Culturally adapted depression education and engagement in treatment among Hispanics in primary care: outcomes from a pilot feasibility study

Abstract

Background Low use of anti-depressant medication, poor doctor-patient communication, and persistent stigma are key barriers to the treatment of depression in Hispanics. Common concerns include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications and seeking mental health treatments. In 2014, the Center for Medicare and Medicaid Services (CMS) funded the Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO) project to implement an education intervention designed to increase disease literacy and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement. Methods The DESEO study utilized a one-group pretest-posttest design to assess the effects a culturally-adapted Depression Education Intervention’s (DEI) on depression knowledge, stigma, and engagement in treatment in a sample of 350 Hispanic primary care patients with depression. The DEI utilized a fotonovela, a health education tool available in English and Spanish that uses posed photographs, captions, and soap opera narratives to raise awareness about depression and depression treatments. Results Participants reported significant decreases in depression symptoms and reported stigma about mental health care. Additionally, participants reported increased knowledge of depression yet greater negative perceptions about antidepressant medication. Finally, 89.5% of participants reported entering some form of treatment at follow-up. Conclusions Culturally adapted depression education shows promise in increasing understanding of depression, decreasing stigma, and increasing treatment engagement among Hispanic patients in a community-based health center. Results have implications for practice in addressing common concerns about depression treatments which include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. Trial registration The study was retrospectively registered with www.clinicaltrials.gov: NCT02491034 July 2, 2015.

Depression Education Fotonovela for Engagement of Hispanic Patients in Treatment: A Randomized Clinical Trial

“…Virtually the entire patient sample engaged in treatment of some kind, with more than half receiving a combination of medication and counseling. Increased stigma toward antidepressant use may re ect knowledge gained via the fotnovela about side effects and stigmatizing attitudes toward medication in general, and are similar to ndings from our pilot feasability study of the fotonovela (13). While these attitudes are not unique among Hispanic patients receiving treatment who frequently articulate fear of being stigmatized and deep concerns about depression medication being addictive (27), we conclude the fotonovela, Secret Feelings, likely requires further tailoring to better address known side effects of antidepressants (24,28,29).…”

“…The Depression Education Fotonovela (DEF), Secret Feelings, developed by Cabassa, Molina and Baron (10) differs from typical patient education materials by incorporating popular images, cultural norms and vivid pictures embedded within a soap opera narrative to increase depression knowledge and dispel myths about treatment (8,11). Secret Feelings has demonstrated signi cant improvements in depression knowledge and reductions in stigma toward antidepressants and treatment in a community education setting (12), and preliminary success in a pilot study in a community-based, primary care setting (13).…”

Do adolescents consider mind-body skills groups an acceptable treatment for depression: results from a pilot study

“…Hispanic/Latinx youth are more likely to experience depression compared to other races or ethnicities, [ 56 , 57 ] yet are less likely to engage in mental health treatments [ 8 ]. Research on culturally sensitive, tailored interventions for this population is still in its infancy, although preliminary evidence has shown the clear benefit of interventions that resonate with core values held by Hispanic/Latinx groups [ 58 , 59 ]. For example, group-based therapy like MBSGs may resonate with Hispanic/Latinx populations due to this culture’s embrace of collectivist ideologies and togetherness, called familismo [ 60 , 61 ] .…”

Do Adolescents Consider Mind-Body Skills Groups an Acceptable Treatment for Depression: Results from a Pilot Study.

“…Hispanic/Latinx youth are more likely to experience depression, compared to other races or ethnicities, [49,50] yet are less likely to engage in mental health treatments [8]. Research on culturally sensitive, tailored interventions for this population is still in its infancy, although preliminary evidence has shown the clear bene t of interventions that resonate with core values held by Hispanic/Latinx groups [51,52]. For example, group-based therapy like MBSGs may resonate with Hispanic/Latinx populations due to this culture's embrace of collectivist ideologies and togetherness, called familismo [53,54].…”