Treatment Engagement for Depression Among Latinos in Primary Care after an Education Intervention: Outcomes from the Deseo Project

Background: Barriers to depression treatment among Hispanic populations include persistent stigma, inadequate doctor patient communication and resultant sub-optimal use of anti-depressant medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders. Hispanics are more likely to receive mental health care in primary care settings. We report on outcomes from DESEO: Depression Screening and Education: Options to Reduce Barriers to Treatment, a study which aimed to test a Depression Education Intervention to increase disease literacy, and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement.  

Methods: All adult primary care patients at the community health center were screened with the Patient Health Questionnaire (PHQ-9) and those who screened positive for depression were invited to participate in the Depression Education Intervention (two sessions) with a trained Depression Educator. Stigma, depression, anxiety, and depression knowledge were reported at baseline, a second session, and at the follow-up time points. Repeated measures ANOVA (within-subjects) were used to test for changes over time. Treatment engagement was tested with multinomial logistic regression modeling.

Results: Patients (N=350) were enrolled who screened positive for depression and consented to participation. Nearly all were Hispanic women (n=327, 93.4%) who spoke primarily Spanish (n=332, 95.1%) and had a mean age of 38.81 years (SD=10.60). Almost two-thirds of the sample reported less than a high school education (n=218, 62.3%). Participants completing the protocol (n = 305, 87.1%) were not significantly different from those who dropped out (n = 45, 12.9%). Overall, participants reported significantly lower depression (F[1.876, 562.718]=319.328, p<.001, 𝜂²=.516) and anxiety scores at each time point (F[1.948, 588.251]=167.756, p<.001, 𝜂²=.357). Reported stigma around mental health care (F[1.907, 574.076]=21.914, p<.001, 𝜂²=.068) and social distance scores significantly increased over time (F[1.823, 548.637]=21.914, p<.001, 𝜂²=.068) indicating decreased stigma around mental health issues. Reported concerns about others’ negative perception of psychiatric medication significantly increased over time (F[2, 588]=14.633, p<.001, 𝜂²=.047), though the effect size was small.

            A majority of participants entered some form of treatment by follow-up (n=273 of 305, 89.5%), including counseling (n=167, 54.8%) or combined counseling and medication (n=106, 34.8%). Only about 10% of the sample did not seek treatment following the intervention (n=32, 10.5%). Specifically, participants were 10.8% more likely to report being prescribed medication for every one-point increase in their depression scores (𝛽=.102, Wald t=8.122, df=1, p=.004, exp𝛽=1.108, 95%CI=[1.032, 1.188]). For every one-point increase in DKM scores, participants were 28.8% more likely to engage in counseling (𝛽=.253, Wald t=7.589, df=1, p=.006, exp𝛽=1.288, 95%CI=[1.076, 1.542]) and 40.9% more likely to report taking medication (𝛽=.343, Wald t=11.235, df=1, p=.001, exp𝛽=1.409, 95%CI=[1.153, 1.723]) compared to those who reported no treatment engagement at follow-up.

Conclusion: Low-income, uninsured, Spanish-speaking Latinas in this primary care clinic were significantly more likely to engage in depression treatment after receiving culturally adapted depression education. Since Latinos, in particular, are more likely to receive mental health care in primary care settings, results suggest an opportunity to reduce disparities for populations who lack access to mental health specialists.