Depression is a leading cause of disability in the United States. Patients with limited English proficiency (LEP), particularly Asians and Latinos, who represent the largest demographics with LEP in the country, are at increased risk of poor provider recognition of depressive symptoms and under-treatment of depression. Universal depression screening in primary care, with a focus on initial depression treatment, may be a way to systematically identify patients with LEP who could benefit from treatment. However, barriers to depression care are likely multifactorial and are still poorly understood. The objective of this application is to understand whether universal approaches to depression screening and initial care for depression are equally effective for all groups, or whether targeted efforts are needed to increase depression screening, diagnosis and treatment in primary care among patients with LEP. Within the context of a primary care setting, the specific aims are to (1) evaluate differences in depression screening and initial treatment by patient preferred language after adoption of annual universal depression screening, (2) examine patterns of patient-provider communication about depressive symptoms, and (3) to involve key stakeholders to develop a patient- and provider-facing, practice-based intervention prototype to improve annual depression screening, elicit patient concerns and treatment preferences, foster improved communication and patient empowerment about initial treatment, and increase engagement in depression care.
These aims will be achieved using mixed methods and health disparities research frameworks, and they address the NIMHD research priority areas of developing healthcare interventions to reduce health disparities and to improve patient-clinician communication and shared-decision making. The studies are novel in their focus on the mental health needs of primary care patients with LEP as well as the proposed use of mixed methods to develop a theory-driven intervention prototype. The proposed studies are informed by Dr. Maria Esteli Garcia?s experience as an internist working in diverse, urban primary care settings. Dr. Garcia?s long- term career goal is to improve depression care for patients with LEP in primary care. During the course of this award, Dr. Garcia will undertake didactic and experiential training to improve knowledge and skills in three areas: (1) mixed methods, (2) evidence-based depression care, and (3) experimental designs for use in real world settings. Dr. Garcia has assembled a mentorship team with expertise in mixed methods, health services and implementation science research, evidence-based depression treatment, and intervention design to ensure completion of the proposed research and training and successful transition to independence. Ultimately, these projects are expected to provide the foundation for future R34 and R01 applications and further refinement of an intervention to reduce mental health disparities by improving depression screening and initial depression care for patients with LEP.

Public Health Relevance

Depression leads to increased morbidity and mortality. Furthermore, patients with limited English proficiency (LEP) face additional challenges when obtaining treatment for depressive symptoms in primary care; systematic depression screening and a focus on initial treatment may help reduce these disparities in depression care. Completion of the proposed studies is expected to improve depression care for patients with LEP in primary care, by (1) evaluating implementation of depression screening and initial depression care in a large health care system, (2) examining patient-physician communication about depressive symptoms, and (3) incorporating stakeholder perspectives in the development of an intervention prototype to promote depression screening and patient-provider discussion of diagnosis and treatment preferences in routine primary care visits.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZMD1)
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Dagher, Rada Kamil
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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