Depression Treatment Preferences of Low-Income Latinos: A Qualitative Study

Background and Purpose: Latino adults, particularly those living in poverty and with limited English proficiency, experience major disparities in accessing and receiving high quality depression care. Eliminating these inequities in depression care will require the development and implementation of evidence-based depression treatments that are tailored to the needs and preferences of underserved populations. Little is known, however, about Latinos' depression treatment preferences or their experiences with depression treatments. The aims of this qualitative study are to: (1) examine how depression treatment preferences are formed and sustained overtime; and (2) examine Latinos' experiences with evidence-based depression treatments in primary care.

Methods: A convenience sample (N = 40) of low-income Latinos who screened positive for major depression and/or dysthymia was selected from an NIMH-funded randomized controlled trial of collaborative care for depression in public primary care settings. Patients from both the waitlist and intervention condition (4-months of CBT and/or medication management) were selected. In-depth semi-structured qualitative interviews were conducted at baseline and 4-month follow-up. Transcripts were analyzed using the methodology of coding, consensus, co-occurrence, and comparison, an analytical strategy rooted in grounded theory.

Results: The majority of participants were female (85%), Spanish-speaking (75%), foreign-born (73%), and of Mexican-origin (59%). At baseline, depression symptoms (as measured by the PHQ-9) on average were in the moderate to severe range. Ninety-two percent of subjects reported a co-morbid mental disorder (e.g., PTSD, Generalized Anxiety Disorder), and 92.5% reported physical comorbidities (e.g., diabetes, hypertension). Participants preferred individual over group counseling and reported apprehension about taking antidepressant medications. Treatment preferences were shaped by previous experiences with depression care, treatment expectations, and the experiences of family members and/or friends with mental health care. Treatment preferences were not static and seemed to shift with exposure to new treatment experiences. For example, participants who were at first reluctant to take antidepressant medications were willing to initiate medication once they experienced positive results (e.g., symptom relief, improvements in functioning) from counseling. Participants in the intervention condition (n = 19) reported gaining a better understanding of depression and its treatment. Perceived benefits of treatment included learning and using new skills to cope with depression and anxiety, having more control over depression, improving interpersonal relationships, and being willing to seek professional help in the future.

Conclusions and Implications: This qualitative study of low-income Latinos with depression provides in-depth information regarding treatment preferences and client-centered experiences with evidence-based depression treatments in primary care. Consistent with the limited studies in this area, findings suggest that our participants preferred counseling over medications, but were more accepting of medication after first engaging in counseling. Perceived benefits of depression treatment indicated that clients valued acquisition of knowledge about depression, development of coping skills and self-efficacy, and improved interpersonal relationships. Implications for developing and implementing evidence-based depression treatments in the Latino community will be discussed.