Improvement in Depressive Symptoms Among Hispanic/Latinos Receiving a Culturally Tailored IMPACT and Problem-Solving Intervention in a Community Health Center
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The present study investigated whether a culturally-tailored problem-solving intervention delivered by a trained depression care specialist (DCS) would improve depressive symptoms over a 6 month period among Hispanic/Latino patients in a federally-qualified community health center by the California–Mexico border. Participants included 189 low income Hispanic/Latino patients of Mexican heritage. Based on the improving mood-promoting access to collaborative treatment (IMPACT) evidence-based treatment, patients received evidence-based problem-solving therapy. The Patient Health Questionnaire-9 (PHQ-9) was administered to assess changes in self-reported depressive symptoms between baseline and monthly for a 6-month follow up period. The majority of participants were female (72.5 %) with a mean age of 52.5 (SD = 11.7). The mean PHQ-9 at baseline was 16.9 (SD = 4.0) and at the 6-month follow-up, the average PHQ-9 decreased to 9.9 (SD = 5.7). A linear mixed model analysis showed significant improvement in PHQ-9 scores over a 6 month period (F = 124.1; p < 0.001) after controlling for age, gender, smoking and diabetes. There was a significant three way interaction between time, gender and smoking (p = 0.01) showing that the depressive symptoms among male smokers did not improve as much as non-smoking males and females. Results suggest that a culturally-tailored problem solving approach can significantly reduce depressive symptoms among Hispanic/Latino low-income patients.
KeywordsHispanic/Latinos Depression Integrated Care IMPACT
Special thanks to staff and administration of San Ysidro Health Center in San Diego County, CA. The study was supported by Grant Number P20MD002293-01, from the San Diego EXPORT Center, National Center of Minority Health and Health Disparities and grant number T32HL079891 from the National Heart Lung and Blood Institute, National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
- Arean, P. A., Perri, M. G., Nezu, A. M., Schein, R. L., Christopher, F., & Joseph, T. X. (1993). Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatment for depression in older adults. Journal of Consulting and Clinical Psychology, 61(6), 1003–1010.CrossRefPubMedGoogle Scholar
- Balcázar, H., Alvarado, M., Cantu, F., Pedregon, V., & Fulwood, R. (2009). A promotora de salud model for addressing cardiovascular disease risk factors in the US-Mexico border region. Preventing Chronic Disease, 6(1). A02. http://www.cdc.gov/pcd/issues/2009/jan/08_0020.htm. Accessed Aug 2014.
- Balcázar, H., Wise, S., Rosenthal, E. L., Ochoa, C., Rodriguez J, Hastings D, et al. (2012). An ecological model using promotores de salud to prevent cardiovascular disease on the US-Mexico border: the HEART project. Preventing Chronic Disease, 9, 110100. doi: 10.5888/pcd9.110100.
- Bocker, E., Glasser, M., Nielsen, K., & Weidenbacher-Hoper, V. (2012). Rural older adults’ mental health: Status and challenges in care delivery. Rural Remote Health, 12, 2199.Google Scholar
- California Mental Health Services Authority. (2013). Integrated behavioral health project. Warm hand-off referrals by the primary care provider to the behavioralist. http://www.ibhp.org/?section=pages&cid=122.2007. Accessed Nov 2013.
- Center for Disease Control and Prevention (CDC). (2008). Smoking attributable mortality, years of potential life lost, and productivity losses–united states, 2000–2004. MMWR. Morbidity and Mortality Weekly Report, 57(45), 1226–1228.Google Scholar
- Ell, K. (2013). Social worker-led, culturally tailored therapy and support improve treatment adherence, depression-related symptoms, and patient satisfaction in low-income hispanics with diabetes. http://www.innovations.ahrq.gov/content.aspx?id=3318. Accessed April 2013.
- González, H. M., Tarraf, W., Whitfield, K., & Gallo, J. J. (2012). Vascular depression prevalence and epidemiology in the United States. Journal of Psychiatric Research, 46, 4.Google Scholar
- Grazier, K. L., Smith, J. E., Song, J., & Smiley, M. L. (2013). Integration of depression and primary care: Barriers to adoption. Journal of Primary Care & Community Health.Google Scholar
- Herrman, H., Patrick, D. L., Diehr, P., Martin, M. L., Fleck, M., Simon, G. E., et al. (2002). Longitudinal investigation of depression outcomes in primary care in six countries: The LIDO study. Functional status, health service use and treatment of people with depressive symptoms. Psychological Medicine, 32(5), 889–902.CrossRefPubMedGoogle Scholar
- Inagaki, M., Ohtsuki, T., Yonemoto, N., Oikawa, Y., Kurosawa, M., Muramatsu, K., et al. (2013). Prevalence of depression among outpatients visiting a general internal medicine polyclinic in rural Japan. General Hospital Psychiatry, 35(3), 286–290.Google Scholar
- Lorenzo-Blanco, E. I., Unger, J. B., Ritt-Olson, A., Soto, D., & Baezconde-Garbanati, L. (2011). Acculturation, gender, depression, and cigarette smoking among U.S. Hispanic youth: The mediating role of perceived discrimination. Journal of Youth and Adolescence, 40(11), 1519–1533.CrossRefPubMedCentralPubMedGoogle Scholar
- Philis-Tsimikas, A., Fortmann, A., Lleva-Ocana, L., Walker, C., & Gallo, L. C. (2011). Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: A project Dulce promotora randomized trial. Diabetes Care, 34(9), 1926–1931.CrossRefPubMedCentralPubMedGoogle Scholar
- Reinschmidt, K. M., & Chong, J. (2007). SONRISA: A curriculum toolbox for promotores to address mental health and diabetes. Preventing chronic disease, 4(4:A101. Epub).Google Scholar
- Teufel-Shone, N. I., Drummond, R., & Rawiel, U. (2005). Developing and adapting a family-based diabetes program at the U.S.-Mexico border. Preventing Chronic Disease, 2(1), 1–9.Google Scholar
- US Department of Health and Human Services. Health Resources and Service Administration (HRSA). Primary Care: The Health Center Program. Centro de Salud de la Comunidad San Ysidro. http://bphc.hrsa.gov/uds/datacenter.aspx?q=d&bid=091080&state=CA. Accessed January 2014.
- World Health Organization. (2004). The World Health report 2004: Changing history, annex table 3: Burden of disease in DALYs by cause, sex, and mortality stratum in WHO regions, estimates for 2002, Geneva. http://www.emro.who.int/health-topics/depression/. Accessed October 2012.