Ethnicity and preferences for depression treatment
ABSTRACT The objective of this work was to describe ethnic differences in attitudes toward depression, depression treatment, stigma and preferences for depression treatment (counseling vs. medication).
This study used a cross-sectional Internet survey measuring treatment preference, stigma and attitudes toward depression. Depressive symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale. Multivariable regression models adjusting for treatment attitudes and demographics estimated the independent effect of ethnicity on treatment preference.
A total of 78,753 persons with significant depressive symptoms (CES-D>22), including 3596 African Americans, 2794 Asians/Pacific Islanders and 3203 Hispanics, participated. Compared to whites, African Americans, Asians/Pacific Islanders and Hispanics were more likely to prefer counseling to medications [odds ratio (OR)=2.6, 95% confidence interval (95% CI)=2.4-2.8; OR=2.5, 95% CI=2.2-2.7; and OR=1.8, 95% CI=1.7-2.0, respectively]. Ethnic minorities were less likely to believe that medications were effective and that depression was biologically based, but were more likely to believe that antidepressants were addictive and that counseling and prayer were effective in treating depression. Attitudes and beliefs somewhat attenuated the association between ethnicity and treatment preference in adjusted analyses.
Racial and ethnic minorities prefer counseling for depression treatment more than whites. Beliefs about the effects of antidepressants, prayer and counseling partially mediate preferences for depression treatment.
SourceAvailable from: Margarita Alegria[Show abstract] [Hide abstract]
ABSTRACT: This paper reports on the development of the Cultural Formulation Interview-Fidelity Instrument (CFI-FI) which assesses clinician fidelity to the DSM-5 Cultural Formulation Interview (CFI). The CFI consists of a manualized set of standard questions that can precede every psychiatric evaluation. It is based on the DSM-IV Outline for Cultural Formulation, the cross-cultural assessment with the most evidence in psychiatric training. Using the New York sample of the DSM-5 CFI field trial, two independent raters created and finalized items for the CFI-FI based on six audio-taped and transcribed interviews. The raters then used the final CFI-FI to rate the remaining 23 interviews. Inter-rater reliability ranged from .73 to 1 for adherence items and .52 to 1 for competence items. The development of the CFI-FI can help researchers and administrators determine whether the CFI has been implemented with fidelity, permitting future intervention research.Journal of Health Care for the Poor and Underserved 01/2014; 25(3):1397-417. DOI:10.1353/hpu.2014.0132 · 1.10 Impact Factor
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ABSTRACT: African Americans seek mental health treatment at lower rates than Whites. This disparity has been attributed to African Americans' attitudes toward services, alternate coping, and differences in care. Research on microaggressions adds an important element to this literature. Including discussion of microaggressions in counseling training may illuminate subtle student biases.Los individuos Afroamericanos buscan recibir tratamientos de salud mental en un índice menor que los Blancos. Esta disparidad ha sido atribuida a las actitudes de los Afroamericanos hacia los servicios, formas de afrontamiento alternativas, y a las diferencias en la asistencia. Las investigaciones sobre microagresiones añaden un elemento importante a esta documentación. Incluir la discusión sobre microagresiones en la formación de consejeros puede iluminar los sesgos sutiles de los estudiantes.04/2009; 37(2). DOI:10.1002/j.2161-1912.2009.tb00094.x
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ABSTRACT: Objectives. Studies have repeatedly shown racial and ethnic differences in mental health care. Prior research focused on relationships between patient preferences and ethnicity, with little attention given to the possible relationship between physicians' ethnicity and their treatment recommendations. Design. A questionnaire was mailed to a national sample of US primary care physicians and psychiatrists. It included vignettes of patients presenting with depression, anxiety, and medically unexplained symptoms. Physicians were asked how likely they would be to advise medication, see the patient regularly for counseling, refer to a psychiatrist, or refer to a psychologist or licensed mental health counselor. Results. The response rate was 896 of 1427 (63%) for primary care physicians and 312 of 487 (64%) for psychiatrists. Treatment preferences varied across diagnoses. Compared to whites (referent), black primary care physicians were less likely to use antidepressants (depression vignette), but more likely to see the patient for counseling (all vignettes), and to refer to a psychiatrist (depression vignette). Asian primary care physicians were more likely to see the patient for counseling (anxiety and medically unexplained symptoms vignettes) and to refer to a psychiatrist (depression and anxiety vignettes). Asian psychiatrists were more likely to recommend seeing the patient regularly for counseling (depression vignette). Conclusions. Overall, these findings suggest that physician race and ethnicity contributes to different patterns of treatment for basic mental health concerns.Ethnicity and Health 05/2014; DOI:10.1080/13557858.2014.921893 · 1.28 Impact Factor