Despite the development of treatments of proven efficacy, treatment retention for Hispanics with major depressive disorder continues to be a major public health problem. Dropout rates from pharmacotherapy and psychotherapy in Hispanics are substantially higher than in non-Hispanic whites. Yet surprisingly little is known about clinical strategies to improve retention among Hispanics with major depressive disorder. Based on emerging literature and on promising pilot data derived from two small randomized trials of medication alone versus Interpersonal Psychotherapy (IPT) alone or combined with medication allowing for telephone session, we propose to compare treatment retention and outcome of depressed Hispanics patients who receive either: 1) antidepressant treatment following the Texas Medication Algorithm for Depression (TMA), or 2) an intervention based on patient treatment choice among the following options: a) TMA alone (i.e., medication alone), b) Brief IPT (IPT-B) alone with optional telephone sessions, or c) a combination of the TMA medication regimen and IPT-B. In order to maximize patient preference, satisfaction, and treatment retention, patients in the choice arm will be allowed to switch among the three treatments at any point during the study. To obtain preliminary data on the influence of insurance on choice, patients randomized to the choice arm will be further randomized to either a no co-payment for psychotherapy visit or $2 co-payment per visit (the median co-payment in the states in which Medicaid covers psychological services). Medication visits will have no co-payment on either study arm. All treatments will be delivered in Spanish or English depending on patient preference. In addition to quantitative data on retention and outcome, a mixed-method (quantitative-qualitative) approach will help to identify the mechanisms of action and key components of the proposed intervention. It will also characterize patient groups most responsive to the intervention and assess level of patient acceptance and satisfaction with treatment. We believe the proposed intervention holds promise for improving treatment retention for depressed Hispanics. The intervention is patient-centered, culturally sensitive, and honors patient preferences in the selection of evidence-based treatments. The findings from our intervention, if successful, would form an empirical foundation for the delivery of care to Hispanics and other socioeconomically disadvantaged populations that face logistical barriers to traditional mental health services.
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