Time to Remission Among Hispanic Patients Being Treated in an Integrated Health Care Model

Background

The integration of primary medical care and behavioral health services is referred to as integrated health care (IHC). IHC interventions, specifically with a social worker serving as the behavioral health provider, have proven effective. We present findings from an NIH funded randomized controlled trial for the treatment of depression in an adult Hispanics primary care population. Previous evidence on the role of the social worker in IHC suggests that depression and anxiety significantly decrease and reach remission within five sessions, on average. The purpose of this study was to examine the specific role of the social work number of sessions in achieving remission in a culturally adapted treatment model.

Methods

Participants (N=150) were enrolled in an integrated, multi-disciplinary treatment model which included culturally tailored education. Depression treatment included regular sessions with a bilingual Licensed Clinical Social Worker who provided brief psychotherapy interventions. We conducted a survival analysis testing the time between baseline Patient Health Questionnaire (PHQ-9) scores to a 50% reduction in scores and time to remission (PHQ-9 < 5). The Kaplan-Meier method was utilized to assess basic demographic data and scores, and the Cox regression method was utilized to assess the effect of four predictors – depression, anxiety, medication initiation, and age.

Results

At baseline, 98.0% of the sample reported moderate to severe depressive symptoms. The vast majority were women (n=133, 88.7%), Spanish speaking (n=136, 90.7%), and reported some high school or less education (n=79, 52.7%). Overall, depression scores decreased by at least 50% within the first three MBIC sessions after baseline and participants’ reached remission within the first five sessions (PHQ-9 = 5 or less). Results of the survival analyses revealed that gender, language (Spanish or English), marital status, age, education level, and comorbidity type (diabetes, cancer, high blood pressure, or heart disease) were not significantly related to time to 50% reduction in PHQ-9 scores, or time to remission.

Conclusion

Depressed Hispanic patients treated in an integrated, multidisciplinary model, engaged in treatment with a social worker, reached remission within the first five sessions. These findings are particularly meaningful given the sample of Hispanics who historically experience disparities in treatment and therefore poor outcomes. The role of the social worker is essential to increase access to quality treatment, especially for racial and ethnic minority populations. Social workers are trained to work with individuals and groups while recognizing each person’s unique needs through cultural experiences. Though social work practice is broad in nature, social workers provide empathy, connection, crisis intervention, and support to very diverse and marginalized.