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Plys E, Fidai S, Robinson DN, Nogg KA, Phimphasone-Brady P. Open to interpretation: An integrated primary care behavioral health training approach for treating linguistically diverse patients. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2023; 41:537-546. [PMID: 37227825 PMCID: PMC11025311 DOI: 10.1037/fsh0000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Integrated primary care settings serve an increasingly high volume of linguistically diverse patients. In English language-dominant countries, limited English proficiency (LEP) is associated with disparities in access and quality of behavioral health (BH) care. Interpretive services (IS) aim to address these disparities by assisting in the delivery of clinical care between patients and providers who speak different languages. Yet, there is a need for greater emphasis on the utilization of IS in clinical training for BH professionals (e.g., psychology, social work, counseling, and family therapy). METHOD In this conceptual article, we describe a BH practicum rotation for predoctoral psychology trainees in a free, student-run integrated primary care clinic that largely serves uninsured adults with LEP. First, we discuss our training model which includes a 90-min didactic lecture on IS for BH and supervised applied clinical experiences (e.g., psychotherapy, warm handoffs, and consultation). Then, we present vignettes prepared by trainees about the challenges and benefits associated with delivering BH care with IS at the predoctoral level of training. RESULTS From the practicum experience, clinical psychology trainees reported improved knowledge and competencies in utilizing IS as well as generalizable skills for delivering BH care with a focus on multicultural practice. DISCUSSION We recommend that other integrated primary care BH training sites consider emphasizing training in IS. This article concludes with recommendations for implementation and dissemination of our training model on other sites. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado Denver—Anschutz Medical Campus
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Sophia Fidai
- Graduate School of Professional Psychology, University of Denver
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Eghaneyan BH, Sanchez K, Killian MO. Response to Letter to the Editor on The Integration of Behavioral Health and Primary Care for Hispanic/Latino Patients with Depression and Comorbid PTSD. J Behav Health Serv Res 2023; 50:558-560. [PMID: 37106161 DOI: 10.1007/s11414-023-09839-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Brittany H Eghaneyan
- Department of Social Work, California State University, 800 N. State College Blvd., Fullerton, CA, 92831, USA.
| | - Katherine Sanchez
- Baylor Scott & White Research Institute, 3434 Live Oak St, Ste 501, Dallas, TX, 75204, USA
| | - Michael O Killian
- College of Social Work, Florida State University, 296 Champions Way, Tallahassee, FL, 32306, USA
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Garasia S, Bishop V, Clayton S, Pinnington G, Arinze C, Jalil E. Health outcomes, health services utilization, and costs consequences of medicare uninsurance among migrants in Canada: a systematic review. BMC Health Serv Res 2023; 23:427. [PMID: 37138351 PMCID: PMC10154752 DOI: 10.1186/s12913-023-09417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Medically uninsured groups, many of them migrants, reportedly delay using healthcare services due to costs and often face preventable health consequences. This systematic review sought to assess quantitative evidence on health outcomes, health services use, and health care costs among uninsured migrant populations in Canada. METHODS OVID MEDLINE, Embase, Global Health, EconLit, and grey literature were searched to identify relevant literature published up until March 2021. The Cochrane Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool was used to assess the quality of studies. RESULTS Ten studies were included. Data showed that there are differences among insured and uninsured groups in reported health outcomes and health services use. No quantitative studies on economic costs were captured. CONCLUSIONS Our findings indicate a need to review policies regarding accessible and affordable health care for migrants. Increasing funding to community health centers may improve service utilization and health outcomes among this population.
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Affiliation(s)
- Sophiya Garasia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
| | - Valerie Bishop
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Stephanie Clayton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Genevieve Pinnington
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Chika Arinze
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Ezza Jalil
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Eghaneyan BH, Killian MO, Sanchez K. The Integration of Behavioral Health and Primary Care for Hispanic/Latino Patients with Depression and Comorbid PTSD. J Behav Health Serv Res 2023; 50:95-107. [PMID: 36352161 PMCID: PMC9646280 DOI: 10.1007/s11414-022-09824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
Comorbid PTSD and depression are notably high within primary care settings serving low-income and/or immigrant Hispanic/Latino populations. There is limited research examining how comorbid PTSD impacts the response to depression treatment for patients within these settings. The purpose of this study was to examine PTSD-depression comorbidity and its association with treatment outcomes among Hispanic/Latino patients enrolled in an integrated behavioral health intervention for depression. Participants were Hispanic/Latino adult primary care patients who met the criteria for depression and were not currently in treatment. Depression and anxiety severity were assessed at baseline and the 6 and 12 month follow-ups. Outcomes were compared between participants who met the criteria for a PTSD diagnosis and those that did not. Depression and anxiety scores significantly decreased through the 1-year intervention period regardless of PTSD diagnosis. More research is needed to understand what elements of culturally adapted, linguistically concordant treatment benefit diverse patients the most.
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Affiliation(s)
- Brittany H. Eghaneyan
- Department of Social Work, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA 92831 USA
| | - Michael O. Killian
- College of Social Work, Florida State University, 296 Champions Way, Tallahassee, FL 32306 USA
| | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX 76019 USA
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Sheth N, Patel S, O’Connor S, Dutton MA. Working Towards Collaborative, Migrant-Centered, and Trauma-Informed Care: a Mental Health Needs Assessment for Forced Migrant Communities in the DC Metropolitan Area of the United States. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2021. [DOI: 10.1007/s12134-021-00884-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gehringer R, Freytag A, Krause M, Schlattmann P, Schmidt K, Schulz S, Zezulka SJ, Wolf F, Grininger J, Berger M, Vollmar HC, Gensichen J. Psychological interventions for posttraumatic stress disorder involving primary care physicians: systematic review and Meta-analysis of randomized controlled trials. BMC FAMILY PRACTICE 2020; 21:176. [PMID: 32847509 PMCID: PMC7450546 DOI: 10.1186/s12875-020-01244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/11/2020] [Indexed: 11/21/2022]
Abstract
Background Evidence-based psychological interventions for posttraumatic stress disorder (PTSD) are available in specialized settings, but adequate care in primary care is often lacking. The aim of this systematic review was to determine the effectiveness of psychological interventions for PTSD involving primary care physicians (PCPs) and to characterize these interventions as well as their providers. Method A systematic review and meta-analyses of randomized controlled trials (RCTs). Primary outcome were symptoms of PTSD. Results Four RCTs with a total of 774 patients suffering from PTSD symptoms were included, all applying cognitive behavioural based interventions. Three studies with psychological interventions being conducted by case managers were pooled in a meta-analysis. Interventions were not effective in the short term (0–6 months; SMD, − 0.1; 95% CI, − 0.24-0.04; I2 = 0%). Only two studies contributed to the meta-analysis for long term (12–18 months) outcomes yielding a small effect (SMD, − 0.23; 95% CI, − 0.38- -0.08; I2 = 0%). Conclusions Psychological interventions for PTSD in primary care settings may be effective in the long term but number and quality of included studies was limited so the results should be interpreted with caution.
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Affiliation(s)
- Rebekka Gehringer
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany.
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Markus Krause
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Sven Schulz
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Sophie Jana Zezulka
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Florian Wolf
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Jonas Grininger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Mathias Berger
- Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany.,Department of Family Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
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Riza E, Kalkman S, Coritsidis A, Koubardas S, Vassiliu S, Lazarou D, Karnaki P, Zota D, Kantzanou M, Psaltopoulou T, Linos A. Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices. Healthcare (Basel) 2020; 8:E115. [PMID: 32354069 PMCID: PMC7349376 DOI: 10.3390/healthcare8020115] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Strengthening community-based healthcare is a valuable strategy to reduce health inequalities and improve the integration of migrants and refugees into local communities in the European Union. However, little is known about how to effectively develop and run community-based healthcare models for migrants and refugees. Aiming at identifying the most-promising best practices, we performed a scoping review of the international academic literature into effective community-based healthcare models and interventions for migrants and refugees as part of the Mig-HealthCare project. METHODS A systematic search in PubMed, EMBASE, and Scopus databases was conducted in March 2018 following the PRISMA methodology. Data extraction from eligible publications included information on general study characteristics, a brief description of the intervention/model, and reported outcomes in terms of effectiveness and challenges. Subsequently, we critically assessed the available evidence per type of healthcare service according to specific criteria to establish a shortlist of the most promising best practices. RESULTS In total, 118 academic publications were critically reviewed and categorized in the thematic areas of mental health (n = 53), general health services (n = 36), noncommunicable diseases (n = 13), primary healthcare (n = 9), and women's maternal and child health (n = 7). CONCLUSION A set of 15 of the most-promising best practices and tools in community-based healthcare for migrants and refugees were identified that include several intervention approaches per thematic category. The elements of good communication, the linguistic barriers and the cultural differences, played crucial roles in the effective application of the interventions. The close collaboration of the various stakeholders, the local communities, the migrant/refugee communities, and the partnerships is a key element in the successful implementation of primary healthcare provision.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Shona Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Alexandra Coritsidis
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8434, USA
| | - Sotirios Koubardas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Sofia Vassiliu
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Despoina Lazarou
- Institute of Human Sciences, Wadham College, University of Oxford, Oxford OX1 3PN, UK
| | - Panagiota Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Dina Zota
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Athena Linos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
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Kaltman S, Watson MR, Campoli M, Serrano A, Talisman N, Kirkpatrick L, Mete M, Green BL. Treatment of depression and PTSD in primary care clinics serving uninsured low-income mostly Latina/o immigrants: A naturalistic prospective evaluation. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2019; 25:579-589. [PMID: 30816751 PMCID: PMC6713614 DOI: 10.1037/cdp0000251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Uninsured immigrants to the United States are psychologically vulnerable due to limited access to mental health services. Latina/o immigrants from Central and South America are further at risk due to high levels of trauma exposure, both in their country of origin and their adopted country. Effective behavioral interventions in primary care are needed to address this services gap for common trauma-related mental disorders, including depression and posttraumatic stress disorder (PTSD). A naturalistic prospective study compared depression and PTSD outcomes for uninsured primary care patients, mostly Latina/o immigrants, in clinics with distinct models for integrating behavioral health services. One clinic had a collaborative care program, that is, a multicomponent, system-level intervention with the goals of facilitating increased screening, improving diagnostic accuracy, increasing uptake of evidence-based treatment, and utilizing measurement-based treatment to target. The other had colocated services, with an on-site therapist. METHOD One hundred thirty-eight patients with presumptive depression were interviewed at baseline. Follow-up data were collected 8 months later. Care received between the two assessments was ascertained by chart review. RESULTS There was a significant decrease in depression symptoms regardless of clinic. Factors associated with improved depression outcomes included absence of comorbid PTSD and lack of additional trauma exposures. Although there was overall improvement in PTSD, there was significantly more improvement in the collaborative care clinic. CONCLUSIONS Results suggest that both models were effective for depression and PTSD; however, the collaborative care model had added benefits for those patients with PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Primary Health Care Models Addressing Health Equity for Immigrants: A Systematic Scoping Review. J Immigr Minor Health 2019; 20:214-230. [PMID: 27858278 DOI: 10.1007/s10903-016-0531-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To examine two healthcare models, specifically "Primary Medical Care" (PMC) and "Primary Health Care" (PHC) in the context of immigrant populations' health needs. We conducted a systematic scoping review of studies that examined primary care provided to immigrants. We categorized studies into two models, PMC and PHC. We used subjects of access barriers and preventive interventions to analyze the potential of PMC/PHC to address healthcare inequities. From 1385 articles, 39 relevant studies were identified. In the context of immigrant populations, the PMC model was found to be more oriented to implement strategies that improve quality of care of the acute and chronically ill, while PHC models focused more on health promotion and strategies to address cultural and access barriers to care, and preventive strategies to address social determinants of health. Primary Health Care models may be better equipped to address social determinants of health, and thus have more potential to reduce immigrant populations' health inequities.
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10
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Paat YF, Green R. Mental health of immigrants and refugees seeking legal services on the US-Mexico border. Transcult Psychiatry 2017; 54:783-805. [PMID: 29226794 DOI: 10.1177/1363461517746316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The debates on the mental health benefits associated with immigration are mixed. On the one hand, immigrants are provided with more opportunities not available in their home countries. On the other hand, they are far away from home and may have been exposed to traumatic experiences on their journeys to the receiving country. Even after settling down in the receiving country, most continue to face legal battles associated with their immigration status, as shown in this study. This study examined the risk and protective factors associated with the mental health conditions in a sample of 39 immigrants and refugees seeking legal services on the US-Mexico border. Participants were recruited from a southwestern community agency serving the region's immigrant population over the past three decades. Negative mental health states including stress, sadness, and anxiety were frequently reported by the participants. Six themes were identified as significantly related to the participants' adjustment in the US: (1) political turmoil and safety issues; (2) economic hardship and extreme poverty; (3) trauma before and after resettlement; (4) immigration status; (5) family relational strain; and (6) identity struggle and acculturation. Overall, results demonstrate the complexity of issues pertaining to cross-country migration, cultural sensitivities, and mental health.
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Affiliation(s)
| | - Rachel Green
- Diocesan Migrant & Refugee Services, Inc., El Paso, Texas
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11
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Lokko HN, Chen JA, Parekh RI, Stern TA. Racial and Ethnic Diversity in the US Psychiatric Workforce: A Perspective and Recommendations. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:898-904. [PMID: 27421839 DOI: 10.1007/s40596-016-0591-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/04/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Hermioni N Lokko
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
| | - Justin A Chen
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | - Theodore A Stern
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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12
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Zhong BL, Liu TB, Chan SSM, Jin D, Hu CY, Dai J, Chiu HFK. Prevalence and correlates of major depressive disorder among rural-to-urban migrant workers in Shenzhen, China. J Affect Disord 2015; 183:1-9. [PMID: 25989590 DOI: 10.1016/j.jad.2015.04.031] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In China, rural-to-urban migrant workers (MWs) are a large and vulnerable population that may be at high risk for depression, but previous studies focused on depressive symptoms of MWs and no study has investigated the epidemiology of major depressive disorder (MDD). The objective of this study was to determine the prevalence and correlates of one-month and lifetime MDD among MWs in Shenzhen, China, and mental health services utilization of MWs with lifetime MDD. METHODS A total of 3031 MWs were recruited from 10 manufacturing factories and interviewed with the Chinese version of the Mini International Neuropsychiatric Interview. RESULTS The one-month and lifetime prevalence rates of MDD were 1.39% (95% CI: 0.97%, 1.80%) and 5.08% (95% CI: 4.30%, 5.86%), respectively. No significant gender and age-group differences were found in these rates. The risk factors for lifetime MDD included lower education, worse living condition, poorer self-perceived physical health, migration before adulthood, infrequently calling family members, and having done lots of jobs. Only 3.25% of the respondents with lifetime MDD had sought professional help prior to the interview. LIMITATIONS The MW sample was selected from manufacturing factories, we should be cautious in generalizing our findings to MWs of other industries. CONCLUSIONS Compared with the Chinese general population, MWs may have a similar prevalence of MDD, but the rate of lifetime mental health services use of MWs with lifetime MDD is extremely low. MDD is a major public health concern for this population. There is an urgent need to improve mental health services for MWs.
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Affiliation(s)
- Bao-Liang Zhong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| | - Tie-Bang Liu
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, PR China
| | - Sandra S M Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR
| | - Dong Jin
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, PR China
| | - Chi-Yi Hu
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, PR China
| | - Jing Dai
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, PR China
| | - Helen F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR.
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Reigada LC, McGovern A, Tudor ME, Walder DJ, Warner CM. Collaborating With Pediatric Gastroenterologists to Treat Co-Occurring Inflammatory Bowel Disease and Anxiety in Pediatric Medical Settings. COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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14
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Meredith LS, Eisenman DP, Green BL, Kaltman S, Wong EC, Han B, Cassells A, Tobin JN. Design of the Violence and Stress Assessment (ViStA) study: a randomized controlled trial of care management for PTSD among predominantly Latino patients in safety net health centers. Contemp Clin Trials 2014; 38:163-72. [PMID: 24747932 DOI: 10.1016/j.cct.2014.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/06/2014] [Accepted: 04/09/2014] [Indexed: 11/24/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national "safety nets" for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12 months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care.
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Affiliation(s)
- Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA; VA HSR&D Center for the Study of Healthcare Provider Behavior, 16111 Plummer Street (152), North Hills, CA 91343, USA.
| | - David P Eisenman
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Bonnie L Green
- Department of Psychiatry, Georgetown University Medical School, 4000 Reservoir Road NW Suite 120, Washington, DC 20007, USA
| | - Stacey Kaltman
- Department of Psychiatry, Georgetown University Medical School, 4000 Reservoir Road NW Suite 120, Washington, DC 20007, USA
| | - Eunice C Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
| | - Andrea Cassells
- Clinical Directors Network (CDN), 5W 37th St # 10, New York, NY 10018, USA
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), 5W 37th St # 10, New York, NY 10018, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Ave, Bronx, NY 10461, USA; Center for Clinical and Translational Sciences, The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
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Abstract
Posttraumatic stress disorder (PTSD) is common in primary care but it is frequently not detected or treated adequately. There is insufficient evidence to recommend universal screening for PTSD in primary care, but clinicians should remain alert to PTSD among patients exposed to trauma, and among those with other psychiatric disorders, irritable bowel syndrome, multiple somatic symptoms and chronic pain. A two-stage process of screening (involving the PC-PTSD), and, for those with a positive screen, a diagnostic evaluation (using the PTSD-Checklist), can detect most patients with PTSD with few false positives. Evidence-based recommendations are provided for treatment in primary care or referral to mental health.
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Santiago CD, Kaltman S, Miranda J. Poverty and mental health: how do low-income adults and children fare in psychotherapy? J Clin Psychol 2012; 69:115-26. [PMID: 23280880 DOI: 10.1002/jclp.21951] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Poverty is associated with an increased risk for psychological problems. Even with this increased risk for mental health problems and need for care, many low-income adults and families do not receive treatment because of logistical, attitudinal, and systemic barriers. Despite significant barriers to obtaining care, research suggests that low-income individuals show significant benefit from evidence-based mental healthcare. In this article, we review the link between poverty and mental health, common barriers to obtaining mental health services, and treatment studies that have been conducted with low-income groups. Finally, we discuss the implications of the research reviewed and offer recommendations for clinicians working with low-income children or adults, highlighting the importance of evidence-based care, extensive outreach, and empathic respect.
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Hails K, Brill CD, Chang T, Yeung A, Fava M, Trinh NH. Cross-cultural aspects of depression management in primary care. Curr Psychiatry Rep 2012; 14:336-44. [PMID: 22580834 DOI: 10.1007/s11920-012-0276-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Major depressive disorder (MDD) is a prevalent illness in minority populations. Minority patients with MDD are often unrecognized and untreated. This review examines promising interventions to address MDD in primary care settings, where minority groups are more likely to seek care. Since 2010, eleven interventions have been developed to address patient-specific and provider-specific barriers, many of which are adaptations of the collaborative care model. Other promising interventions include cultural tailoring of the collaborative care model, as well as the addition of telepsychiatry, motivational interviewing, cultural consultation, and innovations in interpreting. Overall, collaborative care was found feasible and improved satisfaction and treatment engagement of depressed minority patients in primary care. It remains inconclusive whether these newer intervention models improve MDD treatment outcomes. Future research will be needed to establish the effectiveness of these intervention models in improving the treatment outcomes of minority populations with MDD.
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Affiliation(s)
- Katherine Hails
- Depression Clinical & Research Program, Massachusetts General Hospital, One Bowdoin Square, Boston, MA 02114, USA.
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