Department of Psychiatry, Columbia University, New York State Psychiatric Institute, USA.
Psychiatry. 2013 Fall;76(3):210-22. doi: 10.1521/psyc.2013.76.3.210.
Compared to non-Latino Whites, U.S. racial/ethnic minority groups show higher non-adherence with outpatient antidepressant therapy, including lower retention, despite adjusting for sociodemographic and insurance covariates. Culturally salient concerns about antidepressants leading to ambivalence about treatment engagement may contribute to this discrepancy. To improve treatment adherence among depressed Latinos, we developed motivational pharmacotherapy, a novel approach that combines motivational interviewing, standard pharmacotherapy, and attention to Latino cultural concerns about antidepressants. This 12-week, open-trial, pre-post pilot study assessed the impact of motivational pharmacotherapy on antidepressant therapy retention, response (symptoms, functioning, and quality of life), and visit duration among n = 50 first-generation Latino outpatients with major depressive disorder. At study endpoint, 20% of patients discontinued treatment, with a mean therapy duration of 74.2 out of 84 days. Patients' symptoms, psychosocial functioning, and quality of life improved significantly. Mean visit length was 36.7 minutes for visit 1 and 24.3 minutes for subsequent visits, compatible with use in community clinics. Responder and remitter rates were 82% and 68%. Compared to published Latino proportions of non-retention (32-53%) and previous studies at our clinic with similar samples and medications (36-46%), Motivational pharmacotherapy appears to improve Latino retention in antidepressant therapy and should be investigated further in controlled designs.
与非拉丁裔白人相比，美国的少数族裔群体在接受门诊抗抑郁治疗时表现出更高的不依从性，包括保留率较低，尽管调整了社会人口统计学和保险协变量。对导致对治疗参与犹豫不决的抗抑郁药的文化上明显的担忧可能导致了这种差异。为了提高拉丁裔抑郁症患者的治疗依从性，我们开发了动机药理学治疗，这是一种结合动机访谈、标准药物治疗和关注拉丁裔文化对抗抑郁药的担忧的新方法。这项为期 12 周的开放试验、前后试点研究评估了动机药理学治疗对 50 名第一代拉丁裔门诊重度抑郁症患者的抗抑郁治疗保留率、反应（症状、功能和生活质量）和就诊时间的影响。在研究结束时，20%的患者停止治疗，平均治疗时间为 84 天中的 74.2 天。患者的症状、心理社会功能和生活质量显著改善。第 1 次就诊的平均就诊时间为 36.7 分钟，随后的就诊时间为 24.3 分钟，与社区诊所的使用兼容。应答率和缓解率分别为 82%和 68%。与发表的拉丁裔不保留率（32-53%）和我们诊所以前使用类似样本和药物的研究（36-46%）相比，动机药理学治疗似乎提高了拉丁裔患者对抗抑郁治疗的保留率，应在对照设计中进一步研究。
