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Culturally Focused Depression Screening, Diagnosis and Consultation

Culturally Focused Depression Screening, Diagnosis and Consultation Massachusetts General Hospital
Boston
Depression
Latino

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.


Summary Results

Due to implementation challenges and low enrollment rates, it is unknown if culturally-adapted psychiatric consultations and depression toolkits can improve depressive symptoms and increase diagnosis and treatment of depression for Asian and Latino American primary care patients. However, among the 27 Latino American patient interviewees who received the intervention, over 70% said they liked having the service offered in their primary care physician's office; reported their expectations about the program were met; and felt the providers and recommendations were culturally sensitive. Compared to Caucasians, Asian Americans were less likely to agree to be contacted (OR 0.59), while Latino Americans were more likely to agree to be contacted (OR 1.68). Compared to those with a PHQ2 score <2, those with a PHQ-2 score of 2 or greater were more likely to agree to be contacted (OR 3.17). 

Publications


Association of Race, Ethnicity and Language with Participation in Mental Health Research among Adult Patients in Primary Care
Journal of Immigrant and Minority Health. Published online 2014 Nov 15.
Full Article 

Impact of a Culturally Focused Psychiatric Consultation on Depressive Symptoms Among Latinos in Primary Care
Psychiatric Services. 2014;65(10):1256-1262.
Full Article (subscription may be required)

Evaluating Patient Acceptability of a Culturally Focused Psychiatric Consultation Intervention for Latino Americans with Depression
Journal of Immigrant and Minority Health. Published online 2013 Oct 5.
Full Article 

A Study of a Culturally Focused Psychiatric Consultation Service for Asian American and Latino American Primary Care Patients with Depression
BMC Psychiatry. 2011;11:166.
Full Article 

Principal Investigators

  • Nhi-Ha T. Trinh, MD, MPH (Psychiatrist, Massachusetts General Hospital)
  • C. Andres Bedoya, PhD (Staff Psychologist, Massachusetts General Hospital)