Treatment of Depression Among Impoverished Primary Care Patients From Ethnic Minority Groups

Miranda, Jeanne; Azocar, Francisca; Organista, Kurt C.; Dwyer, Eleanor; Areane, Patricia

doi:10.1176/appi.ps.54.2.219

Cited by 295 publications

(211 citation statements)

References 28 publications

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“…The interpersonal resources of many women were extremely limited and marked by conflictual family relationships, responsibilities of single parenthood, and social isolation. Practical resource limitations, such as difficulties with transportation, can interfere with women’s ability to maintain treatment involvement (38). …”

Section: Discussionmentioning

confidence: 99%

“…We note, however, that depression outcomes were substantially similar on self-report and interviewer-rated measures. Finally, although participants received $30 compensation for completing each research assessment, some types of assistance that could improve treatment engagement in a low-income population (38), such as transportation and child care, were not available. Although these “real-world” limitations may have interfered with treatment engagement and completion, this clinical trial was representative of usual care in community mental health.…”

Section: Discussionmentioning

confidence: 99%

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A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

Talbot¹,

Chaudron²,

Ward³

et al. 2011

Psychiatric Services

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Objectives Many depressed women seen in community mental health centers (CMHCs) have histories of childhood sexual abuse and are economically disadvantaged. Randomized trials are needed to test the effectiveness of evidence-based interventions in this population and setting. This study compared interpersonal psychotherapy with usual care psychotherapy among women in a CMHC. Methods Among 1,100 women seeking treatment in a CMHC, 230 (21%) had major depression and histories of childhood sexual abuse. Seventy women with major depression and sexual abuse before age 18 were randomly assigned to interpersonal psychotherapy (N=37) or usual care psychotherapy (N=33). Staff clinicians provided all treatments. Participants were assessed at study entry and at ten, 24, and 36 weeks after random assignment. Generalized estimating equations were used to examine change over time. Results Compared with women assigned to usual care, women who received interpersonal psychotherapy had greater reductions in depressive symptoms (Hamilton Rating Scale, p=.05, d=.34; Beck Depression Inventory–II, p=.01, d=.29), posttraumatic stress disorder symptoms (p=.04, d=.76), and shame (p=.002, d=.38). Interpersonal psychotherapy and usual care yielded comparable improvements in social and mental health–related functioning. Conclusions Interpersonal psychotherapy compared favorably to usual care psychotherapy in a CMHC in improving psychiatric symptoms and reducing shame among sexually abused women. However, there is a critical need for continued research to develop more effective treatments for the social and psychiatric sequelae of interpersonal trauma and socioeconomic disadvantage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

Talbot¹,

Chaudron²,

Ward³

et al. 2011

Psychiatric Services

View full text Add to dashboard Cite

show abstract

“…For example, ethnic minority patients are more likely to leave care prematurely (Miranda, Azocar, Organista, Dwyer, & Arean, 2003), and therefore, may benefit from more intensive support and follow-up. Ongoing economic and social stressors, particularly among poor patients, may also make participation in mental health care more difficult (e.g., lack of transportation and childcare).…”

Section: Guidelines Must Be Adapted To Respond To the Unique Needs Ofmentioning

confidence: 99%

Implementation of Guideline-Based Care for Depression in Primary Care

Rollman

Korsen

Schulberg

2005

Adm Policy Ment Health

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Evidence-based clinical practice guidelines for treating depression in primary care settings were developed, in part, to ensure that health services are provided in a consistent, highquality, and cost-effective manner. Yet for a variety of reasons, guideline-based primary care for depression remains the exception rather than the rule. This work provides a brief review of effective strategies used to customize and then deliver evidence-based treatment for depression in primary care settings; describes two representative case studies that illustrate locally customized collaborative care strategies for treatment delivery; and concludes with principles and implications for policy and practice based on our practical experiences.

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“…access to and quality of mental healthcare exist, 13,14 and under-served communities with low provider availability may rely on alternative settings, such as faith-based 15,16 or substance abuse programs. 17,18 A recent Institute of Medicine report suggests that integrating heath and nonhealth services settings is essential to address chronic health needs.…”

Section: Main Measuresmentioning

confidence: 99%

Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles

et al. 2013

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BACKGROUND:As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. OBJECTIVE: To understand the distribution of need and current burden of services for depression in underresourced, diverse communities in Los Angeles. DESIGN: Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. PARTICIPANTS: Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. MAIN MEASURES:Comparisons by setting in 6-month retrospective recall of depression services use. KEY RESULTS: Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. CONCLUSIONS: Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.KEY WORDS: depression services; community-partnered; participatory research; CPPR; CBPR; community-based; under-resourced. J Gen Intern Med 28(10):1279-87 DOI: 10.1007/s11606-013-2480-7 © Society of General Internal Medicine 2013 BACKGROUND Current healthcare reforms call for expansions of primary care and integrated medical homes for safety-net populations. 1,2 Primary care is a "de facto" mental health setting, 3 where rates of recognition and treatment for depression are lower than in specialty mental health settings. 4 While collaborative care is effective for primary care depressed patients, [5][6][7] little is known about how to conceptualize depression management in neighborhoods with high rates of poverty and ethnic minority representation. 8 Neighborhood poverty is predictive of depression onset, 9 and while prevalence of depressive disorders is similar for Latinos and African Americans relative to non-Hispanic whites, 10,11 African Americans may have greater severity when depressed. 12 Ethnic and socioeconomic disparities in access to and quality of mental health...

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Treatment of Depression Among Impoverished Primary Care Patients From Ethnic Minority Groups

Abstract: Supplemental case management improves retention in traditional mental health outpatient care and can improve outcomes for Spanish-speaking patients.

Cited by 295 publications

References 28 publications

A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

Implementation of Guideline-Based Care for Depression in Primary Care

Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles

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