Prevalence of major depressive disorder among Chinese-Americans in primary care

Validity of the Chinese Language Patient Health Questionnaire 2 and 9: A Systematic Review

Introduction

Chinese Americans with limited English proficiency have higher mental health needs than English speakers but are more likely to be undiagnosed and undertreated for depression. Increasing anti-Asian hate crimes during the COVID-19 pandemic has increased the urgency to accurately detect depressive symptoms in this community. This systematic review examines the validity of the Patient Health Questionnaire (PHQ)-2/9 for depression screening in Chinese-speaking populations.

Methods

We queried PubMed, Web of Science, Embase, and PsycINFO databases, examining studies through September 2021. Studies were included if they evaluated the Chinese language PHQ-2 or PHQ-9 and diagnosed depression using a clinical interview. Two investigators independently extracted study data and assessed quality using the QUADAS-2. Study sensitivities and specificities were combined in random effects meta-analyses.

Results

Of 513 articles, 20 met inclusion criteria. All examined the PHQ-9; seven also examined the PHQ-2. Studies were conducted in Mainland China (17), Hong Kong (1), Taiwan (1), and the United States (1). Fourteen studies were published in English; six in Chinese. Studies were diverse in setting, participant age, and comorbidities. For the Chinese language PHQ-9, Cronbach's alpha ranged from 0.765 to 0.938 for included studies (optimal cutoff scores ranged from 6 to 11). For the PHQ-2, Cronbach's alpha ranged from 0.727 to 0.785 (optimal cutoff scores 1-3). Overall, the PHQ-9 pooled sensitivity was 0.88 (95% CI 0.86-0.90), and pooled specificity was 0.87 (95% CI 0.83-0.91). Similarly, the pooled PHQ-2 sensitivity was 0.84 (95% CI 0.80-0.87), and pooled specificity was 0.87 (95% CI 0.78-0.93). The overall risk of bias was low (12 studies) or indeterminate (8 studies).

Discussion

While limited by missing study information, the Chinese language PHQ-9 appears to be a valid depression screening tool among Chinese-speaking populations across geographic and clinical settings. Further research should explore optimal cutoff scores for this population for routine depression screening and the validity of the tool to measure response to depression treatment.

The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis

BACKGROUND

Major depressive disorder is characterized by a depressed mood or feeling of sadness, loss of interest or pleasure in everyday activities. Depressed individuals have a cognitive impairment, low self-esteem, difficulty making decisions, feeling helpless and hopeless. The factors that have been associated with depression include the lack of social support, living in rural areas, suffering from chronic diseases, smoking, and alcohol abuse. This study aimed to investigate the global prevalence of major depressive disorder in the elderly.

METHOD

The electronic database such as Web of Science (WoS), Scopus, SID, PubMed, Google Scholar, Mag Iran, and IranDoc were systematically searched for studies reporting the prevalence of major depressive disorderin the elderly published up to March 2021. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) software. Heterogeneity between the studies was evaluated using the I² index. Begg and Mazumdar rank correlation test was used to assess publication bias.

RESULT

A total of 20 studies involving 18953 participants were included in this study. The global prevalence of major depression in the elderly was 13.3 % (95 % CI: 8.4-20.3 %). In the subgroup analysis, the prevalence of major depression in elderly women was 11.9 % (95 % CI: 7.6-18.6) and men 9.7 % (95 % CI: 5.2-17.3). No comparison was made between the two sexes, but based on the confidence intervals and large overlap, the two groups are not statistically different. Among continents, Australia had the highest prevalence of major depression in the elderly at 20.1 % (CI: 14.5-27.2 %). This was followed by Europe at 12.9 % (95 % CI: 5.1-28.9 %).

CONCLUSION

Major depressive disorder has a growing trend in the elderly population of the world. The prevalence of major depression in the elderly depends on various clinical and demographic factors such as age and gender. Therefore, mental health and the quality of life (QoL) of the elderly are important. The present study emphasizes the importance of social support in mental health that can reduce depression in the elderly.

Outcomes of an online computerized cognitive behavioral treatment program for treating chinese patients with depression: A pilot study

OBJECTIVE

This pilot study examined the feasibility, safety, and effectiveness of using an online computerized cognitive behavioral therapy (CBT) for treating Chinese patients with depression.

METHODS

Seventy-five Chinese patients with depression in outpatient clinics were randomized into a 5-week intervention. The intervention group received the Chinese translated version of MoodGYM in addition to usual treatment, and the control group continued with usual treatment. Participants completed the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) pre- and post-intervention.

RESULTS

We conducted multivariate linear regression analyses to compare the change in CES-D scores for completers after the intervention. Seventy-eight percent (n=29) of participants in the intervention group and 84% (n=32) of patients in the control group completed the post-treatment assessments, and no serious adverse events were reported. Results indicated that while both groups significantly improved at post test, the intervention group improved significantly more than the control group (t(59)=2.37, p=0.02).

CONCLUSION

Computerized CBT can be a cost-effective adjunct to medication treatment, particularly in areas with limited access to mental health services. The use of online computerized CBT has been found to be effective in many studies in Western countries, but has not been studied among Chinese outpatients. This study suggests that online computerized CBT is acceptable, and that MoodGYM is a feasible and efficacious augmentative treatment, specifically when used within an outpatient clinic population. With this small sample size we were able to demonstrate that the addition of MoodGYM to usual care improved treatment outcomes for outpatients with depression in China.

Depression Symptom Patterns and Social Correlates among Chinese Americans

The aim of this study is to examine and compare the depression symptoms pattern and social correlates in three groups: foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. This study used data from the Collaborative Psychiatric Epidemiology Surveys (CPES). The study sample consists of 599 Chinese Americans (468 for the foreign-born and 121 for the US-born) and 4032 non-Hispanic whites. Factor analysis was used to examine the depression symptom patterns by each subgroup. Four depression symptoms dimensions were examined: negative affect, somatic symptoms, cognitive symptoms, and suicidality. Logistic regression was used to investigate the effects of sociodemographic (age, gender, marital status, and education), physical health condition, and social relational factors (supports from and conflict with family and friends) on specific types of depression symptoms separately for the three subgroups. The findings showed little differences in depression symptom patterns but clear variation in the social correlates to the four depression dimensions across the three ethnocultural groups, foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. Clinicians should take into account the sociocultural factors of patients when making diagnosis and suggesting treatments. In addition, psychiatrists, psychologists, or other mental health service providers should offer treatment and coping suggestions based on the specific symptom dimensions of patients, and patients’ ethnocultural backgrounds.

Antidepressant medication use before and after kidney transplant: implications for outcomes - a retrospective study

We examined a novel database wherein national US transplant registry identifiers were linked to records from a large pharmaceutical claims warehouse (2008-2015) to characterize antidepressant use before and after kidney transplantation, and associations [adjusted hazard ratio (aHR) 95% CI] with death and graft failure. Among 72 054 recipients, 12.6% filled antidepressant medications in the year before transplant, and use was more common among women and patients who were white, unemployed, and had limited functional status. Pre-transplant antidepressant use was associated with 39% higher 1-year mortality (aHR 1.39, 95% CI 1.18-1.64) and 15% higher all-cause graft loss risk (aHR 1.15, 95% CI 1.02-1.30). More than 50% of patients who filled antidepressants pre-transplant continued fill post-transplant. Antidepressant use in the first year after transplant was associated with twofold higher risk of death (aHR 1.94, 95% CI 1.60-2.35), 38% higher risk of death-censored graft failure, and 61% higher risk of all-cause graft failure in the subsequent year. Pre-listing antidepressant use was also associated with increased mortality, but transplantation conferred a survival benefit regardless of prelisting antidepressant use status. While associations may in part reflect underlying behaviors or comorbidities, kidney transplant candidates and recipients treated with antidepressant medications should be monitored and supported to reduce the risk of adverse outcomes.

Health-related quality of life and health behaviors in a population-based sample of older, foreign-born, Chinese American adults living in New York City

Although the New York City Chinese population aged ≥ 65 years increased by 50% between 2000 and 2010, the health needs of this population are poorly understood. Approximately 3,001 Chinese individuals from high-density Asian American New York City areas were included in the REACH U.S. Risk Factor Survey; 805 (26.8%) were aged ≥ 65 years and foreign-born. Four health-related quality of life and three behavioral risk factor outcome variables were examined. Descriptive statistics were conducted by gender, and logistic regression models assessed sociodemographic and health factors associated with each outcome. Few women were current smokers (1.3% vs. 14.8% of men), 19% of respondents ate fruits and vegetables more than or equal to five times daily, and one-third of individuals received sufficient weekly physical activity. Days of poor health were similar to the national population aged ≥ 65 years, while self-reported fair or poor health was much greater among our Chinese sample; over 60% of respondents rated their health as fair or poor. Lower education and lower obesity were significantly associated with cigarette smoking among men, and older age was significantly associated with insufficient physical activity overall. Female gender was significantly associated with all poor health days; older age was significantly associated with poor days of physical health, and lower income was significantly associated with poor days of physical health and fair or poor self-reported health. This study provides important health-related information on a rapidly growing older population and highlights future research areas to inform culturally appropriate health promotion and disease prevention strategies and policies within community-based settings.

Depression among Asian-American Adults in the Community: Systematic Review and Meta-Analysis

OBJECTIVES

In this systematic review, we provide an overview of the literature on depression among Asian-Americans and explore the possible variations in depression prevalence estimates by methodological and demographic factors.

METHODS

Six databases were used to identify studies reporting a prevalence estimate for depression in Asian-American adults in non-clinical settings. Meta-analysis was used to calculate pooled estimates of rates of depression by assessment type. Statistical heterogeneity was assessed for subgroup analyses by gender, age, ethnicity, and other participant characteristics.

RESULTS

A total of 58 studies met the review criteria (n = 21.731 Asian-American adults). Heterogeneity across the studies was considerably high. The prevalence of major depression assessed via standardized clinical interviews ranged between 4.5% and 11.3%. Meta-analyses revealed comparable estimated prevalence rates of depression as measured by the Center for Epidemiologic Studies Depression Scale (35.6%, 95% CI 27.6%-43.7%) and the Geriatric Depression Scale (33.1%, 95% CI 14.9%-51.3%). Estimates varied by Asian racial/ethnic group and other participant characteristics. Estimates of depression among special populations, which included maternity, caregivers, and homosexuals, were significantly higher than estimates obtained from other samples (58.8% vs 29.3%, p = .003). Estimates of depression among Korean and Filipino-Americans were similar (33.3%-34.4%); however, the estimates were twice as high as those for Chinese-Americans (15.7%; p = .012 for Korean, p = .049 for Filipino).

CONCLUSION

There appears to be wide variability in the prevalence rates of depression among Asian-Americans in the US. Practitioners and researchers who serve Asian-American adults need to be sensitive to the potential diversity of the expression of depression and treatment-seeking across Asian-American subgroups. Public health policies to increase Asian-American access to mental health care, including increased screening, are necessary. Further work is needed to determine whether strategies to reduce depression among specific Asian racial/ethnic groups is warranted.

Depressive symptoms in Chinese-American subjects with cognitive impairment

OBJECTIVES

To compare the prevalence of depressive symptoms and frequency of antidepressant use between a group of elderly Chinese-American subjects with and without cognitive impairment and a group of matched white subjects. A secondary aim was to examine the clinical and demographic predictors of depressive symptoms across these groups.

METHODS

The study was conducted at an academic neurology subspecialty clinic. This was a case-control study with 140 Chinese-American subjects and 140 demographically and cognitively matched white subjects. In each group, there were 48 cognitively normal and 92 cognitively impaired participants (49 with mild cognitive impairment, 43 with Alzheimer disease). The proportion of individuals with significant depressive symptoms, as indicated by a Geriatric Depression Scale score ≥6 of 15, and frequency of antidepressant use were compared across groups by using χ(2) analysis. Factors predicting depressive symptoms, including racial and diagnostic group, age, gender, Mini-Mental State Examination score, level of functional impairment, education level, and medical comorbidities, were assessed by using linear regression analysis.

RESULTS

Significant depressive symptoms were more common in cognitively impaired Chinese-American (35%) than cognitively impaired white (15%; χ(2)[1] = 9.4; p = 0.004) subjects. Chinese-American subjects with cognitive impairment were less likely to be receiving treatment for depression (12%) than white subjects with cognitive impairment (37%; χ(2)[1] = 15.6; p = 0.002). Racial and diagnostic group, age, level of functional impairment, Mini-Mental State Examination score, and education level were all statistically significant independent predictors of Geriatric Depression Scale score.

CONCLUSIONS

Elderly Chinese-American subjects with cognitive impairment are at increased risk for unrecognized and untreated depressive symptoms compared with elderly white subjects with cognitive impairment. Education level may contribute to this risk or it may be a surrogate marker for other factors contributing to depressive symptoms in this group.

Japanese Americans' health concerns and depressive symptoms: implications for disaster counseling

This study examined factors contributing to depressive symptoms among Japanese Americans. Data were collected in Houston, Texas, in 2008, before the March 2011 Japan earthquake, through a community survey including demographic and mental health questions and the Hopkins Symptoms Checklist. Among 43 Japanese American respondents in this convenience sample, the depression prevalence was 11.6 percent. Chi-square results found that having anxiety symptoms and holding a master's degree had statistically significant relationships with depressive symptoms. An independent sample t test found that those having depressive symptoms experienced significantly more health issues than those without depressive symptoms. When these statistically significant variables were entered into a logistic regression model, the overall effect of having health issues, anxiety symptoms, and a master's degree collectively predicted depressive symptoms. It was also found that Japanese Americans rarely consult mental health professionals; in particular, female Japanese American respondents tend to seek help from religious leaders. As implied by these findings, the reluctance of Japanese Americans to seek formal help can be explained by social stigma, a health-oriented approach to treatment, and other cultural considerations. Practice implications focus on disaster counseling with a connection between mental health needs and health care support.

A meta-analytic study: the relationship between acculturation and depression among Asian Americans

Acculturation is an important and popular cultural research variable among specific ethnic populations that is used to explain the process of assimilating into the host culture. Acculturation has often been used to account for psychosocial changes and health outcomes and has been used to explain health disparities among ethnic groups. Using Asian Americans as an illustrative ethnic group, the authors see that researchers have highlighted the influence of acculturation on health outcomes. Some researchers suggest that this relationship is positive, whereas others postulate that the opposite is true. Because of the highly complex and divergent findings in the literature, this meta-analysis addresses the question of how acculturation (as measured by acculturation scales) is related to depression (a specific mental health outcome) among the Asian American population living in North America. Analyses were based on 38 studies. The meta-analyses reveal that when acculturation is measured as assimilation to the American culture, there is a small but statistically significant negative relationship between acculturation and depression scores. When acculturation is measured as orientation to the Asian culture, the relationship between acculturation and depression scores is also negative, but not statistically significant.

Depression care management for Chinese Americans in primary care: a feasibility pilot study

This study describes a culturally relevant intervention using a collaborative depression care model to integrate mental health and primary care services for depressed low income Chinese-Americans at a community health center. A total of 6,065 patients were screened for depression. Of the 341 who screened positive, 57 participated and were randomly assigned to receive either enhanced physician care with care management (32) or enhanced physician care only (25). All enrolled participants were assessed at baseline and 4 monthly follow-up visits for depression, physical and mental health functioning, and perceived stigma toward receiving depression care, to determine the impact, if any, of their mental health treatment. Both groups reported significant reduction of depressive symptoms and improved mental health functioning from baseline to follow-up assessments although there was no significant difference between the two groups. Although the study found no advantage to adding the care management component in the treatment of depression, screening and assertive treatment of immigrant Chinese Americans who tend to underutilize mental health services is important and consistent with the increased adoption of team based care models in patient centered medical homes. High refusal rates for enrollment in the study have implications for future study designs for this group.

Prevalence and natural course of late-life depression in China primary care: a population based study from an urban community

BACKGROUND

Primary care is the most promising venue for the management of late-life depression in China. The current study was designed to establish the prevalence of major depressive disorder among older adults in primary care, and to examine the correlates, and the natural course of late-life depression over a year.

METHODS

A sample of 1275 adults aged over 60 years was recruited from a primary care clinic in urban China for screening with PHQ-9, and 262 participants stratified by PHQ-9 score were interviewed to collect the presence of major depressive disorder (MDD), the availability of social support, and physical health and functional status. Participants were followed up for 12 months at 3-month intervals.

RESULTS

The estimated prevalence of MDD was 11.3% with the SCID interview. Increasing age, female gender, and lower educational level, living alone, low support from family, high medical illness burden, and impairment of daily function were significantly associated with MDD in later life. Less than 1% of these patients received treatments. More than 60% of patients with MDD at baseline remained depressed throughout the 12 month follow-up period; and only 3 patients had been treated during the 12-month follow-up.

LIMITATIONS

The correlates of late-life depression observed here may not necessarily serve as risk factors guiding the development of future prevention strategies.

DISCUSSION

In an urban Chinese primary care setting, late-life depression was found to be a common condition. Few patients with MDD received treatment for their condition, and the majority remained depressed over the following year.

Disability beliefs and help-seeking behavior of depressed Chinese-American patients in a primary care setting

In this study the authors assessed the effects of disability beliefs, conceptualization and labeling of emotional disabilities, and perceived barriers on help-seeking behaviors among depressed Chinese Americans in a primary care setting. Forty-two Chinese Americans participated in semistructured interviews using established psychological measures and open-ended questions adapted from the Explanatory Model Interview Catalogue. The authors found that care utilization appears to be complicated by somatization of emotional problems, variations in causal attribution to depression, barriers to receiving mental health care, and the burden of comorbid physical conditions. Their findings highlight the importance of addressing these issues and educating patients about body-mind dialectic common to depression.

Depression diagnoses after living kidney donation: linking U.S. Registry data and administrative claims

BACKGROUND

Limited data exist on correlates of psychological outcomes after kidney donation.

METHODS

We used a database integrating Organ Procurement and Transplantation Network registrations for 4650 living kidney donors from 1987 to 2007 with administrative data of a U.S. private health insurer (2000-2007 claims) to identify depression diagnoses among prior living donors. The burden and demographic correlates of depression after enrollment in the insurance plan were estimated by Cox regression. Graft failure and death of the donor's recipient were examined as time-varying exposures.

RESULTS

After start of insurance benefits, the cumulative frequency of depression diagnosis was 4.2% at 1 year and 11.5% at 5 years, and depression among donors was less common than among age- and gender-matched general insurance beneficiaries (rate ratio, 0.70; 95% confidence intervals [CI], 0.60-0.81). Demographic and clinical correlates of increased likelihood of depression diagnoses among the prior donors included female gender, white race, and some perioperative complications. After adjustment for donor demographic factors, recipient death (adjusted hazard ratio (aHR), 2.23; 95% CI, 1.11-4.48) and death-censored graft failure (aHR, 3.30; 95% CI, 1.49-7.34) were associated with two to three times the relative risk of subsequent depression diagnosis among nonspousal unrelated donors. There were trends toward increased depression diagnoses after recipient death and graft failure among spousal donors but no evidence of associations of these recipient events with the likelihood of depression diagnosis among related donors.

CONCLUSIONS

Recipient death and graft loss predict increased depression risk among unrelated living donors in this privately insured sample. Informed consent and postdonation care should consider the potential impact of recipient outcomes on the psychological health of the donor.

Culturally attuned Internet treatment for depression amongst Chinese Australians: a randomised controlled trial

INTRODUCTION

Although depression can be treated effectively with Cognitive Behaviour Therapy (CBT), only a small percentage of Chinese Australians access evidence-based treatment due to practical and cultural barriers. The present study examined the efficacy and acceptability of an Internet delivered CBT (iCBT) program to treat Chinese Australians with depression.

METHODS

The Chinese depression iCBT program (the Brighten Your Mood Program) is a culturally adapted version of the clinically efficacious Sadness iCBT Program. Fifty-five Chinese Australians with depression were randomly allocated to either an immediate treatment group or to a waitlist control group. Treatment consisted of an 8 week program with 6 CBT online educational lessons, homework assignments, additional resources presented in Chinese and English, and weekly telephone support with Mandarin/Cantonese-speaking support personnel. An intention-to-treat model was used for data analyses.

RESULTS

Seventeen of twenty-five (68%) treatment group participants completed all lessons within the timeframe. Compared to controls, treatment group participants reported significantly reduced symptoms of depression on the Chinese versions of the Beck Depression Inventory (CBDI) and Patient Health Questionnaire-9 item (CB-PHQ-9). The within- and between-group effect sizes (Cohen's d) were 1.41 and 0.93 on the CBDI, and 0.90 and 0.50 on the CB-PHQ-9, respectively. Participants rated the procedure as acceptable, and gains were sustained at three-month follow-up.

LIMITATIONS

The study included several subclinical participants and some measures that have not been previously validated with Chinese Australians.

CONCLUSIONS

Results provide preliminary support for the efficacy and acceptability of an iCBT program at reducing symptoms of depression in Chinese Australians.

Diabetes mellitus and risk of subsequent depression: a longitudinal study

BACKGROUND

Findings of previous studies on the association between diabetes and the risk of depression are contradictory. Furthermore, much less is known concerning the association among young adults.

OBJECTIVE

To investigate whether diabetes is associated with an increased risk of subsequent development of depression, with emphasis on age-specific variations.

DESIGN

A cohort study.

SETTING

Claims data of one million subjects randomly selected from 23 million people covered by the Taiwan National Health Insurance program.

PARTICIPANTS

From the claims data, we identified 14,048 patients aged ≥ 20 years with newly diagnosed diabetes in 2000-2002 and randomly selected 55,608 non-diabetic subjects for comparison, that were frequency-matched by calendar year, age, and gender. Incidence rates of depression to the end of 2007 were identified, and risks were compared between the two groups.

RESULTS

The incidence of depression was 1.80-times higher in the diabetic group than in nondiabetic subjects over a median follow-up of 6.5 years (adjusted hazard ratio [HR]=1.46, 95% confidence interval [CI]: 1.24-1.71). Age-specific HRs for incidence of depression in relation to diabetes were not statistically different between the patient subgroups aged 20-39, 40-49, 50-59, 60-69 and ≥ 70 years (p value for age-diabetes interaction=0.33). Stratified analyses showed that the association was much stronger for subjects without comorbid cardiovascular disease than for those with this comorbidity. Insulin treatment was associated with a 43% reduced risk of depression in diabetic patients.

CONCLUSIONS

In this population-based study, diabetic patients were at a higher risk for subsequent depression. Adequate treatment reduced the risk.

A study of the effectiveness of telepsychiatry-based culturally sensitive collaborative treatment of depressed Chinese Americans

BACKGROUND

Chinese American patients with Major Depressive Disorder (MDD) tend to underutilize mental health services and are more likely to seek help in primary care settings than from mental health specialists. Our team has reported that Culturally Sensitive Collaborative Treatment (CSCT) is effective in improving recognition and treatment engagement of depressed Chinese Americans in primary care. The current study builds on this prior research by incorporating telemedicine technology into the CSCT model.

METHODS/DESIGN

We propose a randomized controlled trial to evaluate the acceptability and effectiveness of a telepsychiatry-based culturally sensitive collaborative treatment (T-CSCT) intervention targeted toward Chinese Americans. Patients meeting the study's eligibility criteria will receive either treatment as usual or the intervention under investigation. The six-month intervention involves: 1) an initial psychiatric interview using a culturally sensitive protocol via videoconference; 2) eight scheduled phone visits with a care manager assigned to the patient, who will monitor the patient's progress, as well as medication side effects and dosage if applicable; and 3) collaboration between the patient's PCP, psychiatrist, and care manager. Outcome measures include depressive symptom severity as well as patient and PCP satisfaction with the telepsychiatry-based care management service.

DISCUSSION

The study investigates the T-CSCT model, which we believe will increase the feasibility and practicality of the CSCT model by adopting telemedicine technology. We anticipate that this model will expand access to culturally competent psychiatrists fluent in patients' native languages to improve treatment of depressed minority patients in primary care settings.

TRIAL REGISTRATION

NCT00854542.

Detection of depression with different interpreting methods among Chinese and Latino primary care patients: a randomized controlled trial

Language barriers may contribute to the under-detection of depression in Latinos and Asians. A total of 782 English, Spanish, and Chinese-speaking primary care patients were enrolled in a randomized controlled trial. Language discordant patients were randomized to Remote Simultaneous Medical Interpreting (RSMI) or usual and customary (U&C) interpreting. The Beck Depression Inventory-Fast Screen (BDI-FS) was administered. Patients were tracked for 1 year. A total of 462 patients completed the BDI-FS. Thirty-three percent had a positive (> or = 4) screen. Twenty-seven percent of BDI-FS positive patients were diagnosed with depression. Among BDI-FS positive patients, Chinese-speakers were less likely to be diagnosed compared with English speakers (31% vs. 10%, P < 0.05). There was a trend towards greater diagnosis with RSMI (27% detection with RSMI vs. 20% U&C, P = 0.41). The diagnosis of depression among BDI-FS positive patients in our population was low, particularly among Chinese-speakers. RSMI could be an important part of a multi-faceted approach to improving the detection of depression.

Culturally sensitive collaborative treatment for depressed chinese americans in primary care

OBJECTIVES

We examined the feasibility and effectiveness of using culturally sensitive collaborative treatment (CSCT) to improve recognition, engagement, and treatment of depressed Chinese Americans in primary care.

METHODS

Chinese American patients in a primary care setting (n = 4228) were screened for depression. The primary study outcome was treatment engagement rate, and the secondary outcome was treatment response.

RESULTS

Of the study participants, 296 (7%) screened positive for depression, 122 (41%) of whom presented for a psychiatric assessment; 104 (85%) were confirmed with major depressive disorder, and 100 (96%) of these patients were randomized into treatment involving either care management or usual care. Patients in the care management and usual care groups did not differ in terms of their outcomes. CSCT resulted in a nearly 7-fold increase in treatment rate among depressed patients in primary care.

CONCLUSIONS

CSCT is both feasible and effective in improving recognition and treatment engagement of depressed Chinese Americans. Care management may have limited effects on depressed patients treated by psychiatrists, given that these patients tend to have favorable responses in general.

How symptom manifestations affect help seeking for mental health problems among Chinese Americans

This study aims to examine how help-seeking behaviors of Chinese Americans are associated with the types of mental disorder, the tendency to somatize symptoms, social disruptiveness of symptoms, and comorbidity. Based on data from the Chinese American Psychiatric Epidemiological Study, we examined 246 Chinese Americans with a diagnosable major depressive disorder, anxiety disorder, or somatoform disorder, using hierarchical logistic regression analyses. Compared with respondents with somatoform disorder, those with anxiety or depressive disorder were 94% and 87% less likely to seek professional help. The tendency to somatize distress is positively related to soliciting help, especially medical help. Social disruptiveness had a very potent positive association with help seeking whereas comorbidity is nonsignificant when the symptom severity is controlled. The overall picture indicates that somatic expression of distress is a major impetus to help seeking, which happens to concur with the cultural conceptualization and subjective embodied experience of mental disorders among Chinese.

Recognizing and engaging depressed Chinese Americans in treatment in a primary care setting

OBJECTIVES

To examine the effectiveness of depression screening and the Engagement Interview Protocol (EIP) in identifying and engaging in treatment depressed Chinese Americans in a primary care setting.

METHODS

Chinese American patients who attended a primary care clinic between 15 September, 2004 and 14 September, 2005 were screened for depression using the Chinese Bilingual version of the Patient Health Questionnaire (CB-PHQ-9). Patients who screened positive (CB-PHQ-9>or=15) were evaluated using the EIP to establish psychiatric diagnosis and to engage patients in treatment.

RESULTS

Three thousand eight hundred and twelve patients completed the CB-PHQ-9, of which 113 (3.2%) screened positive for MDD. Among those screening positive, six (5.3%) had been receiving psychiatric treatment for depression, 57 (50%) declined to receive a psychiatric interview or were unable to be contacted, and 50 (44%) agreed to be interviewed with the EIP. Out of the 50 patients interviewed, 44 (88%) had their MDD diagnosis confirmed; among them, 41 (93%) agreed to receive treatment for depression and three (7%) declined intervention.

CONCLUSIONS

Under-recognition and under-treatment of depressed Chinese Americans in primary care settings continue to be prevalent. Recognition of depression can be enhanced by using the brief CB-PHQ-9 to screen for depression. Half of the Chinese Americans who screened positive for MDD declined evaluation by a mental health professional. Most of the depressed Chinese Americans who were evaluated agreed to receive treatment. Enhanced cultural sensitivity with the use of the EIP in psychiatric assessment may have contributed to the success in engaging depressed Chinese Americans in treatment.

Linguistic disparities in health care access and health status among older adults

BACKGROUND

English proficiency may be important in explaining disparities in health and health care access among older adults.

SUBJECTS

Population-based representative sample (N=18,659) of adults age 55 and older from the 2001 California Health Interview Survey.

METHODS

We examined whether health care access and health status vary among older adults who have limited English proficiency (LEP), who are proficient in English but also speak another language at home (EP), and who speak English only (EO). Weighted bivariate and multivariate survey logit analyses were conducted to examine the role of language ability on 2 aspects of access to care (not having a usual source of care, delays in getting care) and 2 indicators of health status (self-rated general health and emotional health).

RESULTS

Limited-English proficient adults were significantly worse off (1.68 to 2.49 times higher risk) than EO older adults in 3 of our 4 measures of access to care and health status. Limited-English proficient older adults had significantly worse access to care and health status than EP older adults except delays in care. English proficient adults had 52% increased risk of reporting poorer emotional health compared with EO speakers.

CONCLUSIONS

Provision of language assistance services to patients and training of providers in cultural competence are 2 means by which health care systems could reduce linguistic barriers, improve access to care, and ultimately improve health status for these vulnerable populations.

Depression and gender differences: focus on Taiwanese American older adults

Secondary analysis of cross-sectional data was used to examine gender differences and depression in elderly Taiwanese Americans. There is a paucity of health-related research focused on Asian Americans. This is especially true in the area of mental health. Depression, the most common psychiatric illness in older adults, is under-diagnosed in Asian Americans. A convenience sample of 100 elderly Taiwanese Americans, 47 women and 53 men, was used. Women were older, had higher depressions cores, more physical illness, poorer sleep scores, and less physical activity. Regression analysis indicated that 25% of the variance in depression scores was explained by sleep quality and physical activity.