WITHDRAWN: Engagement and Retention in Depression Treatment Among Hispanics in an Integrated Health Care Intervention: A Mixed Methods Analysis

Background and Purpose: Disparities in the utilization of mental health services remain significant among Hispanics in the United States. While integrated health care models can contribute to the elimination of disparities experienced by Hispanics, more research on how patient-level factors impact engagement and retention within these models is needed. The current study utilized data from a federally funded study that implemented a culturally adapted integrated health care intervention in order to evaluate the impact of sociodemographic and psychological factors on mental health treatment participation among a sample of Hispanic primary care patients.

Methods: Utilizing a convergent mixed methods design, quantitative (N=150) and qualitative (n=22) data were collected and analyzed separately with a merging of results to provide a more in-depth and holistic understanding of mental health treatment participation among study participants. The study took place in a community health center from February 2016 to February 2019. Eligibility criteria included adults 18 years or older, self-identified as Hispanic, diagnosed with depression, and not in treatment. All participants were enrolled in a one-year intervention period with a Depression Care Manager (DCM) that included brief psychotherapy, symptom measurement, and medication management (when applicable). Quantitative data collection included baseline assessments (age, gender, language, marital status, education level, depression knowledge, stigma towards treatment, comorbidity, depression severity, and anxiety severity) and two dependent variables: total number of visits with the DCM and treatment completion with the DCM. Negative binomial regression models and binary logistic regression models were used to assess the relationship between baseline measures and total number of visits and between baseline measures and treatment completion. Qualitative data collection included individual interviews with a subsample of participants who completed their final research follow-up visit using a semi-structured interview guide. A directed content analysis approach was utilized to analyze the interview transcripts.

Results: Most participants (N=150) were female (89%) and Spanish speaking (91%). Participants were highly engaged in treatment with an average number of sessions of 11.90 (SD=6.97) and 76% completing treatment. Results of the quantitative analysis demonstrated that having a comorbid physical health condition was significantly associated with a higher number of sessions with the DCM (IRR = 1.27, p = .037). None of the baseline assessments were significantly related to treatment completion. Interview participants (n=22) had all completed treatment and were also primarily female (86%) and Spanish speaking (91%). Qualitative results revealed several themes related to treatment engagement (recognizing the need for treatment, perceptions of depression and treatment, values, and access) and retention (satisfaction with treatment, support systems, and barriers).

Conclusions and Implications: Taken together, results highlight the importance of screening for depression, educating patients throughout treatment, and providing culturally and linguistically competent care to improve access and satisfaction with treatment. Future research should continue to examine patient-level factors and experiences to understand how integrated health care models can be developed and implemented to address barriers to care, leading to increased participation, improved outcomes, and the elimination of mental health disparities experienced by Hispanics.