US Hispanics underutilize specialty mental health services (SMHS) relative to non-Hispanic Whites and to their own mental health need. By contrast, Hispanic utilization of primary care for mental health problems is nearly equivalent to that of majority Whites, after adjusting for clinical and socioeconomic covariates. Cultural factors play a key role in this selective underutilization, since adjusted rates of SMHS use are lowest among less acculturated, migrant Hispanics. Despite advances in cultural competence, the field lacks empirically tested, operationalized programs of care to address these cultural barriers. In their absence, quality enhancement approaches based in primary care have not closed the ethnic gap in depression treatment relative to Whites. Culturally congruent methods are needed to help bridge the care of Hispanic patients from general health to SMHS settings, since mental health services based in primary care have limited applicability beyond large, well-financed healthcare systems. ? The goal of this R34 application is to develop an operationalized, Culturally Congruent Program of care for Hispanics with Major Depressive Disorder (CCP-MDD) that can facilitate their entry, retention, and successful treatment in SMHS when referred from primary care. Program development will be conducted through four iterated modifications of the Cultural Formulation (CF), a DSM-IV Guideline for how to conduct a cultural assessment. Modifications will be based on previous CF research, qualitative data obtained from focus groups with depressed patients and their relatives, and results from the treatment of Hispanic primary care patients with MDD across a spectrum of acculturation levels. We will also obtain initial data on the effectiveness of CCP-MDD in facilitating SMHS entry, retention, and positive treatment outcome during an 18-week trial of stepped care for MDD that includes medication and/or interpersonal psychotherapy (IPT). ? The research team has extensive experience with the CF model, conducting medication and IPT treatment of Hispanics with MDD, and developing manualized treatments for depression. Our ongoing research relationship with several independent Hispanic primary care physicians in Upper Manhattan ensures the feasibility of the study. Development of a manualized, culturally congruent program of depression care for Hispanics with preliminary empirical support would constitute a significant step forward in cultural competence research. If successful, CCP-MDD could then be tested against usual care in a larger randomized, controlled trial. ? ? ?
