Determining Depression Treatment Preferences of Low-Income Latinos in Primary Care Settings

This study will determine ways to make depression care more responsive to the needs of consumers in primary care clinics serving low-income Latinos.

Depression is a serious illness that is difficult to diagnose and treat, especially in populations that underutilize mental health services. The Latino population is one such group. Accommodating patient preferences for care, provider capacities, and administrator priorities is essential to the development of effective depression care interventions that are sustainable in public sector systems. However, little is understood regarding the depression treatment preferences of low-income Latinos who have not received quality depression care and who may not feel that they can voice their opinions about their health care. In addition, little is known about the preferences, capabilities, and priorities of providers and administrators in primary care clinics. This study will determine ways to make depression care more responsive to the needs of consumers in primary care clinics serving low-income Latinos. The study will also evaluate the effectiveness of various treatments in reducing depression.

Following baseline assessments of depression treatment preferences and resources, participants in this open label study will be randomly assigned to receive collaborative care either immediately or after a waiting period. Individuals assigned to receive immediate care will undergo treatment for 12 weeks. Other participants will receive treatment at a later time. All participants will have the option to receive one of the following treatments: (1) medication management from the Depression Care Specialist (DCS) and antidepressant medication from their primary care provider (PCP); (2) cognitive-behavioral therapy from the DCS; or (3) a combination of both treatments. Depression treatment outcomes and preferences will be measured post-intervention. Provider and administrator preferences will also be measured post-intervention and potential strategies for implementing patient-centered depression care programs will be identified.

• Behavioral: Collaborative care treatment
  Patients receiving collaborative care treatment choose 12 weeks of CBT and/or medication management (antidepressants prescribed by patients' primary care provider) from the study depression care specialist (DCS).
• Behavioral: Enhanced usual care
  Usual care participants are assigned to a 16-week wait-list for the study treatment, during which they are free to receive treatment elsewhere. A letter is given to participants' primary care providers (PCP) that indicates they screened positive for depression. In addition, patients receive an information booklet about depression and a community resource list.

• Experimental: 1
  Participants will receive collaborative care
  Intervention: Behavioral: Collaborative care treatment
• Active Comparator: 2
  Participants will receive enhanced usual care
  Intervention: Behavioral: Enhanced usual care

Inclusion Criteria:

For Participating Patients:

• Attending one of the study clinics for primary care
• English or Spanish-speaking
• Screens positive for major depressive disorder or dysthymia

For Providers:

• All primary care providers providing at least one day of services at one of the study clinics

For Administrators:

• Administrative, medical, and nursing directors from each study site and directors of affiliated local mental health clinics

Exclusion Criteria:

For Participating Patients:

• Acutely suicidal
• Screens positive for bipolar disorder, psychotic disorder, or cognitive impairment