Depression Screening and Treatment for Patients Seeking Care at a Public Emergency Department
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University of Southern California
Los Angeles
Depression
Public emergency department
Latinos |
PROJECT
Depression screening along with support from a community health worker and social worker.
Latino community health workers screen patients for depression and other mental health challenges while they seek care in the emergency department. Those who screen positive for depression review depression-education materials with the community health worker and are scheduled to meet with a bilingual, bicultural social worker who provides services on-site.
Using depression care guidelines, the social worker offers patients a choice of treatment consisting of eight weeks of problem-solving therapy, antidepressant medication, or both and makes appropriate referrals. Patients also receive information about mental health resources in their community and a letter for their primary care physician to inform them that the patient screened positive for depression.
RATIONALE
Low-income, minority patients disproportionately utilize the emergency department as a surrogate for primary care and are rarely screened or provided with depression treatment while there. Integrating a motivational, personalized, culturally and linguistically appropriate assessment of substance use and other mental health service needs with active treatment referrals into emergency medical services may significantly improve access to, and participation in, depression treatment.
The involvement of the departments of medicine, psychiatry and emergency medicine in this project provides cross-disciplinary collaboration and insights on how to screen for and improve the delivery of depression treatment in the
emergency department. It is hoped that subsequent reduction of the adverse consequences of depression will improve patient outcomes and decrease rates of emergency department overutilization.
EVALUATION PLAN
Funded by Finding Answers in 2006.
Researchers are conducting a randomized controlled trial in which patients are randomized to either the intervention or a wait-list control group. Members of the control group receive bilingual depression reading materials, local mental health care resources, and a letter for their primary care physicians informing them that the patients screened positive for depression. Control patients are being offered the option of receiving the intervention after follow-up data collection. Intervention group patients are receiving eight weeks of therapy, medication or both.
At the end of the study period, and at three and six months post-intervention, patients are being surveyed to assess mental health service utilization, patient satisfaction, reduction in depressive symptoms and change in quality of life. A pre-post study using administrative data sets is evaluating the health care utilization of the patients before and after the intervention. Semi-structured interviews with patients and providers, as well as focus groups with administrators, community health workers and social workers, are being conducted to explore barriers to depression care as well as their experiences with, and recommendations for the implementation of the intervention.
Principal Investigator:
- Sarita A. Mohanty, MD, MPH
For More Information
Please Contact:
Sarita Mohanty, MD, MPH
samohant@usc.edu
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