Depression and Clinical Research Program, Massachusetts General Hospital, Boston, USA.
BMC Psychiatry. 2011 Oct 13;11:166. doi: 10.1186/1471-244X-11-166.
BACKGROUND: Ethnic minorities with depression are more likely to seek mental health care through primary care providers (PCPs) than mental health specialists. However, both provider and patient-specific challenges exist. PCP-specific challenges include unfamiliarity with depressive symptom profiles in diverse patient populations, limited time to address mental health, and limited referral options for mental health care. Patient-specific challenges include stigma around mental health issues and reluctance to seek mental health treatment. To address these issues, we implemented a multi-component intervention for Asian American and Latino American primary care patients with depression at Massachusetts General Hospital (MGH). METHODS/DESIGN: We propose a randomized controlled trial to evaluate a culturally appropriate intervention to improve the diagnosis and treatment of depression in our target population. Our goals are to facilitate a) primary care providers' ability to provide appropriate, culturally informed care of depression, and b) patients' knowledge of and resources for receiving treatment for depression. Our two-year long intervention targets Asian American and Latino American adult (18 years of age or older) primary care patients at MGH screening positive for symptoms of depression. All eligible patients in the intervention arm of the study who screen positive will be offered a culturally focused psychiatric (CFP) consultation. Patients will meet with a study clinician and receive toolkits that include psychoeducational booklets, worksheets and community resources. Within two weeks of the initial consultation, patients will attend a follow-up visit with the CFP clinicians. Primary outcomes will determine the feasibility and cost associated with implementation of the service, and evaluate patient and provider satisfaction with the CFP service. Exploratory aims will describe the study population at screening, recruitment, and enrollment and identify which variables influenced patient participation in the program. DISCUSSION: The study involves an innovative yet practical intervention that builds on existing resources and strives to improve quality of care for depression for minorities. Additionally, it complements the current movement in psychiatry to enhance the treatment of depression in primary care settings. If found beneficial, the intervention will serve as a model for care of Asian American and Latino American patients.
背景:与心理健康专家相比,少数民族抑郁症患者更有可能通过初级保健提供者(PCP)寻求心理健康护理。然而,提供者和患者都存在特定的挑战。PCP 特定的挑战包括不熟悉不同患者群体的抑郁症状谱、解决心理健康问题的时间有限,以及心理健康护理的转诊选择有限。患者特定的挑战包括对心理健康问题的污名化和不愿意寻求心理健康治疗。为了解决这些问题,我们在马萨诸塞州综合医院(MGH)为亚裔美国人和拉丁裔美国的抑郁症初级保健患者实施了一项多部分干预措施。
方法/设计:我们提出了一项随机对照试验,以评估一种文化上适当的干预措施,以改善我们目标人群中抑郁症的诊断和治疗。我们的目标是促进 a)初级保健提供者提供适当、文化上知情的抑郁症护理的能力,以及 b)患者对接受抑郁症治疗的了解和资源。我们为期两年的干预措施针对 MGH 筛查出的有抑郁症状的成年(18 岁或以上)亚裔美国人和拉丁裔美国初级保健患者。研究干预组中所有符合条件的筛查阳性患者将获得文化聚焦的精神病学(CFP)咨询。患者将与研究临床医生会面,并获得工具包,其中包括心理教育手册、工作表和社区资源。在初次咨询后的两周内,患者将与 CFP 临床医生进行随访。主要结果将确定实施该服务的可行性和成本,并评估患者和提供者对 CFP 服务的满意度。探索性目标将描述筛查、招募和入组时的研究人群,并确定哪些变量影响患者参与该计划。
讨论:该研究涉及一种创新但实用的干预措施,它利用现有资源并努力改善少数民族抑郁症的护理质量。此外,它补充了精神病学领域目前提高初级保健环境中抑郁症治疗的运动。如果发现有益,该干预措施将成为照顾亚裔美国人和拉丁裔美国患者的模式。
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