The overall goal is to develop a culturally congruent intervention for use in outpatient pharmacological practice by a psychiatrist that will increase retention of Hispanics with major depressive disorder (MDD) in antidepressant therapy. Despite major advances in the treatment of psychiatric disorders, Hispanics continue to underutilize mental health services relative to non-Hispanic Whites and to their own mental health need, as evidenced by lower rates of treatment entry and retention. Hispanic dropout from medication therapy for MDD attains rates two to three times those of non-Hispanic Whites. Mental health utilization in general is lowest among less acculturated, migrant Hispanics, even after controlling for socio- economic factors and psychiatric diagnosis, suggesting that cultural factors are important causes of underutilization. Our pilot work with depressed, culturally traditional Hispanics entering antidepressant therapy suggests that cultural incongruence between patients' and psychiatrists' expectations and concerns about treatment produces ambivalence about taking medication or following physician instructions, which in turn interferes with retention. This association between ambivalence about treatment and dropout is predicted by the """"""""transtheoretical model of change"""""""", a schematization of the stages individuals experience in the process of behavior change. However, the validity of this model for Hispanics has not been empirically tested. Motivational Interviewing (MI) is an effective brief psychotherapy that has improved retention among patients with dually diagnosed depression and substance abuse by targeting ambivalence about entering and remaining in treatment. However, MI has not been adapted for Hispanic patients in antidepressant therapy.
The specific aims of this study are to: a) culturally adapt and manualize MI for depressed Hispanics in antidepressant therapy; b) explore the efficacy of 4 sessions of this manualized intervention for improving retention during a 12-week open- label trial with a 2nd generation antidepressant and at 6-month follow-up among 65 Hispanics seeking outpatient medication therapy for non-psychotic MDD; c) explore the predictive validity of the """"""""transtheoretical model of change"""""""" for treatment retention by examining the relationship between the retention measures and baseline stage of change and stage progression during treatment; d) examine the efficacy of MI for helping patients progress through the stages of change. This study will yield pilot data on the efficacy of a manualized cultural adaptation of MI for enhancing retention of Hispanics in antidepressant therapy and on the predictive validity of the """"""""transtheoretical model of change"""""""" in this population. This pilot data will allow us to apply for an R01 to further study this intervention and model in a controlled clinical trial.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21MH066388-01
Application #
6535497
Study Section
Special Emphasis Panel (ZMH1-SRV-C (01))
Program Officer
Hohmann, Ann A
Project Start
2002-09-01
Project End
2004-08-31
Budget Start
2002-09-01
Budget End
2003-08-31
Support Year
1
Fiscal Year
2002
Total Cost
$140,493
Indirect Cost
Name
New York State Psychiatric Institute
Department
Type
DUNS #
167204994
City
New York
State
NY
Country
United States
Zip Code
10032
Patel, Sapana R; Gorritz, Magdaliz; Olfson, Mark et al. (2016) Training community-based primary care physicians in the screening and management of mental health disorders among Latino primary care patients. Gen Hosp Psychiatry 38:71-8
Vargas, Sylvanna M; Cabassa, Leopoldo J; Nicasio, Andel et al. (2015) Toward a cultural adaptation of pharmacotherapy: Latino views of depression and antidepressant therapy. Transcult Psychiatry 52:244-73
Lewis-Fernández, Roberto; Balán, Iván C; Patel, Sapana R et al. (2013) Impact of motivational pharmacotherapy on treatment retention among depressed Latinos. Psychiatry 76:210-22
Balán, Iván C; Moyers, Theresa B; Lewis-Fernández, Roberto (2013) Motivational pharmacotherapy: combining motivational interviewing and antidepressant therapy to improve treatment adherence. Psychiatry 76:203-9
Lewis-Fernández, Roberto; Raggio, Greer A; Gorritz, Magdaliz et al. (2013) GAP-REACH: a checklist to assess comprehensive reporting of race, ethnicity, and culture in psychiatric publications. J Nerv Ment Dis 201:860-71