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Hernandez J, Demiranda L, Perisetla P, Andrews L, Zhang K, Henderson R, Mittal A, Norton HF, Hagen MG. A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States. BMC Public Health 2024; 24:1713. [PMID: 38926697 PMCID: PMC11210103 DOI: 10.1186/s12889-024-19166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND While many populations struggle with health literacy, those who speak Spanish preferentially or exclusively, including Hispanic, immigrant, or migrant populations, may face particular barriers, as they navigate a predominantly English-language healthcare system. This population also faces greater morbidity and mortality from treatable chronic diseases, such as hypertension and diabetes. The aim of this systematic review was to describe existing health literacy interventions for patients with a Spanish-language preference and present their effectiveness. METHODS We carried out a systematic review where Web of Science, EMBASE, and PubMed were queried using MeSH terms to identify relevant literature. Included articles described patients with a Spanish-language preference participating in interventions to improve health literacy levels in the United States. Screening and data abstraction were conducted independently and in pairs. Risk of bias assessments were conducted using validated appraisal tools. RESULTS A total of 2823 studies were identified, of which 62 met our eligibility criteria. The studies took place in a variety of community and clinical settings and used varied tools for measuring health literacy. Of the interventions, 28 consisted of in-person education and 27 implemented multimedia education, with 89% of studies in each category finding significant results. The remaining seven studies featured multimodal interventions, all of which achieved significant results. CONCLUSION Successful strategies included the addition of liaison roles, such as promotores (Hispanic community health workers), and the use of multimedia fotonovelas (photo comics) with linguistic and cultural adaptations. In some cases, the external validity of the results was limited. Improving low health literacy in patients with a Spanish-language preference, a population with existing barriers to high quality of care, may help them better navigate health infrastructure and make informed decisions regarding their health. REGISTRATION PROSPERO (available at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257655.t ).
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Affiliation(s)
- Joel Hernandez
- University of Central Florida College of Medicine, University of Central Florida, Orlando, USA
| | - Liliana Demiranda
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Priyanka Perisetla
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Lauren Andrews
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Keer Zhang
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Rebecca Henderson
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Ajay Mittal
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA
| | - Hannah F Norton
- University of Florida Health Science Center Libraries, Gainesville, FL, USA
| | - Melanie G Hagen
- Equal Access Research, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4 Floor, Suite 4592, Gainesville, FL, 32610-3008, USA.
- Department of Internal Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
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Deane AE, Elmore JS, Mayes TL, Robinson S, AlZubi Y, Wakefield SM, Trivedi MH. Shifting From Best Practice to Standard Practice: Implementing Measurement-Based Care in Health Systems. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01715-0. [PMID: 38896285 DOI: 10.1007/s10578-024-01715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
There is a high prevalence of untreated depression in adults and youth observed at the population level in the United States, and many who would benefit from treatment do not receive it. One proposed effort to increase access to care is the use of measurement-based care (MBC; repeated use of symptom measures for screening and treatment guidance) by primary care physicians to treat non-complex cases of depression. MBC has been shown to improve patient outcomes compared to care as usual, but there are barriers that need to be addressed at the health system level for effective implementation to occur. Herein we provide an overview of MBC and detail benefits and barriers of MBC implementation. Relevant considerations and guidance for implementing MBC are presented, and a case example of a health system implementing MBC is included. Though issues of reimbursement, limited human and technological resources, and resistance to systemic change are barriers to implementing MBC, effective strategies exist to overcome these barriers. In addition to helping health systems align with changes to value-based care models, effective implementation of MBC can likely improve patient outcomes and result in net financial benefits.
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Affiliation(s)
- Amber E Deane
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Skylar Robinson
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Yasmin AlZubi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA.
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Duarte M, Salamanca M, Gonzalez JM, Roman Laporte R, Gattamorta K, Lopez Martinez FE, Clochesy J, Rincon Acuna JC. Prediction of Positive Patient Health Questionnaire-2 Screening Using Area Deprivation Index in Primary Care. Clin Nurs Res 2024; 33:355-369. [PMID: 38801166 DOI: 10.1177/10547738241252887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Depression is recognized as a significant public health issue in the United States. The National Survey on Drug Use and Health reports that 21.0 million adults aged 18 or older had major depressive disorder in 2020, including 14.8 million experiencing a major depressive episode with severe impairment. The aim is to predict the positivity of Patient Health Questionnaire-2 (PHQ-2) outcomes among patients in primary care settings by analyzing a range of variables, including socioeconomic status, demographic characteristics, and health behaviors, thereby identifying those at increased risk for depression. Employing a machine learning approach, the study utilizes retrospective data from electronic health records across 15 primary care clinics in South Florida to explore the relationship between social determinants of health (SDoH), including area of deprivation index (ADI) and PHQ-2 positivity. The study encompasses 15 primary care clinics located in South Florida, where a diverse patient population receives care. Analysis included 94,572 patient visits; 74,636 records were included in the study. If a zip+4 was not available or an ADI score did not exist, the visit was not included in the final analysis. Screening involved the PHQ-2, assessing depressed mood and anhedonia, with a cutoff >2 indicating positive screening. ADI was used to assess SDoH by matching patients' residential postal codes to ADI national percentiles. Demographics, sexual history, tobacco use, caffeine intake, and community involvement were also evaluated in the study. Over 40 machine learning algorithms were explored for their accuracy in predicting PHQ-2 outcomes, using software tools including Scikit-learn and stats models in Python. Variables were normalized, scored, and then subjected to predictive regression models, with Random Forest showing outstanding performance. Feature engineering and correlation analysis identified ADI, age, education, visit type, coffee intake, and marital status as significant predictors of PHQ-2 positivity. The area under the curve and model accuracies varied across clinics, with specific clinics showing higher predictive accuracy and others (p > .05). The study concludes that the ADI, as a proxy for SDoH, alongside other individual factors, can predict PHQ-2 positivity. Health organizations can use this information to anticipate health needs and resource allocation.
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Affiliation(s)
| | | | - Juan M Gonzalez
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | | | - Karina Gattamorta
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | | | - John Clochesy
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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Byhoff E, Dinh DH, Lucas JA, Marino M, Heintzman J. Mental Health Care Use by Ethnicity and Preferred Language in a National Cohort of Community Health Center Patients. Psychiatr Serv 2024; 75:363-368. [PMID: 37880967 PMCID: PMC10984775 DOI: 10.1176/appi.ps.20220585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Disparities in U.S. mental health care by race and ethnicity have long been documented. The authors sought to compare specialty mental health service use among non-Hispanic White, English-preferring Hispanic, and Spanish-preferring Hispanic patients who accessed care in community health centers (CHCs). METHODS Retrospective electronic medical records data were extracted for patients ages ≥18 years who received care in 2012-2020 at a national CHC network. Zero-inflated Poisson regression models were used to estimate the likelihood of receiving mental health services, which was compared with expected annual rates of mental health service use. RESULTS Of the 1,498,655 patients who received care at a CHC during the study, 14.4% (N=215,098) received any specialty mental health services. English- and Spanish-preferring Hispanic patients were less likely to have had a mental health visit (OR=0.69, 95% CI=0.61-0.77, and OR=0.65, 95% CI=0.54-0.78, respectively). Compared with non-Hispanic White patients, Spanish-preferring Hispanic patients had an estimated annualized rate of 0.59 (95% CI=0.46-0.76) mental health visits. CONCLUSIONS Among patients who were likely to receive specialty mental health services, Spanish-preferring patients had a significantly lower rate of mental health care use. Although overall access to mental health care is improving, unequal access to recurring specialty mental health care remains among patients who do not prefer to use English.
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Affiliation(s)
- Elena Byhoff
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - Dang H Dinh
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - Jennifer A Lucas
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - Miguel Marino
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - John Heintzman
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
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Davis CH, Donahue ML, Gaudiano BA, Uebelacker LA, Twohig MP, Levin ME. Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial. Cogn Behav Ther 2024; 53:48-69. [PMID: 37855277 PMCID: PMC10841889 DOI: 10.1080/16506073.2023.2265560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
Depression is most often treated in primary care, where the prevailing treatment is antidepressant medication. Primary care patients with depression are less likely to be exposed to psychosocial interventions, despite evidence suggesting many of these treatments are effective. An example is acceptance and commitment therapy (ACT), a behavioral treatment for depression with a growing evidence base. A self-guided ACT intervention with a peer narrative (i.e. storytelling) format was developed with the intention of creating a treatment option for primary care patients that was more accessible than traditional psychotherapy. Titled LifeStories, the online program features videos of real individuals sharing coping skills for depression based on lived experiences and key ACT principles. A total of 93 primary care patients taking antidepressants were randomized to either continued antidepressant treatment alone or antidepressant treatment plus LifeStories for 4 weeks. There were no differences over time on depression severity and psychological inflexibility. However, LifeStories led to greater improvements in quality of life and increased patients' interest in additional treatment compared to antidepressant medication alone.Clinical trial pre-registration: ClinicalTrials.gov (NCT04757961).
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Affiliation(s)
| | | | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Butler Hospital, Providence, RI
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Butler Hospital, Providence, RI
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De Oliveira G, Cianelli R, Solorzano Martinez AJ, Villegas N, Iriarte E. Biopsychosocial Factors of Depression Among Hispanic Women Aged ≥50 Years. J Psychosoc Nurs Ment Health Serv 2023; 61:32-42. [PMID: 37256745 DOI: 10.3928/02793695-20230523-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of the current study was to identify biopsychosocial factors associated with depressive symptoms among Hispanic women aged ≥50 years. Cross-sectional data related to 10 biological, psychological, and social factors were analyzed. Center for Epidemiologic Studies Depression Scale scores suggested that 32% of the sample had depressive symptoms. Self-esteem, self-perception of health status, income, and chronic pain had statistically significant associations with depressive symptoms. A logistic regression analysis showed that increasing self-esteem scores were associated with decreases in the likelihood of having depressive symptoms. Findings underscore that depression is associated with biological, psychological, and social factors. Culturally tailored interventions that aim at targeting these factors may have an impact on Hispanic women's depression and overall well-being. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 32-42.].
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Eustis EH, LoPresti J, Aguilera A, Schueller SM. Cultural Responsivity in Technology-Enabled Services: Integrating Culture Into Technology and Service Components. J Med Internet Res 2023; 25:e45409. [PMID: 37788050 PMCID: PMC10582817 DOI: 10.2196/45409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 10/04/2023] Open
Abstract
Technology-enabled services (TESs) are clinical interventions that combine technological and human components to provide health services. TESs for mental health are efficacious in the treatment of anxiety and depression and are currently being offered as frontline treatments around the world. It is hoped that these interventions will be able to reach diverse populations across a range of identities and ultimately decrease disparities in mental health treatment. However, this hope is largely unrealized. TESs include both technology and human service components, and we argue that cultural responsivity must be considered in each of these components to help address existing treatment disparities. To date, there is limited guidance on how to consider cultural responsivity within these interventions, including specific targets for the development, tailoring, or design of the technologies and services within TESs. In response, we propose a framework that provides specific recommendations for targets based on existing models, both at the technological component level (informed by the Behavioral Intervention Technology Model) and the human support level (informed by the Efficiency Model of Support). We hope that integrating culturally responsive considerations into these existing models will facilitate increased attention to cultural responsivity within TESs to ensure they are ethical and responsive for everyone.
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Affiliation(s)
- Elizabeth H Eustis
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, United States
| | - Jessica LoPresti
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Stephen M Schueller
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
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Sedlakova J, Westermair AL, Biller-Andorno N, Meier CA, Trachsel M. Comparison of analog and digital patient decision aids for the treatment of depression: a scoping review. Front Digit Health 2023; 5:1208889. [PMID: 37744684 PMCID: PMC10513051 DOI: 10.3389/fdgth.2023.1208889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Patient decision aids (PDAs) are important tools to empower patients and integrate their preferences and values in the decision-making process. Even though patients with mental health problems have a strong interest in being more involved in decision making about their treatment, research has mainly focused on PDAs for somatic conditions. In this scoping review, we focus on patients suffering from depression and the role of PDAs for this patient group. The review offers an overview of digital and analog PDAs, their advantages and disadvantages as well as recommendations for further research and development. Methods A systematic search of the existing literature guided by the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for scoping reviews (PRISMA-ScR) was conducted. Three electronic literature databases with the appropriate thematic focus were searched (PubMed, PsycInfo, and Web of Science). The search strategy used controlled and natural language to search for the key concepts decision aids and depression. The articles were selected in a two-step process guided by predefined inclusion and exclusion criteria. We narratively synthetized information extracted from 40 research articles. Results We included 40 articles in our review. Our review revealed that there is more focus on digital PDAs in research than in clinical practice. Digitalization can enhance the benefits of PDAs by developing tools that are more efficient, interactive, and personalized. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. There is more research needed to study which forms of PDAs are most appropriate for various patient groups (e.g., older adults, or patients with comorbidities), and to identify the most effective ways of PDAs' integration in the clinical workflow. The findings from our review could be well aligned with the International Patient Decision Aids Standards. Discussion More research is needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups.
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Affiliation(s)
- Jana Sedlakova
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
| | - Anna Lisa Westermair
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
- Clinical Ethics Unit, University Hospital of Basel (USB), Basel, Switzerland
- Clinical Ethics Unit, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
| | - Christoph A. Meier
- Department of Internal Medicine, University Hospital Zurich (USZ), Zürich, Switzerland
- Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Manuel Trachsel
- Clinical Ethics Unit, University Hospital of Basel (USB), Basel, Switzerland
- Clinical Ethics Unit, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
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Enslow MR, Galfalvy HC, Sajid S, Pember RS, Mann JJ, Grunebaum MF. Racial and ethnic disparities in time to first antidepressant medication or psychotherapy. Psychiatry Res 2023; 326:115324. [PMID: 37390599 PMCID: PMC10530353 DOI: 10.1016/j.psychres.2023.115324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
Time from first DSM4 major depressive episode (MDE) until treatment in the community was compared across racial/ethnic groups. This secondary analysis used structured baseline data from a depression research clinic (N = 260). Chi-square and survival analyses compared rates and delays to antidepressant medication and psychotherapy. Non-Hispanic Black and Hispanic (any race) participants had lower rates of both antidepressant medication and psychotherapy and longer delays to antidepressant medication compared with non-Hispanic White participants. The results underscore the need to reduce these disparities.
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Affiliation(s)
- Meghan R Enslow
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Hanga C Galfalvy
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Sumra Sajid
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | | | - J John Mann
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States
| | - Michael F Grunebaum
- Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, United States.
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Kunz-Lomelin A, Killian M, Eghaneyan BH, Sanchez K. Antidepressant Adherence Among Hispanics: Patients in an Integrated Health Care Model. J Multidiscip Healthc 2022; 15:3029-3037. [PMID: 36605408 PMCID: PMC9809177 DOI: 10.2147/jmdh.s387218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose We report on antidepressant (AD) adherence among Hispanics seeking mental health services in a community primary care clinic in Texas as an ancillary outcome from a National Institutes of Health-funded study that collected data on Hispanic AD adherence over a period of two years (February 2016-February 2018). Adherence to AD medications was measured throughout the year-long trial and compared across various demographic characteristics. Since Hispanic individuals often experience stigma and cultural barriers related to AD treatment, we sought to understand what factors may increase the likelihood of non-adherence in this population. Patients and Methods This study focused on 69 patients who were prescribed AD medications while receiving treatment through an integrated health care model. Adherence was measured with the Patient Adherence Questionnaire, a validated 2-item questionnaire that asks patients about their medication use (missed medications or dosage changes) over the past week. We looked at patient adherence at two key time points (4-weeks and 13-weeks) and utilized logistic regression to identify factors that may increase or decrease the likelihood of adherence in Hispanic patients at a community primary care clinic. Results Non-adherence to AD medication was 49.3% at 4-weeks and 57% at 13-weeks post-treatment initiation. Logistic regression analyses revealed that age was the only significant predictor of AD non-adherence. As age increased, the likelihood of adherence increased by 12.2% at 13-weeks post-treatment initiation and by 11.1% at 4-weeks post-treatment initiation. Conclusion The likelihood of Hispanic patients to adhere to AD therapy increased with the age of the patient. Since primary care is the most likely place to be prescribed an AD for Hispanic patients, further research to better understand adherence is essential. Integrated health care interventions designed to help identify, reduce, or eliminate barriers to adherence and improve cultural understanding may help address issues of non-adherence in primary care settings.
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Affiliation(s)
- Alan Kunz-Lomelin
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA,Correspondence: Alan Kunz-Lomelin, 3825 Hunters Trail, Carrollton, TX, 75007, USA, Tel +1 (972) 358-0575, Email
| | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | | | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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Blake C. Depression Screening Implementation: Quality Improvement Project in a Primary Care Clinic for First Responders. Workplace Health Saf 2022; 70:543-550. [PMID: 36214536 DOI: 10.1177/21650799221119147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression in the U.S. population affects approximately 17.5 million people, with an approximate annual economic cost of US$326 billion. The overall objective of this quality improvement program was implementation of a standardized screening protocol using a validated screening instrument to identify depression in first responders in a primary care setting. METHODS This program applied the Knowledge-to-Action framework utilizing the 9-question Patient Health Questionnaire (PHQ-9) screening tool. The outcome measure was screening completion with a process measure of depression questionnaires provided to patients, and balance measures of time of visit and referral rate. In a pre-/postintervention project design, clinic staff were trained on depression screening. PHQ-9 questionnaires were placed in all exam rooms for patients and providers to discuss. Referrals were made to the staff psychologist or to medical providers based on evaluations. FINDINGS From pre- to postintervention, screening increased from less than 1% to a screening rate of 92%. Appointments for depression intervention increased to 50%, 44 patients for counseling and 12 for medical therapy. CONCLUSIONS/APPLICATIONS TO PRACTICE A standardized screening protocol using a validated self-assessment tool improved depression surveillance and increased referrals for treatment. A training program with an accompanying policy was designed to sustain this program and may serve as a model for other programs serving first responders.
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Affiliation(s)
- Canaan Blake
- University of Texas Health Science Center at San Antonio
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12
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Crutchley RD, Keuler N. Sub-Analysis of CYP-GUIDES Data: Assessing the Prevalence and Impact of Drug-Gene Interactions in an Ethnically Diverse Cohort of Depressed Individuals. Front Pharmacol 2022; 13:884213. [PMID: 35496293 PMCID: PMC9039251 DOI: 10.3389/fphar.2022.884213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: Minority groups are underrepresented in pharmacogenomics (PGx) research. Recent sub-analysis of CYP-GUIDES showed reduced length of stay (LOS) in depressed patients with CYP2D6 sub-functional status. Our primary objective was to determine whether PGx guided (G) versus standard treatment (S) influenced LOS among different race/ethnic groups. Secondary objectives included prevalence of drug-gene interactions (DGIs) and readmission rates (RAR). Methods: Retrospective sub-analysis of CYP-GUIDES data comprising CYP2D6 phenotypes was reclassified using standardized CYP2D6 genotype to phenotype recommendations from the Clinical Pharmacogenetics Implementation Consortium (CPIC) and Dutch Pharmacogenetics Working Group (DPWG). The Mann-Whitney test was used to determine differences in LOS between groups G and S and Kruskal Wallis test to compare LOS among different race/ethnic groups. Logistic regression was used to determine covariates associated with RAR. Results: This study included 1,459 patients with 67.3% in G group (n = 982). The majority of patients were White (57.5%), followed by Latinos (25.6%) and Blacks (12.3%). Although there were no differences in LOS between G and S groups, Latinos had significant shorter LOS than Whites (p = 0.002). LOS was significantly reduced by 5.6 days in poor metabolizers in group G compared to S (p = 0.002). The proportion of supra functional and ultra-rapid metabolizers (UMs) were 6 and 20.3% using CYP-GUIDES and CPIC/DPWG definitions, respectively. Prevalence of DGIs was 40% with significantly fewer DGIs in Blacks (p < 0.001). Race/ethnicity was significantly associated with RAR (aOR 1.30; p = 0.003). Conclusion: A greater number of patients were classified as CYP2D6 UMs using CPIC/DPWG definitions as compared to CYP-GUIDES definitions. This finding may have clinical implications for using psychotropics metabolized by CYP2D6.
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Affiliation(s)
- Rustin D. Crutchley
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Yakima, WA, United States
- *Correspondence: Rustin D. Crutchley,
| | - Nicole Keuler
- School of Pharmacy, University of the Western Cape, Cape Town, South Africa
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13
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Sanchez K, Eghaneyan BH, Killian MO, Cabassa LJ, Trivedi MH. Depression education fotonovela for engagement of Hispanic patients in treatment: a randomized clinical trial. BMC Psychiatry 2021; 21:635. [PMID: 34949169 PMCID: PMC8705454 DOI: 10.1186/s12888-021-03641-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/06/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We report the primary outcomes from a randomized clinical trial testing a novel culturally-adapted patient education intervention to increase engagement of Hispanic patients in depression treatment. The Depression Education Fotonovela (DEF), Secret Feelings, incorporates popular images, cultural norms, and vivid pictures embedded within a soap opera narrative to increase depression knowledge and dispel myths about treatment. We then assessed engagement in a integrated care treatment model in response to the education intervention and subsequent changes in depression symptoms in a large community-based clinic whose patient population is majority Hispanic. METHOD The sample included 150 adult Hispanic patients with a confirmed diagnosis of depression who were randomly assigned to either: [1] integrated care + fotonovela; or [2] integrated care + standard education. Differences between treatment groups were examined as were changes in depression, anxiety, depression knowledge, and stigma scores over time and engagement in treatment. RESULTS Results indicated that while depression scores significantly decreased over time for participants (F [2.811, 416.054] = 197.69, p < .001, η2 = .572), no differences between the two education groups were found (F [1, 148] = 0.70, p = .403, η2 = .005). At 12-month follow-up, 101 patients (80.8%) reported a 50% of greater reduction in depression scores from baseline. CONCLUSIONS We found little difference between the two education groups, suggesting that either may helpful for engaging Hispanic patients into care. Better tailoring of patient education, with the fotonovela or similarly adapted tools, will require more directly addressing the stigma associated with antidepressant medication. TRIAL REGISTRATION The study was registered with www.clinicaltrials.gov : NCT02702596 , on 03/20/2016. Retrospectively registered.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, Texas, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 6363 Forest Park Rd, Dallas, TX, 75235, USA.
| | - Brittany H. Eghaneyan
- grid.253559.d0000 0001 2292 8158Department of Social Work, California State University, Fullerton, USA
| | - Michael O. Killian
- grid.255986.50000 0004 0472 0419College of Social Work, Florida State University, 296 Champions Way, UCC 2500, Tallahassee, FL 32306 USA
| | - Leopoldo J. Cabassa
- grid.4367.60000 0001 2355 7002George Warren Brown School of Social Work, Washington University in St. Louis, Goldfarb Hall, Room 358, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
| | - Madhukar H. Trivedi
- grid.267313.20000 0000 9482 7121Department of Psychiatry, UT Southwestern Medical Center, 6363 Forest Park Rd, Dallas, TX 75235 USA
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14
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Thomas EC, Ben-David S, Treichler E, Roth S, Dixon L, Salzer M, Zisman-Ilani Y. A Systematic Review of Shared Decision-Making Interventions for Service Users With Serious Mental Illnesses: State of the Science and Future Directions. Psychiatr Serv 2021; 72:1288-1300. [PMID: 34369801 PMCID: PMC8570969 DOI: 10.1176/appi.ps.202000429] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Shared decision making (SDM) is a health communication model that may be particularly appealing to service users with serious mental illnesses, who often want to be involved in making decisions about their mental health care. The purpose of this systematic review was to describe and evaluate participant, intervention, methodological, and outcome characteristics of SDM intervention studies conducted within this population. METHODS Systematic searches of the literature through April 2020 were conducted and supplemented by hand searching of reference lists of identified studies. A total of 53 independent studies of SDM interventions that were conducted with service users with serious mental illnesses and that included a quantitative or qualitative measure of the intervention were included in the review. Data were independently extracted by at least two authors. RESULTS Most studies were conducted with middle-age, male, White individuals from Western countries. Interventions fell into the following categories: decision support tools only, multicomponent interventions involving decision support tools, multicomponent interventions not involving decision support tools, and shared care planning and preference elicitation interventions. Most studies were randomized controlled trials with sufficient sample sizes. Outcomes assessed were diverse, spanning decision-making constructs, clinical and functional, treatment engagement or adherence, and other constructs. CONCLUSIONS Findings suggest important future directions for research, including the need to evaluate the impact of SDM in special populations (e.g., young adults and racial-ethnic minority groups); to expand interventions to a broader array of decisions, users, and contexts; and to establish consensus measures to assess intervention effectiveness.
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Affiliation(s)
| | | | - Emily Treichler
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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15
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Cunningham LD, Salgado EF, Aalsma MC, Garabrant JM, Staples JK, Gordon JS, Salyers MP. Do adolescents consider mind-body skills groups an acceptable treatment for depression: results from a pilot study. BMC Pediatr 2021; 21:475. [PMID: 34706710 PMCID: PMC8549145 DOI: 10.1186/s12887-021-02942-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/13/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Mind-Body Skills Groups (MBSGs) have shown promise in reducing adolescent depression symptoms; however, little is known about adolescents' perspectives on this treatment. The objective of this study was to understand the acceptability of a new treatment for depressed adolescents in primary care settings. METHODS Adolescents participating in a 10-week MBSG treatment were interviewed to understand their perspectives on the acceptability and effectiveness of the treatment. Interviews were collected at post-intervention and at a 3-month follow-up visit. RESULTS A total of 39 adolescents completed both the post-intervention and 3-month follow-up interview. At post-intervention and follow-up, 84% of adolescents stated the MBSGs helped them. When asked how the MBSGs helped them, 3 areas were identified: learning new MBSG activities and skills, social connection with others within the group, and outcomes related to the group. Many adolescents reported no concerns with the MBSGs (49% at post- intervention; 62% at follow-up). Those with concerns identified certain activities as not being useful, wanting the group to be longer, and the time of group (after school) being inconvenient. Most adolescents reported that their life had changed because of the group (72% at post-intervention; 61% at follow-up), and when asked how, common responses included feeling less isolated and more hopeful. CONCLUSIONS Adolescents found the MBSGs to be helpful and acceptable as a treatment option for depression in primary care. Given the strong emphasis on treatment preference autonomy and the social activities within the group, MBSGs appear well-suited for this age group. TRIAL REGISTRATION NCT03363750 ; December 6th, 2017.
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Affiliation(s)
- Lindsey D. Cunningham
- Department of Psychology, Florida International University, 11200 SW 8th St, AHC5, Miami, FL 33199 USA
| | - Eduardo F. Salgado
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, LD 120B, Indianapolis, IN 46202 USA
| | - Matthew C. Aalsma
- Department of Pediatrics – Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 W. 10th Street, Suite 2025, Indianapolis, IN 46202 USA
| | - Jennifer M. Garabrant
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, LD 120B, Indianapolis, IN 46202 USA
| | - Julie K. Staples
- The Center for Mind-Body Medicine, 5225 Connecticut Avenue NW, Suite 414, Washington, DC 20015 USA
| | - James S. Gordon
- The Center for Mind-Body Medicine, 5225 Connecticut Avenue NW, Suite 414, Washington, DC 20015 USA
| | - Michelle P. Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, LD 120B, Indianapolis, IN 46202 USA
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16
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Logie CH, Okumu M, Lukone SO, Loutet M, McAlpine A, Latif M, Berry I, Kisubi N, Mwima S, Kyambadde P, Neema S, Small E, Balyejjusa SM, Musinguzi J. Ngutulu Kagwero (agents of change): study design of a participatory comic pilot study on sexual violence prevention and post-rape clinical care with refugee youth in a humanitarian setting in Uganda. Glob Health Action 2021; 14:1940763. [PMID: 34402763 PMCID: PMC8381980 DOI: 10.1080/16549716.2021.1940763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
With over 1.4 million refugees, Uganda is Sub-Saharan Africa’s largest refugee-hosting nation. Bidi Bidi, Uganda’s largest refugee settlement, hosts over 230,000 residents. There is a dearth of evidence-based sexual violence prevention and post-rape clinical care interventions in low- and middle-income humanitarian contexts tailored for refugee youth. Graphic medicine refers to juxtaposing images and narratives, often through using comics, to convey health promotion messaging. Comics can offer youth-friendly, low-cost, scalable approaches for sexual violence prevention and care. Yet there is limited empirical evaluation of comic interventions for sexual violence prevention and post-rape clinical care. This paper details the study design used to develop and pilot test a participatory comic intervention focused on sexual violence prevention through increasing bystander practices, reducing sexual violence stigma, and increasing post exposure prophylaxis (PEP) knowledge with youth aged 16–24 and healthcare providers in Bidi Bidi. Participants took part in a single-session peer-facilitated workshop that explored social, sexual, and psychological dimensions of sexual violence, bystander interventions, and post-rape clinical care. In the workshop, participants completed a participatory comic book based on narratives from qualitative data conducted with refugee youth sexual violence survivors. This pilot study employed a one-group pre-test/post-test design to assess feasibility outcomes and preliminary evidence of the intervention’s efficacy. Challenges included community lockdowns due to COVID-19 which resulted in study implementation delays, political instability, and attrition of participants during follow-up surveys. Lessons learned included the important role of youth facilitation in youth-centred interventions and the promise of participatory comics for youth and healthcare provider engagement for developing solutions and reducing stigma regarding SGBV. The Ngutulu Kagwero (Agents of change) project produced a contextually and age-tailored comic intervention that can be implemented in future fully powered randomized controlled trials to determine effectiveness in advancing sexual violence prevention and care with youth in humanitarian contexts.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada.,United Nations University Institute for Water, Environment & Health (UNU-INWEH), Hamilton, ON, Canada
| | - Moses Okumu
- School of Social Work, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.,School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Miranda Loutet
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alyssa McAlpine
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Maya Latif
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nelson Kisubi
- Uganda Refugee and Disaster Management Council, Yumbe, Uganda
| | - Simon Mwima
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda.,Most at Risk Population Initiative (MARPI), Kampala, Uganda
| | - Stella Neema
- Department of Anthropology & Sociology, Makerere University, Kampala, Uganda
| | - Eusebius Small
- School of Social Work, University of Texas Arlington, Arlington, TX, USA
| | | | - Joshua Musinguzi
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
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17
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Psychometric Properties of Three Measures of Stigma Among Hispanics with Depression. J Immigr Minor Health 2021; 23:946-955. [PMID: 34152503 DOI: 10.1007/s10903-021-01234-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
While many measures of mental illness stigma have been developed, few have been validated in Hispanic populations. This study examined the psychometric properties of three stigma measures (Stigma Concerns about Mental Health Care [SCMHC], Social Distance Scale [SDS], and Latino Scale for Antidepressant Stigma [LSAS]) among a depressed, Hispanic sample. Data were collected during baseline assessments for two studies taking place in primary care settings (N = 500). Psychometric and factor validity were tested for each measure. Confirmatory factor analyses indicated adequate model fit, and adequate internal consistency reliability was found for all three measures. Stigma scores significantly differed by education level and gender. Findings from this analysis provide support for the use of the SCMHC, SDS, and LSAS in a depressed, Hispanic population. Assessing barriers to depression treatment, including stigma, are critical in engaging Hispanics in care and eliminating disparities for the population.
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18
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Dugani SB, Girardo ME, De Filippis E, Mielke MM, Vella A. Risk Factors and Wellness Measures Associated with Prediabetes and Newly Diagnosed Type 2 Diabetes Mellitus in Hispanic Adults. Metab Syndr Relat Disord 2021; 19:180-189. [PMID: 33439762 DOI: 10.1089/met.2020.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To characterize the associations of clinical risk factors, lifestyle factors, and wellness measures with prediabetes and new type 2 diabetes mellitus (T2DM) diagnosis in Hispanic adults and guide primary prevention. Methods: Sangre Por Salud Biobank enrolled 3733 Hispanic adults from Phoenix, AZ, United States, from 2013 to 2018. This analysis included participants with euglycemia, prediabetes, or new T2DM diagnosis (i.e., no prior T2DM diagnosis) at enrollment. Participants completed a baseline questionnaire on cardiometabolic risk factors and wellness measures and provided biometric measurements. The associations of factors and measures with odds (95% confidence interval) of prediabetes and new T2DM diagnosis were analyzed in logistic regression models. Results: Among 3299 participants with euglycemia (n = 1301), prediabetes (n = 1718), and new T2DM diagnosis (n = 280) at enrollment, 72% were women (n = 2376/3299). In adjusted models, most cardiometabolic risk factors were positively associated with prediabetes and new T2DM diagnosis, with stronger associations for new T2DM diagnosis. Obesity (body mass index ≥30 kg/m2 vs. lower) was associated with higher odds of new T2DM diagnosis (3.14 [2.30-4.28]; P < 0.01) than prediabetes versus euglycemia (1.96 [1.66-2.32]; P < 0.01) and Interaction (P = 0.01). Similarly, waist circumference, family history of diabetes, and average systolic and diastolic blood pressure were associated with higher odds of new T2DM diagnosis versus euglycemia than prediabetes versus euglycemia. Using stepwise logistic regression modeling, a parsimonious model of age, family history of diabetes, waist circumference, diastolic blood pressure, passive tobacco exposure, and self-rated general health were associated with new T2DM diagnosis versus euglycemia. Conclusions: In Hispanic adults, modifiable cardiometabolic and lifestyle factors were associated with prediabetes and new T2DM diagnosis. Personalized interventions targeting these factors and measures could guide T2DM primary prevention efforts among Hispanic adults.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marlene E Girardo
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Michelle M Mielke
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adrian Vella
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
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