DESEO: DEpression Screening and Education: Options to Reduce Barriers to Treatment

Barriers to depression treatment among Hispanic populations include persistent stigma, inadequate doctor patient communication (DPC) and resultant sub-optimal use of anti-depressant medications. Stigma is primarily perpetuated due to inadequate disease literacy and cultural factors. Common concerns about depression treatments among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications.

Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with comorbid physical health conditions. Hispanics, in particular, are more likely to receive mental health care in primary care settings. Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for depression only if systems are in place to ensure adequate treatment and follow-up.

Project Purpose, Goals and Objectives Purpose: The purpose of this project is to implement a Depression Education Intervention (DEI) designed to increase disease literacy, and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement. This project will be conducted at one community health center whose patient population is majority Hispanic.

Goal #1: Patients who screen positive for depression will engage in the Depression Education Intervention (DEI) (two sessions) with a trained Depression Educator.

Objectives:

1. To increase knowledge of depression (signs/symptoms, causes, risk factors, treatment, cultural beliefs, and its role in chronic disease) among Hispanics in a primary care setting as measured by changes in scores from pre- to post- DEI on the Knowledge of Depression-MCQ scale.
2. To reduce perceived cultural stigma about depression and its treatment through a culturally and linguistically appropriate educational intervention as measured by changes in scores from pre- to post- DEI on the Stigma Checklist for Latinos in Primary Care.
3. To increase engagement in depression treatment in primary care by Hispanic patients as measured by the iPad Depression Screening application, which will record the treatment decision after the diagnosis and measure the number of patients engaged in depression treatment of any kind (pharmacotherapy, counseling, other behavioral intervention) at the time of the DEI and one month after completion of the DEI.

Goal #2: In order to identify patients with depression, all adult primary care patients will be screened for depression utilizing the 9-item Patient Health Questionnaire (PHQ-9) via the iPad Depression Screening application.

Objectives:

1. To systematically screen all adult primary care patients with an iPad Depression Screening application as measured by number of patients screened compared to the number eligible for screening.
2. To increase provider detection of depression in patients through the proper use and interpretation of the PHQ-9 as measured by depression diagnoses recorded in the EHR.