Olive View – UCLA – Charles R. Drew University
Los Angeles County
Depression
African American, Latino

Project

Clinic operations are redesigned to impact depression care.

This program begins with depression screening for all patients using the Patient Health Questionnaire-2 (PHQ-2) upon arrival for a regularly scheduled visit with their primary care physician.

For patients who screen positive for depression symptoms, the longer PHQ-9 questionnaire is administered. The intervention includes a brief, post-visit counseling session with a nurse—specifically trained to educate patients about managing their depression—who will provide information about mental health resources and support available in the community, address cultural barriers to depression care such as the stigmatization of mental illness, and provide printed materials in the patient’s preferred language.

Primary care physicians receive depression care decision-support tools including paper reminders and algorithms for titrating antidepressant medications. A computerized chronic disease registry will assist with patient monitoring and follow-up.

Rationale

This multi-component program is based on the Chronic Care Model. Primary care practices were identified as a promising location for the intervention because psychotherapeutic treatment of depression was being underutilized. Additionally, in these primary care clinics chronic conditions such as diabetes and hypertension were highly prevalent among the patients diagnosed with depression.

Focus groups with primary care providers were held to inform the development of the program. During the focus groups, physicians noted the lack of depression screening, the lack of clear criteria for diagnosis, inadequate awareness that multiple symptoms might be signs of depression, and inadequate awareness of cultural values and beliefs of minority patients relating to depression and depression care (e.g., strong stigmatization and lack of understanding of mental illness). Clinicians acknowledged the high prevalence of depression in their patient population and displayed great interest in having a clinical infrastructure that would assist them in diagnosing and managing patients with depression better.

Summary Results

Patients were screened for depression at regularly scheduled primary care visits. The intervention of providing a counseling session with a nurse on managing depression to those who screened positive increased the percentage of these patients who sought care for depression (59% vs 19% in controls), but it did not result in a statistically significant different improvement in health outcomes. A comparable percentage of both the intervention (54%) and the control groups (59%)  experienced an improvement in depressive symptoms (5+ point reduction in PHQ-9 scores).  This is a feasible intervention.

Publications

Addressing Stigma of Depression in Latino Primary Care Patients
General Hospital Psychiatry. 2010; 32(2): 182-191.
Full Article (subscription may be required)

Stigma and Depression Treatment Utilization Among Latinos: Utility of Four Stigma Measures
Psychiatric Services. 2010; 61(4): 373-379.
Full Article (subscription may be required)

Principal Investigators

• Lacy E. Wyatt, MD, MPH (UCLA)
• Michael A. Rodriguez, MD, MPH (UCLA)
• Mohsen Bazargan, PhD (DREW University)