The primary care provider (PCP) is the first treatment stop for many individuals suffering from symptoms of depression. This is particularly true of Latinos, who are the largest and fastest-growing ethnic minority group in the United States, and who demonstrate low rates of specialty mental health treatment utilization. Although PCPs frequently prescribe antidepressant medications and refer their patients to mental health specialists, very little is known about what predicts the likelihood that patients will follow through on their PCP's recommendation. I am proposing the first systematic investigation into Latino patient follow-up to PCP mental health treatment recommendations, with a particular emphasis on the relationship between the PCP - patient working alliance, provider cultural competency, and intended and actual follow-up to treatment recommendations. The study's broad, long-term goal is to identify a new area for intervention to improve the rates of mental health service use among Latinos with depression. For this study, I will assess 40 male and 40 female Latino primary care patients who score >10 on a routinely-administered depression screening measure. The assessment will cover such topics as the quality of patients'relationship with their PCP, patients'assessment of their PCP's cultural competency, their own attitudes, beliefs, and level of stigma about depression and its treatment, and their intention to seek treatment for depression. In addition, patients will be asked whether they received a referral from their PCP, and whether they followed up on that referral at the time of the interview.
The specific aims of this study are: (1) To determine whether the PCP-patient working alliance is associated with the patient's intention of following up on the PCP's treatment recommendation for depression, and with patients'actual follow-up. (2) To explore whether Latino patients'assessment of their PCPs'cultural competency is associated with their assessment of the working alliance, and, if so, whether a working alliance that is enhanced by provider cultural competency has a particularly strong effect on the patient's intended and actual treatment follow-up. (3) To understand whether the working alliance is particularly important among patients with moderate levels of stigma and negative attitudes and beliefs about treatment, such that a strong working alliance might increase these patients'intention to follow-up and completed follow-up to the PCP's treatment recommendation.

Public Health Relevance

Depression is one of the most common and disabling psychiatric disorders, yet treatment utilization rates remain very low, particularly among Latinos and other ethnic minority groups. This study is designed to investigate whether the relationship between primary care providers and Latino patients influences follow-up on PCP treatment recommendations for depression, thus creating the potential for new intervention opportunities for improving treatment utilization among Latinos.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZMH1-ERB-N (05))
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Otey, Emeline M
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Clark University (Worcester, MA)
Schools of Arts and Sciences
United States
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Ishikawa, Rachel Zack; Cardemil, Esteban V; Alegría, Margarita et al. (2014) Uptake of depression treatment recommendations among Latino primary care patients. Psychol Serv 11:421-32