Culturally Focused Depression Screening, Diagnosis and Consultation
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Massachusetts General Hospital
Boston
Depression
Primary care practices
Latinos |
PROJECT
Patients receive culturally focused depression screening, consultation and a depression toolkit. The results of the
consultation are communicated to the primary care provider.
Patients who screen positive for symptoms of depression receive a culturally focused psychiatric consultation by a trained psychologist or psychiatrist. Additionally, a web-based system assists providers in making referrals for the culturally focused
consultations, increasing access to the service. Patients diagnosed with depression receive a depression toolkit which includes self-rated depression questionnaires, psycho-educational booklets, worksheets and community resources. Diagnostic and treatment recommendations are communicated to the patient’s primary care provider.
Within two weeks of the initial consultation, patients attend a follow-up visit with the consultants. At that time, the consultant reviews the patients’ use of the toolkit, including the cognitive behavioral-based handouts and answers any questions.
RATIONALE
Ethnic minorities with depression are much more likely to be cared for by primary care physicians than by specialists in mental health. These providers may face difficulty in correctly diagnosing depression in patients from another ethnic background, due to different cues or vocabulary used by patients to describe symptoms, as well as other cultural barriers. The intervention is designed to improve primary care providers’ ability to provide appropriate, culturally informed care and patients’ knowledge of depression treatment resources.
The consultation will be used to make an accurate diagnosis that accounts for appropriate cultural factors, assess the patient’s psychiatric needs in a cultural context and implement a culturally competent intervention. All of these
factors have the potential to improve the rates of depression diagnosis and the quality of treatment for Latino patients. This study will also evaluate the feasibility and cost associated with developing a culturally focused psychiatric consultation service.
EVALUATION PLAN
Funded by Finding Answers in 2009.
The study is evaluating the feasibility and cost associated with implementing the culturally focused consultation service within a primary care setting. The evaluation includes a review of program records and communications, as well as key informant interviews with staff and patients. The study is also collecting and evaluating site-specific process information and data on the costs of the program.
Patients are being evaluated on depressive symptoms at the baseline appointment, and at a six-month follow-up. Screening is based on a self-administered screening instrument, available in English or Spanish. At the end of the study, patients are also being asked to complete a brief questionnaire on their utilization of therapy and antidepressant medication. This evaluation is comparing the patients receiving the consultation intervention to those receiving usual care.
Principal Investigators:
- Nhi-Ha T. Trinh, MD, MPH (Psychiatrist, Massachusetts General Hospital)
- C. Andres Bedoya, PhD (Staff Psychologist, Massachusetts General Hospital)
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