Racial Differences in Visit Duration of Outpatient Psychiatric Visits

Olfson, Mark; Cherry, Donald K.; Lewis‐Fernández, Roberto

doi:10.1001/archgenpsychiatry.2008.523

Cited by 50 publications

(35 citation statements)

References 52 publications

(51 reference statements)

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“…Although many factors influence both retention and recruitment, retention remains conceptually distinct. Treatment experiences and other factors may take on greater importance after enrollment (14–16). …”

Section: Introductionmentioning

confidence: 99%

Retention and Attrition Among African Americans in the Star*d Study: What Causes Research Volunteers to Stay or Stray?

et al. 2013

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Background High attrition rates among African-Americans (AA) volunteers are a persistent problem that makes clinical trials less representative and complicates estimation of treatment outcomes. Many studies contrast AA with other ethnic/racial groups, but few compare the AA volunteers who remain in treatment with those who leave. Here, in addition to comparing patterns of attrition between African Americans and whites, we identify predictors of overall and early attrition among African Americans. Method Sample comprised non-Hispanic African-American (n=673) and white (n=2,549) participants in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Chi-square tests were used to examine racial group differences in reasons for exit. Multivariate logistic regression was used to examine predictors of overall attrition, early attrition (by Level 2) and top reasons cited for attrition among African Americans. Results For both African-American and white dropouts, non-compliance reasons for attrition were most commonly cited during the earlier phases of the study while reasons related to efficacy and medication side effects were cited later in the study. Satisfaction with treatment strongly predicted overall attrition among African Americans independent of socioeconomic, clinical, medical or psychosocial factors. Early attrition among African American dropouts was associated with less psychiatric comorbidity, and higher perceived physical functioning but greater severity of clinician-rated depression. Conclusions The decision to drop out is a dynamic process that changes over the course of a clinical trial. Strategies aimed at retaining African Americans in such trials should emphasize engagement with treatment and patient satisfaction immediately following enrollment and after treatment initiation.

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Section: Introductionmentioning

confidence: 99%

Retention and Attrition Among African Americans in the Star*d Study: What Causes Research Volunteers to Stay or Stray?

et al. 2013

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“…Nowadays psychiatrists increasingly see patients from different cultures and ethnic groups and are confronted with the challenge to understand concepts of mental illness they are not familiar with and the way subjective suffering is presented. Racial and ethnic differences are associated with differences in patients' help-seeking behaviour and may result in variations in psychiatric visit duration and in underutilization of mental health treatment facilities [3,36,44].…”

Section: Introductionmentioning

confidence: 99%

Ethnic and migrational impact on the clinical manifestation of depression

Deisenhammer

Coban-Basaran

Mantar

et al. 2011

Soc Psychiatry Psychiatr Epidemiol

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“…At 37 minutes for the first visit and especially at 24 minutes for the subsequent enhanced visits at weeks 1, 4, and 8, visit duration was acceptable for many outpatient clinics. This compares favorably to the average duration of community-based psychiatrist visits in the United States, which was 32-38 minutes per visit in 1989-2006 (Mechanic, McAlpine, & Rosenthal, 2001; Olfson, Cherry, & Lewis-Fernández, 2009; Olfson, Marcus, & Pincus, 1999). Motivational Pharmacotherapy also has the advantage of being conducted within the psychiatrist visit, rather than by adding ancillary Motivational Interviewing sessions with another clinician, thus decreasing service burden.…”

Section: Discussionmentioning

confidence: 75%

Impact of Motivational Pharmacotherapy on Treatment Retention Among Depressed Latinos

Lewis‐Fernández¹,

Balán²,

Patel³

et al. 2013

Psychiatry: Interpersonal and Biological Processes

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Compared to non-Latino Whites, US racial/ethnic minority groups show higher non-adherence with outpatient antidepressant therapy, including lower retention, despite adjusting for sociodemographic and insurance covariates. Culturally salient concerns about antidepressants leading to ambivalence about treatment engagement may contribute to this discrepancy. To improve treatment adherence among depressed Latinos, we developed Motivational Pharmacotherapy, a novel approach that combines Motivational Interviewing, standard pharmacotherapy, and attention to Latino cultural concerns about antidepressants. This 12-week, open-trial, pre-post pilot study assessed the impact of Motivational Pharmacotherapy on antidepressant therapy retention, response (symptoms, functioning, and quality of life), and visit duration among N=50 first-generation Latino outpatients with Major Depressive Disorder. At study endpoint, 20% of patients discontinued treatment, with a mean therapy duration of 74.2 out of 84 days. Patients’ symptoms, psychosocial functioning, and quality of life improved significantly. Mean visit length was 36.7 minutes for visit 1 and 24.3 minutes for subsequent visits, compatible with use in community clinics. Responder and remitter rates were 82% and 68%. Compared to published Latino proportions of non-retention (32-53%) and previous studies at our clinic with similar samples and medications (36-46%), Motivational Pharmacotherapy appears to improve Latino retention in antidepressant therapy, and should be investigated further in controlled designs.

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Racial Differences in Visit Duration of Outpatient Psychiatric Visits

Cited by 50 publications

References 52 publications

Retention and Attrition Among African Americans in the Star*d Study: What Causes Research Volunteers to Stay or Stray?

Retention and Attrition Among African Americans in the Star*d Study: What Causes Research Volunteers to Stay or Stray?

Ethnic and migrational impact on the clinical manifestation of depression

Impact of Motivational Pharmacotherapy on Treatment Retention Among Depressed Latinos

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