The long-term trajectory of depression among Latinos in primary care and its relationship to depression care disparities

Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, Lyons, NJ 08854, USA.
General hospital psychiatry (Impact Factor: 2.61). 03/2011; 33(2):94-101. DOI: 10.1016/j.genhosppsych.2010.12.001
Source: PubMed


Lower use of medication treatment, poorer doctor-patient communication (DPC) and depression stigma are key contributors to mental healthcare disparities among Latinos with depression. The current study investigated the relationship between these key variables and the long-term trajectory of depression in primary care among Latinos.
Participants (N=220) were Latinos presenting to primary care who screened positive for depression. A repeated measures design was used to assess participants at baseline and 6, 25 and 30 months. Repeated measures included depression (Patient Health Questionnaire-9), self-reported quality of DPC and stigma pertaining to antidepressants. Using growth curve modeling, participants' depressive symptom trajectories were examined for a 30-month period. Self-reported utilization of antidepressants, DPC and antidepressant stigma were examined as predictors of the depressive symptom trajectory. In addition, rates of depression improvement/remission and recurrence/relapse were examined.
Improvement/remission was experienced by 69.4% of participants during a 30-month period. Among those who improved/remitted at 6 or 25 months, 63.4% maintained that improvement/remission by 30 months. The long-term trajectory of depressive symptoms demonstrated a significant positive association with antidepressant stigma and significant negative associations with use of antidepressant treatment and quality DPC.
While relapse/recurrence is common, most Latinos in this study experienced improvement in depression over 30 months. For many, there is a considerable time to reach improvement/remission. Also, these findings confirm the significance of antidepressant underutilization, DPC and stigma in the long-term outcome of depression among Latinos in primary care.

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Available from: Mike Gara, Apr 30, 2014
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    • "Modelling of symptom trajectories has been used to study the longitudinal illness course from selective populations such as adolescents [6, 7], mothers who have recently given birth [8], patients with breast cancer [9] and the elderly [10] , however knowledge in community-based and primary care population samples is less well established with only a few studies which have recruited subjects from primary care settings. Two studies conducted in America [10, 11] (Latino population, n = 220; the elderly n = 392) and one in Sweden [12] (elderly; n = 54) had modest and selective samples which limits the generalizability of the findings. A recent study examining the trajectory patterns for depression by Gunn et al. included 789 Australian primary care patients [13]. "
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    • "Two studies have recruited a primary care sample; one from a Latino population (n ¼220) (Interian et al., 2011) and another from people aged over 65 years (n¼ 392) (Cui et al., 2008). The findings from these studies are limited by their selective population approach, modest sample sizes, length of time between follow-up intervals (6 months to 1 year) and reliance on retrospective measurement tools. "
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