Major depressive disorder (MDD) is highly prevalent among minority primary care patients, with impact comparable to the burden of major medical illness, and is associated with diminished quality of life, and elevated healthcare costs. Various effective treatments exist for MDD, but these are frequently not accessed or discontinued by underserved minority populations. Several quality improvement programs targeting provider- and system-level factors have not been able to close the gap between minority and majority patients in utilization of MDD treatment and in receipt of guideline-concordant care. As a result the focus of research in this area is shifting toward the study of patient-level factors and the development of patient- centered interventions specifically targeted to these groups, based on the view that treatment initiation and retention in these populations may be influenced by diverse needs at the individual level. Patient-centered research on treatment decision-making may help people participate in their health decisions in ways they prefer, inform and prepare a person for decision making, and help people to clarify and share their values with their healthcare provider. This application for an NIMH Mentored Patient-Oriented Research Career Development Award, co-mentored by Drs. Harold Alan Pincus and Roberto Lewis-Fernandez, seeks support to provide in-depth research and training experience to develop and test a decision aid intervention as a patient-centered approach for improving the quality of mental health care for underserved minorities.
The specific aims are to: 1) understand and assess patient and provider treatment decision making;2) to develop and acceptability of a decision aid intervention;and 3) assess feasibility of a decision aid intervention for depressed African American and Hispanic primary care patients. Two projects are proposed. Project 1 is a sequential phase mixed-method study of treatment decision-making in depressed minority patients, their family members and providers in primary care. Project 2 is an iterative development and feasibility study of a decision aid intervention for minorities in primary care. A better understanding of patient decision making, preferences and barriers to care has implications for quality improvement interventions that could impact the treatment of underserved depressed minority patients in primary care.
