Treating Minority Patients With Depression and Anxiety: What Does the Evidence Tell Us?

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
General Hospital Psychiatry (Impact Factor: 2.61). 02/2006; 28(1):27-36. DOI: 10.1016/j.genhosppsych.2005.07.002
Source: PubMed


The purpose of this study is to examine the current state of knowledge regarding treating ethnic/racial minority patients with mood and anxiety disorders, emphasizing data-based studies whenever possible.
This article reviews the evidence on poorer access and quality of care for minorities, the biological and cultural differences between minority and majority populations that may impact care and outcomes, and recent studies that address minority treatment response and outcomes both alone and in comparison to majority groups.
Numerous impediments to appropriately treating anxious and depressed minority patients remain. Underutilization and poor quality of mental health care in minorities is due to less-than-favorable illness and treatment beliefs that affect adherence and outcome, stigma, clinician failure to engage the patient, poor patient activation and biological differences that may impact pharmacotherapy choice. However, though limited in number, some studies do indicate that when appropriate treatment is well-delivered to minorities, results are comparable to those seen among Caucasian patients.
The clinician treating members of minority groups must consider differential personal elements, from the biological to the cultural, to achieve treatment success. The limited available data do suggest that minority patients can be successfully treated with available interventions. Of primary importance is for researchers to increase the number of carefully designed intervention studies that allow for ethnic/racial minority-specific analyses.

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    • "Another important factor that precludes Hispanics/Latinos from receiving behavioral health treatment is the high degree of stigma associated with mental health illnesses. The stigma is associated with lack of awareness/knowledge about symptoms of depression, stress and anxiety and lack of access to behavioral health treatment, especially in rural areas by the US-Mexico border (Cherrington et al. 2006; Schraufnagel et al. 2006). These factors also contribute to increase the already reported higher prevalence of depression among Hispanic/ Latinos compared to other US ethnic groups (Reinschmidt and Chong 2007). "
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    ABSTRACT: The present study investigated whether a culturally-tailored problem-solving intervention delivered by a trained depression care specialist (DCS) would improve depressive symptoms over a 6 month period among Hispanic/Latino patients in a federally-qualified community health center by the California-Mexico border. Participants included 189 low income Hispanic/Latino patients of Mexican heritage. Based on the improving mood-promoting access to collaborative treatment (IMPACT) evidence-based treatment, patients received evidence-based problem-solving therapy. The Patient Health Questionnaire-9 (PHQ-9) was administered to assess changes in self-reported depressive symptoms between baseline and monthly for a 6-month follow up period. The majority of participants were female (72.5 %) with a mean age of 52.5 (SD = 11.7). The mean PHQ-9 at baseline was 16.9 (SD = 4.0) and at the 6-month follow-up, the average PHQ-9 decreased to 9.9 (SD = 5.7). A linear mixed model analysis showed significant improvement in PHQ-9 scores over a 6 month period (F = 124.1; p < 0.001) after controlling for age, gender, smoking and diabetes. There was a significant three way interaction between time, gender and smoking (p = 0.01) showing that the depressive symptoms among male smokers did not improve as much as non-smoking males and females. Results suggest that a culturally-tailored problem solving approach can significantly reduce depressive symptoms among Hispanic/Latino low-income patients.
    Community Mental Health Journal 08/2014; 51(4). DOI:10.1007/s10597-014-9750-7 · 1.03 Impact Factor
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    • "Further, it is interesting to note that no pharmacological interventions were identified in our search considering that racial and ethnical differences may influence drug responses, which in turn relates to efficacy of medication prescribed for depression [10]. "
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    ABSTRACT: Background The unprecedented rates of global migration present unique challenges to mental health services in migrant receiving countries to provide efficacious and culturally salient treatment for mental health conditions including depression. This review aimed to identify and evaluate the effectiveness of depression interventions specifically directed towards first-generation immigrant populations. Methods We conducted a systematic review of original research published between 2000 and 2013 that investigated depression interventions in first generation immigrants. Results Fifteen studies were included; the majority focused on Latino immigrants living in the United States (US). Twelve studies investigated the use of psychotherapies; the remainder examined collaborative care models and physical exercise-based interventions. Cognitive Behavioral Therapy and Behavioral Activation tended to improve depressive symptoms, especially when culturally adapted to suit clients while Problem Solving Therapy improved depressive symptomology with and without adaptations. Collaborative care and exercise did not significantly improve depressive symptoms. Conclusion Depression may be effectively treated by means of psychotherapies, especially when treatments are culturally adapted. However the reviewed studies were limited due to methodological weaknesses and were predominantly undertaken in the US with Latino patients. To improve generalizability, future research should be undertaken in non-US settings, amongst diverse ethnic groups and utilize larger sample sizes in either randomized clinical trials or observational cohort studies.
    BMC Psychiatry 06/2014; 14(1):176. DOI:10.1186/1471-244X-14-176 · 2.21 Impact Factor
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    • "Among minority youth, lack of conformance to treatment recommendations for appropriate medications may be the result of cultural beliefs and preferences (McGuire and Miranda 2008; Satcher 2001). For example, studies have shown that the parents of minority youth often prefer psychotherapy over medications relative to non-minority parents (Schraufnagel et al. 2006), and may judge medication use as being of greater risk (Stevens et al. 2009). Interestingly, we observed a non-significant trend suggesting that minority youths diagnosed with bipolar disorder were more likely to receive psychotherapy compared to white youths (P = 0.08). "
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    ABSTRACT: This study examined conformance to clinical practice guidelines for children and adolescents with bipolar disorders and identified patient and provider factors associated with guideline concordant care. Administrative records were examined for 4,047 Medicaid covered youth aged 5-18 years with new episodes of bipolar disorder during 2006-2010. Main outcome measures included 5 claims-based quality of care measures reflecting national treatment guidelines. Measures addressed appropriate pharmacotherapy, therapeutic drug monitoring, and psychosocial treatment. The results indicated that current treatment practices for youth diagnosed with bipolar disorder typically fall short of recommended practice guidelines. Although the majority of affected youth are treated with recommended first-line pharmacotherapy, only a minority receive therapeutic drug monitoring and/or psychotherapy of recommended duration, underscoring the need for quality improvement initiatives.
    Administration and Policy in Mental Health and Mental Health Services Research 04/2014; 42(2). DOI:10.1007/s10488-014-0553-5 · 3.44 Impact Factor
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