Different Depression Treatment Recommendations and Adherence for Spanish- and English-Speaking Patients

Abstract

National guidelines recommend primary care providers (PCPs) screen patients for depression with a standardized tool and address positive screenings. However, depression prevalence is lower in Latinos (8% to 15%, with Spanish speakers at 8%) than non-Latino whites (22%). As a result of these prevalence differences, PCPs may use ethnicity and language of the patient to determine depression screening behaviors. This study examined standard of care (SoC) depression treatment recommendations by ethnicity and language for patients who screened positive for major depression during a medical visit. Methods: 275 patients scored >10 on the Patient Health Questionnaire-9 screening; a chart review assessed treatment referrals, followed by semistructured interviews with 18 patients and 7 PCPs regarding depression treatment behaviors. Results: 138 patients (50%) received SoC treatment recommendations. After controlling for age, gender, and race, a binary logistic regression was performed to determine language and ethnicity effects on SoC depression treatment recommendations (psychotherapy/pharmacotherapy vs other). Spanishspeaking Latinos were 72% less likely to receive SoC recommendations than English speakers (odds ratio [OR] ‫؍‬ 0.39). Interviews with Spanish-speaking patients confirmed that negative perceptions about medications, patient noncompliance, and a shortage of bilingual behavioral health providers within the clinic impacted SoC recommendations and uptake. Conclusions: Spanish-speaking Latinos did not receive or follow through with SoC recommendations as often as English speakers regardless of ethnicity. Future studies should explore reasons why language is a barrier to SoC recommendations for Latinos and explore culturally and linguistically sensitive methods to effectively treat Spanish speakers for depression during a medical visit. (J Am Board Fam Med 2019;32:904-912.)

Detectable viral load associated with unmet mental health and substance use needs among trans women living with HIV in San Francisco, California

“…Research also finds inequitable referrals for mental health among Latinos. One study found that Spanish-speaking Latinos were 72% less likely to receive mental health referrals from primary care providers with patients’ negative perceptions about medications, patient noncompliance, and a shortage of bilingual behavioral health providers within the clinic explaining why [ 47 ]. Trans women who are undocumented may be the least likely to receive referrals and access to mental health care.…”

New Research on Back Pain, Diet and Diabetes, Advanced Care Planning, and Other Issues Frequently Seen in Family Medicine

“…Stephenson et al 22 examined the implementation of standard of care depression treatment recommendations by ethnicity and language for patients who screened positive for major depression during a medical visit at an Integrated Federally Qualified Health Center. Spanish-speaking Latinos were less likely to receive or follow through with standard of care recommendations compared with English-speakers regardless of ethnicity.…”

A preliminary examination of the role of avoidance in behavioral activation treatment among Latinx individuals.

“…Although the prevalence rate of depression among U.S. Latinx individuals varies across epidemiological studies (e.g., Alegría et al, 2008; Menselson et al, 2008), one of the more recent epidemiologic cohort studies conducted to date suggests that the prevalence of depression among Latinx and non-Latinx, White individuals is similar (Wassertheil-Smoller et al, 2004). However, Latinx individuals, particularly those with a Spanish-speaking preference (LSSP), are less likely to receive depression care according to evidence-based guidelines relative to non-Latinx, White Americans, a pattern that persisted for decades (e.g., Blanco et al, 2007; Stephenson et al, 2019). As we continue to strive to create an ethical and equitable health system, it is imperative to target these treatment disparities and provide broader access to effective mental health care by developing and evaluating psychotherapies that address the modifiable depression care needs of this underserved U.S. population.…”