Depression Outcomes of Spanish-and English-Speaking Hispanic Outpatients in STAR*D
ABSTRACT This secondary data analysis from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study compared clinical characteristics and outcome after citalopram treatment for Hispanic outpatients whose language preference was English (N=121) or Spanish (N=74).
Data for Hispanic outpatients with nonpsychotic major depression were gathered from two STAR*D regional centers. Participants received citalopram for up to 14 weeks, with dosage adjustments based on routine clinical assessments. Efforts were made to achieve remission with a measurement-based care approach, with adjustments symptoms and side effects.
Spanish speakers were older, were more likely to be women, were less educated, had lower income, had more medical burden, and were more likely than English speakers to be seen in primary care rather than in psychiatric clinics. Compared with Spanish speakers, English speakers had more previous suicide attempts and more family history of mood disorders. The groups did not differ in a clinically meaningful way in severity of depression. Before adjustment for baseline differences, Spanish-speaking participants had lower rates of and slower times to remission and response compared with English speakers. After adjustment for baseline variables, these differences were no longer significant. Relapse rates did not differ between groups.
Compared with English-speaking Hispanic patients, Spanish-speaking Hispanic patients may have a less robust response to antidepressants. The reasons for this are not clear but may include more disadvantaged social status. The degree to which these results can be generalized to other Hispanic populations or to other non-English-speaking groups remains to be seen.
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ABSTRACT: Background Psychometrically robust and easy-to-administer scales for depressive symptoms are necessary for research and clinical assessment. This is a psychometric study of the Spanish version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) in a clinical sample. Method One-hundred and seventy-three patients (65% women) with a psychiatric disorder including depressive symptoms were recruited. Such symptoms were assessed by means of the QIDS-SR16 and two interviewer-rated instruments: the 17-item Hamilton Depression Rating Scale (HDRS17) and the Clinical Global Impression-Severity (CGI-S) scale. Self-rated measures of health-related quality of life, subjective happiness and perceived social support were also obtained. Dimensionality, internal consistency, construct validity, criterion validity, and responsiveness to change of the QIDS-SR16 were examined. Results Exploratory and confirmatory factor analyses replicated the original one-factor structure. The Spanish version of the QIDS-SR16 showed good to excellent internal consistency (α=0.88), convergent validity [HDRS17 (r=0.77), CGI-S (r=0.78)], and divergent validity [EuroQol-5D Visual Analogue Scale (r=−0.78), Subjective Happiness Scale (r=−0.72)]. The QIDS-SR16 was excellent in discriminating clinically significant from non-significant depressive symptomatology (area under ROC curve=0.93). It also showed a high sensitivity to treatment-related changes: patients with greater clinical improvement showed a greater decrease in QIDS-SR16 scores (p<0.001). Limitations The study was conducted in a single center, which may limit the generalizability of the findings. Conclusions The Spanish version of the QIDS-SR16 retains the soundness of metric characteristics of the original version which makes the scale an invaluable instrument to assess depressive symptoms.
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ABSTRACT: A growing body of literature indicates that ethnic differences exist in the rates of retention and engagement in mental health services, and that these disparities stem partly from the inability of services to fulfill the needs and expectations of ethnic minority populations, including Latinos. Increasing the involvement of Latinos in their own mental health treatment may be an important component for improving their care and increasing their participation in treatment. The Right Question Project (RQP) is an educational strategy that encourages active participation in decisions that are important to the individual by facilitating a person's ability to formulate effective questions and to engage others in an instructive dialogue and shared decision making. The purpose of this article is to describe how this strategy, developed by a community group, was adapted and tailored for use in a mental health setting, with the intention of shifting the level of the client's active involvement with their providers in order to improve attendance at scheduled appointments and retention in mental health care. The article highlights the advantages of using practical interventions that originate from the community to improve the quality of services available to Latinos. At the same time, it reveals challenges and limitations that shaped implementation decisions, especially in terms of cultural, socioeconomic, and systemic factors affecting Latino participants. Implications for mental health providers, trainees, and supervisors are discussed.Professional Psychology Research and Practice 06/2012; 43(3):208-216. DOI:10.1037/a0027730 · 1.34 Impact Factor
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ABSTRACT: Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders affecting children and adolescents. The significant psychiatric, social, and functional impairments associated with this disorder coupled with the high incidence of relapse indicate a need for continued efforts to enhance treatment. Current empirically supported treatments for childhood and adolescent MDD include psychotropic medications, psychotherapy, and a combination of both treatments, with selection of the most appropriate strategy depending on symptom severity. One strategy to enhance treatment outcome is the use of measurement-based care. This article provides a systematic review of measurement-based care in the treatment of childhood and adolescent MDD. It also presents a comprehensive analysis of widely used depression rating scales and discusses their utility in clinical practice. This review found evidence supporting the utility and benefit of depression rating scales to document depression severity in children and adolescents. We also found evidence suggesting that many of these scales are time efficient, and that both clinician-rated and self-rated scales provide accurate assessment of depressive symptomatology. Future research is warranted to examine the utility of measurement-based care in clinical practice with child and adolescent populations.07/2010; 16(4):217-34. DOI:10.1097/01.pra.0000386908.07160.91