Sanchez Katherine, Eghaneyan Brittany H, Killian Michael O, Cabassa Leopoldo, Trivedi Madhukar H
School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA.
Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
Trials. 2017 Aug 3;18(1):363. doi: 10.1186/s13063-017-2109-y.
Significant mental health disparities exist for Hispanic populations, especially with regard to depression treatment. Stigma and poor communication between patients and their providers result in low use of antidepressant medications and early treatment withdrawal. Cultural factors which influence treatment decisions among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with co-morbid physical health conditions. Hispanics, in particular, are more likely to receive mental healthcare in primary care settings. Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for depression only if systems are in place to ensure adequate treatment and follow-up.
We are conducting a randomized controlled trial among 150 depressed adult Hispanics in a primary care safety net setting, testing the effectiveness of a culturally appropriate depression education intervention to reduce stigma and increase uptake in depression treatment among Hispanics, and implement a Measurement-Based Integrated Care (MBIC) model with collaborative, multidisciplinary treatment and culturally tailored care management strategies.
This study protocol represents the first randomized control trial of the culturally adapted depression education fotonovela, Secret Feelings, among Hispanics in a primary care setting. The education intervention will be implemented after diagnosis using an innovative screening technology and enrolled in measurement-based integrated care for the treatment of depression, which will help build the evidence around cultural adaptations in treatment to reduce mental health disparities.
ClinicalTrials.gov, NCT02702596. Registered on 20 March 2016.
西班牙裔人群存在显著的心理健康差异，尤其是在抑郁症治疗方面。患者及其医疗服务提供者之间的耻辱感和沟通不畅导致抗抑郁药物的使用率较低以及早期治疗中断。影响西班牙裔治疗决策的文化因素包括对抗抑郁药物成瘾性和有害性的担忧、对服用过多药物的担心以及服药带来的耻辱感。初级保健机构通常是识别未诊断或未治疗的心理健康障碍的途径，特别是对于患有合并身体疾病的人群。尤其是西班牙裔，更有可能在初级保健机构接受心理健康护理。美国预防服务工作组最近的建议是，只有在有系统确保充分治疗和随访的情况下，初级保健提供者才对成年患者进行抑郁症筛查。
我们正在一个初级保健安全网环境中对150名成年西班牙裔抑郁症患者进行一项随机对照试验，测试一种符合文化背景的抑郁症教育干预措施的有效性，以减少耻辱感并提高西班牙裔对抑郁症治疗的接受度，并实施基于测量的综合护理（MBIC）模式，采用协作式多学科治疗和符合文化特点的护理管理策略。
本研究方案是在初级保健环境中对西班牙裔进行的首次针对文化适应性抑郁症教育连环漫画《隐秘情感》的随机对照试验。教育干预将在诊断后采用创新的筛查技术实施，并纳入基于测量的综合护理以治疗抑郁症，这将有助于积累关于治疗中文化适应性以减少心理健康差异的证据。
ClinicalTrials.gov，NCT02702596。于2016年3月20日注册。
