PROJECT 1 - Improving Clinical Assessment of Diagnosis for Latinos The goal of this proposal is to develop and test a mixed methods approach to helping clinicians in public health psychiatric settings decrease clinical uncertainty by more accurately diagnosing patients with diverse cultural backgrounds and improving, the matching of clinical services to the needs of Latinos. Our approach combines methods from cultural anthropology with statistical methods and psychiatric epidemiology.
The specific aims of this study focus on generating improved cultural formulations and diagnostic accuracy using information from qualitative and quantitative perspectives, iterating between the methods in a complementary fashion.
The specific aims are to:
Aim 1 : Identify the information about symptoms and cultural and social context gathered in the initial diagnostic interview, that clinicians use to make determinations about three disorders: major depression, drug abuse and alcohol abuse;
Aim 2 : Use data from an epidemiological survey to assess the potential sensitivity and specificity of the clinical determinations identified in Aim1 in detecting the underlying diagnosis. We will test the hypothesis that clinical diagnosis is less accurate for Latino than non-Latino white patients;
Aim 3 : Assess clinician and patient reactions to the recommended improvements to diagnostic assessments developed in Aim 2. Using focus groups and consensus panels, prioritize the kinds of information to be collected to improve diagnostic determinations in safety net settings.
Aim 4 : Apply the findings of Aim 3 to make concrete recommendations to improve the efficiency and fairness of diagnostic decisions for Latino and non-Latino white population groups.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Specialized Center (P50)
Project #
5P50MH073469-04
Application #
7686289
Study Section
Special Emphasis Panel (ZMH1)
Project Start
Project End
Budget Start
2008-07-01
Budget End
2009-06-30
Support Year
4
Fiscal Year
2008
Total Cost
$199,470
Indirect Cost
Name
Cambridge Health Alliance
Department
Type
DUNS #
805262995
City
Cambridge
State
MA
Country
United States
Zip Code
02139
Carson, Nicholas J; Katz, Arlene M; Alegría, Margarita (2016) How patients and clinicians make meaning of physical suffering in mental health evaluations. Transcult Psychiatry 53:595-611
Alegría, Margarita; Alvarez, Kiara; Ishikawa, Rachel Zack et al. (2016) Removing Obstacles To Eliminating Racial And Ethnic Disparities In Behavioral Health Care. Health Aff (Millwood) 35:991-9
Earl, Tara R; Fortuna, Lisa Roxanne; Gao, Shan et al. (2015) An exploration of how psychotic-like symptoms are experienced, endorsed, and understood from the National Latino and Asian American Study and National Survey of American Life. Ethn Health 20:273-92
Alegría, Margarita; Molina, Kristine M; Chen, Chih-Nan (2014) Neighborhood characteristics and differential risk for depressive and anxiety disorders across racial/ethnic groups in the United States. Depress Anxiety 31:27-37
Alegría, Margarita; Fortuna, Lisa R; Lin, Julia Y et al. (2013) Prevalence, risk, and correlates of posttraumatic stress disorder across ethnic and racial minority groups in the United States. Med Care 51:1114-23
Nakash, Ora; Alegría, Margarita (2013) Examination of the role of implicit clinical judgments during the mental health intake. Qual Health Res 23:645-54
Alegria, Margarita; Roter, Debra L; Valentine, Anne et al. (2013) Patient-clinician ethnic concordance and communication in mental health intake visits. Patient Educ Couns 93:188-96
Alegria, Margarita; Lin, Julia; Chen, Chih-Nan et al. (2012) The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services. Health Serv Res 47:1322-44
Horvitz-Lennon, Marcela; Alegría, Margarita; Normand, Sharon-Lise T (2012) The effect of race-ethnicity and geography on adoption of innovations in the treatment of schizophrenia. Psychiatr Serv 63:1171-7
Molina, Kristine M; Alegria, Margarita; Chen, Chih-Nan (2012) Neighborhood context and substance use disorders: a comparative analysis of racial and ethnic groups in the United States. Drug Alcohol Depend 125 Suppl 1:S35-43

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