Depression Outcomes of Spanish-and English-Speaking Hispanic Outpatients in STAR*D

Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 12/2008; 59(11):1273-84. DOI: 10.1176/
Source: PubMed


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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    • "The adequacy of the psychometric properties of the QIDS-SR 16 has been demonstrated across multiple and diverse samples, primarily in the USA: outpatients with MDD (Carmody et al., 2006; Liu et al., 2013; Rush et al., 2003; Trivedi et al., 2004; Zimmerman et al., 2012) or bipolar disorder (Bernstein et al., 2010a; Trivedi et al., 2004); primary-care medical patients (Lamoureux et al., 2010); patients with chronic kidney disease (Hedayati et al., 2009) or with co-morbid asthma and MDD (Brown et al., 2008); adolescents (Bernstein et al., 2010b), young adults (González et al., 2013), and elderly individuals (Doraiswamy et al., 2010). Although the Spanish version of the QIDS-SR 16 is increasingly used (e.g., Bernstein et al., 2007; Feinberg et al., 2014; Lesser et al., 2008; Rush et al., 2006b; Trinh et al., 2011), to date, there is a striking lack of studies addressing its psychometric properties. By contrast, these have been recently examined for the parent IDS- SR 30 in a large Spanish sample of MDD patients (Gili et al., 2011). "
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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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