Ester Carolina Apesoa-Varano

Publications (3)7.96 Total impact

• Article: Falling through the cracks: gaps in depression treatment among older Mexican-origin and white men.

  Ladson Hinton, Ester Carolina Apesoa-Varano, Hector M González, Sergio Aguilar-Gaxiola, Megan Dwight-Johnson, Judith C Barker, Cindy Tran, Ramiro Zuniga, Jürgen Unützer
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  ABSTRACT: OBJECTIVES: This study aims (i) to compare depression frequency and self-reported depression treatment in Mexican-origin and white men; (ii) to examine ethnic differences in self-reported prior depression diagnosis and types of treatment; and (iii) to determine whether Mexican-origin men (both English and Spanish language preferring) are less likely than white men to report receiving depression treatment after controlling for potential confounders. METHODS: This is a cross-sectional, observational study of Mexican-origin and white men (60 years old and over) presenting for primary care visits at six outpatient clinics in California's Central Valley. Clinical depression was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), module for past-year major depression and questions for chronic depression. Past year, self-reported prior depression diagnosis and treatment (i.e., medication, psychotherapy, mental health referral) were assessed through a structured questionnaire. RESULTS: The frequency of past-year clinical depression was similar for both ethnic groups, yet Mexican-origin men were significantly less likely than whites to report receiving a prior diagnosis of depression or prior depression treatment. Compared with whites, the odds of untreated depression in Mexican-origin men was 4.35 (95% CI 1.35-14.08) for those interviewed in English and 10.40 (95% CI 2.11-51.25) for those interviewed in Spanish. For both ethnic groups, the majority (i.e., approximately two-thirds) of men receiving depression treatment also met criteria for past-year clinical depression. CONCLUSIONS: Mexican-origin older men in primary care suffer from significant gaps in depression care (i.e., diagnosis and treatment) compared with whites. Delivering effective depression treatment (i.e., so that depression remits) remains elusive for both ethnic groups. Copyright © 2012 John Wiley & Sons, Ltd.
  International Journal of Geriatric Psychiatry 03/2012; · 2.42 Impact Factor
• Article: Curing and caring: the work of primary care physicians with dementia patients.

  Ester Carolina Apesoa-Varano, Judith C Barker, Ladson Hinton
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  ABSTRACT: The symbolic framework guiding primary care physicians' (PCPs) practice is crucial in shaping the quality of care for those with degenerative dementia. Examining the relationship between the cure and care models in primary care offers a unique opportunity for exploring change toward a more holistic approach to health care. The aims of this study were to (a) explore how PCPs approach the care of patients with Alzheimer's disease (AD), and (b) describe how this care unfolds from the physicians' perspectives. This was a cross-sectional study of 40 PCPs who completed semistructured interviews as part of a dementia caregiving study. Findings show that PCPs recognize the limits of the cure paradigm and articulate a caring, more holistic model that addresses the psychosocial needs of dementia patients. However, caring is difficult to uphold because of time constraints, emotional burden, and jurisdictional issues. Thus, the care model remains secondary and temporary.
  Qualitative Health Research 06/2011; 21(11):1469-83. · 2.19 Impact Factor
• Article: Clinician approaches and strategies for engaging older men in depression care.

  Ester Carolina Apesoa-Varano, Ladson Hinton, Judith C Barker, Jürgen Unützer
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  ABSTRACT: The aim of this study is to explore primary care physicians' (PCPs) and depression care managers' (DCMs) approaches to diagnosing and treating depression in older men. The authors focus on older men because studies have shown that they are undertreated compared with women and younger groups. The authors contribute to previous research by identifying facilitators of care for older men from the perspective of clinicians. Participants in this study were part of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial, an effectiveness study of collaborative care for late-life depression in 18 diverse primary care practices. Nine PCPs and 11 DCMs were interviewed to collect information on specific roles in caring for depressed patients and their experiences in working with depressed older men. All interviews were tape-recorded, transcribed verbatim, and analyzed thematically in several steps using standard qualitative data analysis techniques. : The authors identified three general approaches to building trust and talking about the depression: 1) an indirect approach ("call it something else"), 2) a gradual approach ("building up to depression"), and 3) a direct approach ("shock and awe"). The authors also found specific strategies that PCPs and DCMs used to manage depression among elderly male patients, such as increased monitoring of mood, treating somatic symptoms first, medicalizing depression, and enlisting the cooperation of family. In our interviews, enlisting family involvement was the most prominent strategy used by clinicians. A variety of approaches and strategies are used by clinicians for diagnosing and treating depressed older men. Clinicians change strategies as a response to a patient's compliance with treatment and the decision about which strategy to pursue is usually made on an "on-the-go" basis throughout the course of clinician-patient interaction. Based on clinicians' experience, depression management requires concerted efforts and persistence, and the family seems to play an important role in how older men receive the diagnosis of depression and adhere to clinicians' prescribed treatment. However, more research is needed to discover the best way of engaging and working with family members to facilitate effective depression care for older adults.
  The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 02/2010; 18(7):586-95. · 3.35 Impact Factor