Measurement, Education and Tracking in Integrated Care (METRIC): use of a culturally adapted education tool versus standard education to increase engagement in depression treatment among Hispanic patients: study protocol for a randomized control trial.

BACKGROUND: Significant mental health disparities exist for Hispanic populations, especially with regard to depression treatment. Stigma and poor communication between patients and their providers result in low use of antidepressant medications and early treatment withdrawal. Cultural factors which influence treatment decisions among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with co-morbid physical health conditions. Hispanics, in particular, are more likely to receive mental healthcare 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. METHODS: We are conducting a randomized controlled trial among 150 depressed adult Hispanics in a primary care safety net setting, testing the effectiveness of a culturally appropriate depression education intervention to reduce stigma and increase uptake in depression treatment among Hispanics, and implement a Measurement-Based Integrated Care (MBIC) model with collaborative, multidisciplinary treatment and culturally tailored care management strategies. DISCUSSION: This study protocol represents the first randomized control trial of the culturally adapted depression education fotonovela, Secret Feelings, among Hispanics in a primary care setting. The education intervention will be implemented after diagnosis using an innovative screening technology and enrolled in measurement-based integrated care for the treatment of depression, which will help build the evidence around cultural adaptations in treatment to reduce mental health disparities. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02702596. Registered on 20 March 2016.

Type 2 Diabetes and Depression: Patient, Family Member, and Primary Care Provider Perspectives on the Development of an Integrated Self-Management Intervention.

PURPOSE: The purpose of the current study was to engage a local primary care clinic community that serves the Latino immigrant population to obtain their input regarding the design and implementation of a proposed integrated behavioral intervention that will simultaneously target T2DM and depression self-management in this high risk patient population. METHODS: Nine key informant interviews and 3 focus groups were conducted. Key informant interviews were conducted with the medical director, a primary care provider, a diabetes educator, and a medical assistant from each site, as well as the counselor who serves both sites. Fourteen patients with T2DM who screened positive for depression and 7 of their family members participated in the focus groups. Key informants and focus group participants were asked about patient challenges with diabetes management, the role of depression in T2DM, their impressions of the proposed intervention, and motivators and barriers to participation in the intervention. RESULTS: Commonly reported challenges with diabetes management included the struggle with healthy eating and information exchange upon diagnosis. T2DM and depression were seen as interrelated and described by many as having a cyclical relationship. Key informants and focus group participants uniformly supported the proposed intervention and recommended the involvement of family members. CONCLUSIONS: Results of this study support the need and acceptability of individualized behavioral interventions that target T2DM and depression simultaneously.