Examining Perceptions and Experiences of Antidepressant Use Among Hispanics in Integrated Care

Background: While Hispanics demonstrate similar rates of depressive disorders compared to non-Hispanic, Whites, they experience disparities in utilization of mental health care including low rates of initiation and adherence to antidepressant medication. Integrated behavioral health models have demonstrated effectiveness in increasing the use of antidepressant medications leading to improvement in depression among Hispanics in primary care. Given that the use of antidepressant medications is a significant predictor of improved depressive symptoms, it is important to increase our understanding of uptake and utilization of antidepressants to improve mental health outcomes for patients in primary care. The purpose of this study was to examine the experiences and perceptions of using antidepressants among Hispanics who completed treatment in an integrated behavioral health model in a primary care setting.

Method:  Purposive sampling was used to recruit participants among a sample of Hispanic patients who completed 12-month participation in an integrated behavioral health model for the treatment of depression in a community health center. The intervention included regular meetings with a care manager, who was a bi-lingual LCSW. A descriptive phenomenological approach was utilized to explore the experiences of patients enrolled. Semi-structured, individual interviews were conducted in Spanish and English. Interviews were audio-recorded and translated/transcribed. The data was then coded line-by-line using an open coding process by the first and second authors. Next, the authors reached an agreed-upon translation of the initial codes into new, overarching themes.

Results: Nineteen women and three men participated in the study (N=22). Ages of the participants ranged from 33 to 51 and a majority (n=20) spoke Spanish. Sixteen participants reported taking antidepressants during their time in the study. Themes generated from the analysis included beliefs about antidepressants before and after the study, motivations to use antidepressants, and challenges taking antidepressants. All the participants reported believing that medication could be beneficial to patients with depression and many discussed how their beliefs about medications had positively changed as a result of being in the study. While some participants only considered antidepressant use because of their care manager, others initiated treatment because they wanted a quick solution and preferred medication over therapy. Some participants were hesitant to use medication due to past experiences with family and friends, while others reported concerns involving cultural views, side effects, and the fear of addiction. Many participants noted the role the care manager had in addressing these concerns, thus motivating and enabling them to begin and continue medication use.

Conclusions: Multidisciplinary integrated behavioral health models show promise for eliminating mental health disparities experienced by ethnic minority populations. Results of this study emphasize the role that care managers play in educating and assisting patients with medication management in these models. While many Hispanic patients may have stigma and other concerns about taking medications, care managers that have time to build trust and rapport with patients can help them overcome many of these barriers and empower them to pursue the treatment option they believe is best for them.