake of mental health care among employed low-income Latinos. (PsycINFO Database Record

Emotional nonacceptance within the context of traumatic event exposure: The explanatory role of anxiety sensitivity for traumatic stress symptoms and disability among Latinos in a primary care setting.

Research has found that Latinos (versus non-Latino Whites) evince higher rates of posttraumatic stress symptoms (PTS) and posttraumatic stress disorder (PTSD), yet little attention has been given to intra-individual, emotion-related processes to explicate the higher incidence of these symptoms among Latinos. Participants included 183 trauma-exposed adult Latinos (88.5% female; Mage=37.7, SD=10.7 and 93.4% reported Spanish as their first language) who attended a community-based primary healthcare clinic in Houston. It was hypothesized that anxiety sensitivity would explain the relation between emotional nonacceptance and traumatic stress symptoms, namely re-experiencing, avoidance, and arousal difficulties as well as overall disability. Additionally, it was expected that the observed effects would be evident above and beyond the variance accounted for by number of traumas reported, gender, age, marital status, educational status, years living in the U.S., and negative affectivity. Consistent with our hypotheses, difficulties accepting negative emotions were associated with increased trauma-related re-experiencing, avoidance, and arousal difficulties. Additionally, anxiety sensitivity was an underlying mechanism in the association between emotional nonacceptance and all but one facet of traumatic stress symptoms (i.e., re-experiencing symptoms) and disability. Alternative models yielded no significant effects, providing greater confidence in the direction of the hypothesized effects. Findings are discussed in the context of their significance for informing the development of specialized intervention strategies that target anxiety sensitivity for Latinos in primary care with elevated risk for PTS and PTSD by their heightened levels of emotional nonacceptance.

Colorectal Cancer Screening Preferences among Black and Latino Primary Care Patients.

Colorectal cancer (CRC) screening rates in the U.S. have historically been lower among blacks and Latinos than whites. The advent of a new stool-based test, Cologuard, calls for research to determine which CRC screening test minority individuals might prefer. Ninety black and Latino patients who had undergone screening colonoscopy were personally educated about four CRC screening tests and subsequently asked about their test preference, attributes that influenced preference, and strength of preference. Cologuard (31.1%) and colonoscopy (64.4%) were preferred over computerized tomographic colonography and fecal immunochemical tests. Preference was influenced by distinct test attributes. Individuals who selected Cologuard over colonoscopy were more likely to be >60 and have greater strength of test preference. There was an overriding preference for Cologuard and colonoscopy among black and Latino individuals who had undergone screening colonoscopy. To further improve CRC screening in these populations, patient preferences should guide recommendations.

Interactive effect of negative affectivity and anxiety sensitivity in terms of mental health among Latinos in primary care

From a public health perspective, primary care medical settings represent a strategic location to address mental health disapirty among Latinos. Yet, there is little empirical work that addresses affective vulnerability processes for mental health problems in such settings. To help address this gap in knowledge, the present investigation examined an interactive model of negative affectivity (tendency to experience negative mood states) and anxiety sensitivity (fear of the negative consequences of aversive sensations) among a Latino sample in primary care in terms of a relatively wide range of anxiety/depression indices. Participants included 390 Latino adults (Mage=38.7, SD=11.3; 86.9% female; 95.6% reported Spanish as first language) from a primary care health clinic. Primary dependent measures included depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood and anxiety disorders, and disability. Consistent with prediction, the interaction between negative affectivity and anxiety sensitivity was significantly related to suicidal, social anxiety, and anxious arousal symptoms, as well as number of mood/anxiety diagnoses and disability among the primary care Latino sample. The form of the interactions indicated a synergistic effect, such that the greatest levels of each outcome were found among those with high negative affectivity and high anxiety sensitivity. There was a trending interaction for depressive symptoms. Overall, these data provide novel empirical evidence suggesting that there is a clinically-relevant interplay between anxiety sensitivity and negative affectivity in regard to the expression of anxiety and depressive symptoms among a Latino primary care sample.

Negative Affectivity and Problematic Alcohol Use Among Latinos in Primary Care: The Role of Emotion Dysregulation

Objective: Latinos are the largest and most rapidly growing racial/ethnic group in the United States. In Latino communities, alcohol is the most widely abused substance, yet there is little empirical understanding of the factors underlying problematic alcohol use among Latinos. The current study explored whether negative affectivity exerted an indirect effect via emotion dysregulation in relation to two alcohol-related outcomes. Methods: Participants were 316 Latinos attending a community-based primary care facility (Mage = 39.3, SD = 11.3; 85.4% female; 95.3% first language Spanish), who completed a variety of self-report and interview measures. Mediation analyses evaluated the indirect effect of negative affectivity via emotion dysregulation on problematic drinking and symptoms of alcohol dependence. Results: While there was no direct or total effect of negative affectivity on either alcohol-related outcome, negative affectivity was significantly associated with both problematic alcohol use and symptoms of dependence via emotion dysregulation. Effect sizes were in the medium range, K2 = .09 and .10, respectively. Post-hoc multiple mediation analyses evaluated subfactors of emotion dysregulation as mediators of the negative affectivity–alcohol associations. These results suggested that difficulties engaging in goal-directed behavior might be particularly important in explaining the association between negative affectivity and problematic alcohol use/symptoms of dependence. Last, independent mediation analyses evaluated emotion dysregulation subfactors and found that limited access to effective emotion regulation strategies and difficulties engaging in goal-directed behavior were, independently, significant mediators for both outcomes. Nonacceptance of emotional responses may also mediate negative affectivity and problematic drinking. Surprisingly, impulse control difficulties was not a significant mediator in any model. Conclusions: These data provide novel insight that among Latinos in primary care, emotion dysregulation is a possible mechanism underlying the indirect relationship between negative affectivity and problematic alcohol use and symptoms of dependence. Results also highlight specific facets of emotion dysregulation as potential targets of intervention. Future research should be longitudinal in nature, be conducted among more representative samples, and utilize measures that will better assess the potential variability in these associations. Results of such work may inform the development of alcohol treatment interventions incorporating the use of adaptive emotion regulation among Latinos in primary care.

Interactive Effect of Negative Affectivity and Rumination in Terms of Mental Health Among Latinos in Primary Care.

The present investigation examined the interactive effects of rumination and negative affectivity in relation to anxiety and depressive symptoms and psychopathology among 245 Latino adults (M age=39.7, SD=11.4; 86.9% female; 97.6% reported Spanish as their first language) attending a community-based primary healthcare clinic. As expected, there was a significant interaction between rumination and negative affectivity for depressive, suicidal, social anxiety, anxious arousal symptoms, number of mood and anxiety disorders, and disability among the primary care Latino sample. Inspection of the interaction forms indicated a high degree of conceptual similarity. Specifically, rumination was related to greater levels of suicidal symptoms, social anxiety, anxious arousal, number of mood and anxiety disorders, and disability among individuals with higher, but not lower, levels of negative affectivity. The form of the interaction for depressive symptoms was in line with this pattern, but more extreme; rumination was related to greater levels of depressive symptoms among individuals with both higher and lower levels of negative affectivity. Together, these data provide novel empirical evidence suggesting that there is clinically relevant interplay between rumination and negative affectivity in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.

Training community-based primary care physicians in the screening and management of mental health disorders among Latino primary care patients.

To evaluate a quality improvement intervention to improve the screening and management (e.g., referral to psychiatric care) of common mental disorders in small independent Latino primary care practices serving patient populations of predominantly low-income Latino immigrants. In seven practices, academic detailing and consultation/liaison psychiatry were first implemented (Stage 1) and then supplemented with appointment scheduling and reminders to primary care physicians (PCPs) by clinic staff (Stage 2). Acceptability and feasibility were assessed with independent patient samples during each stage. Participating PCP found the interventions acceptable and noted that referrals to language-matched specialty care and case-by-case consultation on medication management were particularly beneficial. The academic detailing and consultation/liaison intervention (Stage 1) did not significantly affect PCP screening, management or patient satisfaction with care. When support for appointment scheduling and reminders (Stage 2) was added, however, PCP referral to psychiatric services increased (P=.04), and referred patients were significantly more likely to follow through and have more visits to mental health professionals (P=.04). Improving the quality of mental health care in low-resourced primary care settings may require academic detailing and consultation/liaison psychiatric intervention supplemented with staff outreach to achieve meaningful improvement in the processes of care.

Anxiety sensitivity and mindful attention in terms of anxiety and depressive symptoms and disorders among Latinos in primary care

The present investigation examined the interactive effects of anxiety sensitivity and mindful attention in relation to anxiety and depressive symptoms and psychopathology among 145 adult Latinos (85.5% female; Mage=39.9, SD=10.8 and 98.6% used Spanish as their first language) who attended a community-based primary healthcare clinic. As expected, the interaction between anxiety sensitivity and mindful attention was significantly related to number of mood and anxiety disorders, social anxiety, and depressive symptoms. No significant interaction, however, was evident for panic (anxious arousal) symptoms. The form of the significant interaction indicated that Latinos reporting co-occurring higher levels of anxiety sensitivity and lower levels of mindful attention evinced the greatest levels of anxiety/depressive psychopathology, social anxiety, and depressive symptoms. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between anxiety sensitivity and mindful attention in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.

The Role of Anxiety Sensitivity in the Relation Between Experiential Avoidance and Anxious Arousal, Depressive, and Suicidal Symptoms Among Latinos in Primary Care

The present investigation examined the explanatory role of anxiety sensitivity in the relation between experiential avoidance and anxious arousal, depressive, and suicidal symptoms among Latinos seeking health services at a primary healthcare facility. Participants included 138 adult Latinos (86.2 % female; Mage = 38.4, SD = 10.8 and 97.8 % used Spanish as their first language). Results indicated that experiential avoidance was indirectly related to anxious arousal, depressive, and suicidal symptoms through anxiety sensitivity. These observed effects were evident above and beyond the variance accounted for by gender, marital status, educational level, employment status, and negative affectivity. Tests of model specificity [reversing the posited explanatory variable (anxiety sensitivity) and dependent variable(s), respectively] indicated that experiential avoidance is related to anxiety sensitivity, which in turn, is associated with anxious arousal and suicidal symptoms. In regard to depressive symptoms, the relation between experiential avoidance and anxiety sensitivity appears to be reciprocal. The present findings suggest that there is indeed merit in focusing further scientific attention on the interplay between experiential avoidance and anxiety sensitivity in regard to better understanding and possibly intervening to reduce anxiety/depressive vulnerability among Latinos in primary care settings.

Anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and disorders among Latinos in primary care

The present investigation examined the interactive effects of anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and psychopathology among 143 Latinos (85.7% female; Mage=39.0, SD=10.9; 97.2% used Spanish as their first language) who attended a community-based primary healthcare clinic. Results indicated that the interaction between anxiety sensitivity and subjective social status was significantly associated with number of mood and anxiety disorders, panic, social anxiety, and depressive symptoms. The form of the significant interactions indicated that individuals reporting co-occurring higher levels of anxiety sensitivity and lower levels of subjective social status evidenced the greatest levels of psychopathology and panic, social anxiety, and depressive symptoms. The present findings suggest that there is merit in focusing further scientific attention on the interplay between anxiety sensitivity and subjective social status in regard to understanding, and thus, better intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.

Physician counseling on colorectal cancer screening and receipt of screening among Latino patients.

Latinos have lower rates of colorectal cancer (CRC) screening and later stage diagnosis than Whites, which may be partially explained by physician communication factors. We assessed associations between patient-reported physician counseling regarding CRC screening and receipt of CRC screening among Latino primary care patients. This was a cross-sectional telephone survey. The participants of this study were Latino primary care patients 50 years of age or older, with one or more visits during the preceding year. We developed patient-reported measures to assess whether physicians provided explanations of CRC risks and tests, elicited patients' barriers to CRC screening, were responsive to patients' concerns about screening, and encouraged patients to be screened. Outcomes were patient reports of receipt of endoscopy (sigmoidoscopy or colonoscopy) and fecal occult blood test (FOBT) within recommended guidelines. Of 817 eligible patients contacted, 505 (62 %) completed the survey; mean age was 61 years (SD 8.4), 69 % were women, and 53 % had less than high school education. Forty-six percent reported obtaining endoscopy (with or without FOBT), 13 % reported FOBT only, and 41 % reported no CRC screening. In bivariate analyses, physician explanations, elicitation of barriers, responsiveness to concerns, and greater encouragement for screening were associated with receipt of endoscopy (p < 0.001), and explanations (p < 0.05) and encouragement (p < 0.001) were associated with FOBT. Adjusting for covariates, physician explanations (OR = 1.27; 95 % CI 1.03, 1.58) and greater physician encouragement (OR = 6.74; 95 % CI 3.57, 12.72) were associated with endoscopy; patients reporting quite a bit/a lot of physician encouragement had six times higher odds of obtaining the FOBT as those reporting none/a little encouragement (OR = 6.54; 95 % CI 2.76, 15.48). Among primarily lower-socioeconomic status Latino patients, the degree to which patients perceived that physicians encouraged CRC screening was more strongly associated with screening than with providing risk information, eliciting barriers, and responding to their concerns about screening.

Uptake of depression treatment recommendations among Latino primary care patients.

Primary care providers (PCP) are the entry point for public sector depression treatment for many Latino patients. However, many Latino patients do not initiate their PCPs' recommended treatment, which likely contributes to ethnic disparities in depression treatment. This study examined factors related to Latino patients' uptake of their PCPs' recommendations for depression treatment. Ninety Latino primary care patients who received a depression treatment recommendation from their PCP participated in a telephone interview. Patients rated their working alliance with their PCP and their PCP's cultural competence. They also reported their treatment preference, the type of recommendation, and their intended and actual uptake of the recommendation. Patients were contacted at two time points (Time 1: M = 14 days after PCP appointment; Time 2: M = 84 days after PCP appointment) to report their uptake status. At Time 1, 23% of patients had initiated uptake of the treatment recommendation, increasing to 53% at Time 2. Patients who received a medication recommendation were more likely to have followed though on the recommendation, compared with patients who received a psychotherapy recommendation. The working alliance was positively associated with intention to follow up on a treatment recommendation, and also mediated the relationship between cultural competence and intention of following up on the recommendation. PCP's treatment recommendation and the PCP-patient alliance play a role in Latino primary care patients intention to follow a treatment recommendation for depression. An improved understanding of this role could enhance efforts to improve depression treatment uptake.

Impact of a Culturally Focused Psychiatric Consultation on Depressive Symptoms Among Latinos in Primary Care

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. 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. 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. 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.

Screening older Latinos for dementia in the primary care setting.

The purpose was to compare the Spanish language picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) and the Mini Mental State Exam (MMSE) in identifying very mild dementia among Spanish speaking Latino patients. The tests and an independent diagnostic assessment were administered to 112 Latino patients free of medically diagnosed dementia from an urban primary care clinic. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to examine differences in the operating characteristics of the pFCSRT+IR and the MMSE. Cut scores were manipulated to equate sensitivities (specificities) at clinically relevant values to compare differences in specificities (sensitivities) using the Pearson Chi Square test. Youden's index was used to select the optimal cut scores. Twenty-four of the 112 primary care patients (21%) received a research dementia diagnosis, indicating a substantial burden of unrecognized dementia. MMSE scores but not free recall scores were associated with years of education in patients free of dementia. AUC was significantly higher for free recall than for MMSE. Free recall performed significantly better than the MMSE in sensitivity and in specificity. Using optimal cut scores, patients with impaired free recall were 10 times more likely to have dementia than patients with intact recall, and patients with impaired MMSE scores were 4.5 times more likely to have dementia than patients with intact scores. These results suggest that the Spanish language pFCSRT+IR may be an effective tool for dementia screening in educationally diverse Latino primary care populations.