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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    • "Cognitive– behavioral stress management group interventions have been effective in improving cognitive coping strategies and social supports among HIV positive gay men (Lutgendorf et al., 1998), and may be adapted for LGBTQ POC to help members of this community cope effectively with heterosexism and cisgenderism. Cognitive– behavioral therapy has also been effective among diverse racial/ ethnic groups in the treatment of mental health problems (Schraufnagel, Wagner, Miranda, & Roy-Byrne, 2006), but no research to date has tailored these types of strategies to target suicide reduce the risk among LGBTQ POC. The current findings suggest that counseling psychologists who work with this population experiencing suicidal ideation may benefit from focusing on how experiences with both LGBTQ-based discrimination and racism play into presenting mental health problems. "
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    ABSTRACT: Discrimination based on race/ethnicity, sexual orientation, and gender identity has been linked to many negative psychological and physical health outcomes in previous research, including increased suicidal ideation. Two hundred lesbian, gay, bisexual, transgender, and queer (LGBTQ) people of color (POC) were surveyed on their experiences of LGBTQ-based discrimination, racism, mental health (depression, anxiety, satisfaction with life), and suicidal ideation in a national online study based in the United States. A structural equation model (SEM) was created and found that LGBTQ-based discrimination exerted an indirect effect on suicidal ideation through mental health. Racism exerted a direct effect on mental health but was not associated with suicidal ideation in the SEM. The effects of LGBTQ-based discrimination on mental health may be a key area for interventions to reduce suicidal ideation in LGBTQ POC. (PsycINFO Database Record
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    • "). Mishra et al. (2009) reported African American participants in their study preferred racially matched therapists. Yet, racial matching may not always be an option because of the current lack of minority clinicians available in the workforce; nationally African Americans make up less than 4 % of all mental healthcare providers (Schraufnagel et al. 2006). "
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    • "This finding is consistent with epidemiological evidence that individuals of minority racial status, and perhaps African- Americans in particular, may be less likely to complete treatment for depression (Fortuna, Alegria, & Gao, 2010). Although this relationship has been inconsistent across prior meta-analytic reviews of psychotherapy treatments, it is possible that our focus on RCTs increased the potential to find effects, as there is evidence that minority individuals are less likely to be represented in clinical research (George, Duran, & Norris, 2014; Schraufnagel, Wagner, Miranda, & Roy-Byrne, 2006 ) and in depression treatment specifically (Murphy et al., 2013 ). Because of the association between minority status and socioeconomic status (SES) in the United States, it is possible that individuals in some of these studies faced additional barriers to treatment, including issues with transportation , childcare, or work schedule. "
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    ABSTRACT: Dropout from mental health treatment poses a substantial problem, but rates vary substantially across studies and diagnoses. Focused reviews are needed to provide more detailed estimates for specific areas of research. Randomized clinical trials involving individual psychotherapy for unipolar depression are ubiquitous and important, but empirical data on average dropout rates from these studies is lacking. We conducted a random-effects meta-analysis of 54 such studies (N=5852) including 80 psychotherapy conditions, and evaluated a number of predictors of treatment- and study-level dropout rates. Our overall weighted dropout estimates were 19.9% at the study level, and 17.5% for psychotherapy conditions specifically. Therapy orientation did not significantly account for variance in dropout estimates, but estimates were significantly higher in psychotherapy conditions with more patients of minority racial status or with comorbid personality disorders. Treatment duration was also positively associated with dropout rates at trend level. Studies with an inactive control comparison had higher dropout rates than those without such a condition. Limitations include the inability to test certain potential predictors (e.g., socioeconomic status) due to infrequent reporting. Overall, our findings suggest the need to consider how specific patient and study characteristics may influence dropout rates in clinical research on individual therapy for depression. Copyright © 2015 Elsevier Ltd. All rights reserved.
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