Impact of statutory revisions to family-petitioned civil commitment in South Korea.

INTRODUCTION: This study examined the impact of statutory revisions in 2016 which aimed to enhance procedural justice within the process of civil commitment for persons diagnosed with mental illnesses (PDMI) in South Korea. These changes included requiring that PDMI pose a threat of danger to self or others and the need for treatment simultaneously as criteria for petitioning civil commitment. Additionally, the revision established a public entity to oversee the legitimacy of petitions to involuntarily commit PDMI to inpatient treatment. Despite these statutory changes, families providing care for PDMI still appear to depend on civil commitment as a way to seek respite from care burden, not necessarily to respond to psychiatric emergencies involving dangerousness. This practice seems to be aided by processes within the public entity providing oversight. Due to such barriers we hypothesized that, even after the statutory revision in 2016, PDMI who had been civilly committed following petitions from families will not exhibit elevated dangerousness compared to PDMI who had never been hospitalized during the same period. METHODS: Trained interviewers recruited 331 participants self-identified as PDMI from psychiatric rehabilitation agencies in the community and aided them in completing a survey including measures of self-reported hospitalization history, suicidality, and aggression toward others. Participants were classified into four groups: Family-petition committed (FPC) group (n = 30, 9.1%), voluntarily hospitalized (VH) group (n = 34, 10.3%), public-petition committed (PPC) group (n = 31, 9.4%), and never hospitalized (NH) group (n = 236, 71.3%). We conducted logistic regression analyses to compare self-reported dangerousness between groups with the NH group as the reference group. RESULTS: In the past 12 months, 43.5% of PDMI participants had self-reported behaviors that may have met the dangerousness criteria for civil commitment. Controlling for confounding factors, the PPC group was 2.96 times and 3.02 times as likely to report suicidal ideation and physical aggression, respectively, compared to the NH group. However, as hypothesized, the FPC group did not differ from the NH group on any indicator of self-reported dangerousness. CONCLUSION: The findings were based on cross-sectional correlational data and should not be viewed as conclusive evidence that the 2016 statutory revision is ineffective in preventing family-petitioned civil commitment in cases where dangerousness is not apparent. Nevertheless, these findings encourage further empirical studies that illuminate the etiology of procedural justice in civil commitments petitioned by family members and that assess factors and contexts that promote the consideration of least coercive treatments, rather than resorting to involuntary hospitalization when psychiatric emergencies arise.

Health Behavior and Attitudes During the COVID-19 Pandemic Among Vulnerable and Underserved Latinx in the Southwest USA.

The COVID-19 pandemic highlighted deep-rooted health disparities, particularly among Latinx immigrants living on the Mexico-US border. This article investigates differences between populations and adherence to COVID-19 preventive measures. This study investigated whether there are differences between Latinx recent immigrants, non-Latinx Whites, and English-speaking Latinx in their attitudes and adherence to COVID-19 preventive measures. Data came from 302 participants who received a free COVID-19 test at one of the project sites between March and July 2021. Participants lived in communities with poorer access to COVID-19 testing. Choosing to complete the baseline survey in Spanish was a proxy for being a recent immigrant. Survey measures included the PhenX Toolkit, COVID-19 mitigating behaviors, attitudes toward COVID-19 risk behaviors and mask wearing, and economic challenges during the COVID-19 pandemic. With multiple imputation, ordinary least squares (OLS) regression was used to analyze between-group differences in mitigating attitudes and behaviors toward COVID-19 risk. Adjusted OLS regression analyses showed that Latinx surveyed in Spanish perceived COVID-19 risk behaviors as more unsafe (b = 0.38, p = .001) and had stronger positive attitudes toward mask wearing (b = 0.58, p = .016), as compared to non-Latinx Whites. No significant differences emerged between Latinx surveyed in English and non-Latinx Whites (p > .05). Despite facing major structural, economic, and systemic disadvantages, recent Latinx immigrants showed more positive attitudes toward public health COVID-19 mitigating measures than other groups. The findings have implications for future prevention research about community resilience, practice, and policy.

Patterns and Predictors of Sustained Training and Technical Assistance Engagement Among Addiction Treatment and Affiliated Providers.

The current study draws upon data collected over a 4-year period by a regional addiction technology transfer center (ATTC) to better understand the learning patterns and methods of learning engagement among behavioral health professionals. Training participants were found to be predominately female and ethnically diverse, evenly split on attaining a graduate degree, with a third of the participants possessing less than a 4-year college degree. More than one-half reported working in non-health/non-behavioral healthcare settings. Individuals who attended more ATTC events were found to possess less than a master's degree, work in non-behavioral health settings, and identify as Hispanic or other races. In addition, individuals who initially accessed training through an ATTC conference or online asynchronous learning events were found to become engaged learners.

Acceptability and Feasibility of Saliva-delivered PCR Coronavirus 2019 Tests for Young Children.

OBJECTIVES: Access to readily available, reliable, and easy-to-use coronavirus disease 2019 (COVID-19) tests remains critical, despite great vaccination progress. Universal back-to-school testing offered at early care and education ([ECE]; ie, preschool) sites to screen for positive cases may help preschoolers safely return to, and stay in, ECE. We examined the acceptability and feasibility of using a quantitative polymerase chain reaction COVID-19 saliva test for young children (n = 227, 54.0% girls: mean age = 52.3 ± 8.1 months) and their caregivers (n = 70 teachers: mean = 36.6 ± 14.7 years; n = 227 parents: mean = 35.5 ± 9.1 years) to mitigate the spread of COVID-19 and reduce days of school and work missed for households with children who test positive. METHODS: Participants were recruited at ECE sites serving low-income communities as part of the Rapid Acceleration of Diagnostic Testing-Underserved Populations Back to Early Care and Education Safely with Sustainability via Active Garden Education project (NCT05178290). RESULTS: Surveys in English or Spanish administered at testing events to children and caregivers at ECE sites showed child and adult acceptability and feasibility ratings were generally high. More favorable child and parent ratings were positively associated with child age and whether the child was able to produce a saliva sample. Language preference was not associated with any outcomes. CONCLUSIONS: Saliva sampling for COVID-19 at ECE sites is an acceptable strategy as an additional layer of protection for 4- and 5-year-olds; however, alternate testing strategies may be needed for younger children.

Building School-Academic Partnerships to Implement COVID-19 Testing in Underserved Populations.

OBJECTIVE: In April 2021, the US government made substantial investments in students' safe return to school by providing resources for school-based coronavirus disease 2019 (COVID-19) mitigation strategies, including COVID-19 diagnostic testing. However, testing uptake and access among vulnerable children and children with medical complexities remained unclear. METHODS: The Rapid Acceleration of Diagnostics Underserved Populations program was established by the National Institutes of Health to implement and evaluate COVID-19 testing programs in underserved populations. Researchers partnered with schools to implement COVID-19 testing programs. The authors of this study evaluated COVID-19 testing program implementation and enrollment and sought to determine key implementation strategies. A modified Nominal Group Technique was used to survey program leads to identify and rank testing strategies to provide a consensus of high-priority strategies for infectious disease testing in schools for vulnerable children and children with medical complexities. RESULTS: Among the 11 programs responding to the survey, 4 (36%) included prekindergarten and early care education, 8 (73%) worked with socioeconomically disadvantaged populations, and 4 focused on children with developmental disabilities. A total of 81 916 COVID-19 tests were performed. "Adapting testing strategies to meet the needs, preferences, and changing guidelines," "holding regular meetings with school leadership and staff," and "assessing and responding to community needs" were identified as key implementation strategies by program leads. CONCLUSIONS: School-academic partnerships helped provide COVID-19 testing in vulnerable children and children with medical complexities using approaches that met the needs of these populations. Additional work is needed to develop best practices for in-school infectious disease testing in all children.

Evolution of COVID-19 Health Disparities in Arizona.

COVID-19 burdens are disproportionally high in underserved and vulnerable communities in Arizona. As the pandemic progressed, it is unclear if the initial associated health disparities have changed. This study aims to elicit the dynamic landscape of COVID-19 disparities at the community level and identify newly emerging vulnerable subpopulations. Findings from this study can inform interventions to increase health equity among minoritized communities in the Southwest, other regions of the US, and globally. We compiled biweekly COVID-19 case counts of 274 zip code tabulation areas (ZCTAs) in Arizona from October 21, 2020, to November 25, 2021, a time spanning multiple waves of COVID-19 case growth. Within each biweekly period, we tested the associations between the growth rate of COVID-19 cases and the population composition in a ZCTA including race/ethnicity, income, employment, and age using multiple regression analysis. We then compared the associations across time periods to discover temporal patterns of health disparities. The association between the percentage of Latinx population and the COVID-19 growth rate was positive before April 2021 but gradually converted to negative afterwards. The percentage of Black population was not associated with the COVID-19 growth rate at the beginning of the study but became positive after January 2021 which persisted till the end of the study period. Young median age and high unemployment rate emerged as new risk factors around mid-August 2021. Based on these findings, we identified 37 ZCTAs that were highly vulnerable to future fast escalation of COVID-19 cases. As the pandemic progresses, vulnerabilities associated with Latinx ethnicity improved gradually, possibly bolstered by culturally responsive programs in Arizona to support Latinx. Still communities with disadvantaged social determinants of health continued to struggle. Our findings inform the need to adjust current resource allocations to support the design and implementation of new interventions addressing the emerging vulnerabilities at the community level.

Community Health Workers as Puentes/Bridges to Increase COVID-19 Health Equity in Latinx Communities of the Southwest U.S.

This study documents the pivotal role that Community Health Workers (CHW) played while supporting underserved Latinx communities affected by COVID-19-related health inequities. With the support of CHWs' agencies historically serving three Latinx-dense counties in Arizona, we recruited CHWs who participated in a state-wide COVID-19 testing project. Using phenomenology and narrative qualitative research methods, five focus groups were facilitated in Spanish between August and November 2021. Bilingual research team members conducted the analysis of the Spanish verbatim transcripts and CHWs reviewed the results for validity. Three interconnected themes reflected the CHWs experiences: (1) CHWs as puentes/bridges with deep community embeddedness through shared experiences and social/cultural context, (2) CHWs as communication brokers and transformational agents, playing a pivotal role in responding to the health and socioeconomic challenges posed by the COVID-19 pandemic, (3) CHWs satisfaction and frustration due to their dual role as committed community members but unrecognized and undervalued frontline public health workers. These findings emphasize the CHWs' commitment towards supporting their communities, even amidst the stressors of the pandemic. It is important to continue to integrate the role of CHWs into the larger healthcare system as opposed to relegating them to short term engagements as was the case during the COVID-19 pandemic. This article provides a set of practice, policy, and future research recommendations, emphasizing the need to allocate greater budgetary and training resources in support of CHWs.

Perceptions of Health Insurance Among Self-employed Korean Immigrants From South Korea in the United States.

Korean Americans in the United States are more likely than other Asian ethnic groups to lack health insurance despite their high education and economic prosperity. According to the model of health service selection, immigrants' perceptions of the health care system and health care behaviors in their host country are affected by sociocultural referents including premigration health care experience in the country of origin. This study explored Korean immigrants' perceptions of health insurance and their intentions to purchase and maintain health insurance in the United States. We conducted in-depth interviews with 24 self-employed Korean immigrants who migrated from South Korea and were living in the Greater Los Angeles area in 2015. Participants generally had negative perceptions of U.S. health insurance in terms of cost, benefits, simplicity, and accessibility. Coupled with their positive experiences with the single-payer, universal health insurance in South Korea, respondents evaluated U.S. health insurance as not worth purchasing, and indicated they would not maintain health insurance once the individual mandate of the Affordable Care Act was abolished. On the contrary, respondents who immigrated prior to the establishment of the Korean universal health insurance in South Korea were relatively satisfied with U.S. health insurance and had maintained health insurance for substantial periods of time. Korean immigrants' premigration health care experiences appeared to influence their decisions to purchase health insurance in the United States and their intention to maintain health insurance. The study findings highlight the necessity of tailored health education that takes into account sociocultural determinants of health coverage among immigrants.

Lack of continuity of care experienced by people diagnosed with schizophrenia in South Korea.

People diagnosed with schizophrenia (PDS) will find seamlessly coordinated services and care in their communities if they are delivered with a high level of continuity of care (COC). Most studies of COC were conducted in Western countries that initiated deinstitutionalisation several decades ago. Limited studies highlight experiences of COC among PDS who live in societies still heavily relying on institutionalised care, such as prolonged hospitalisation, like South Korea where PDS stay in psychiatric hospitals over 100 days on average. This qualitative study explored COC that PDS experienced in South Korea. We focused on cross-boundary COC, which refers to service coordination at a given moment, and longitudinal COC, which refers to care over a period of time. Twenty-one PDS completed in-depth interviews from June to August 2017. Fifteen participants were male (71.4%), and ages ranged from 26 to 71. We used grounded theory techniques for data analysis, including initial open coding, in vivo coding, constant comparison and axial coding. Findings include that PDS experienced poor longitudinal COC when discharge planning during hospitalisation was absent, which undermined their ability to live independently. Poor employment support effectively undermined recovery even if PDS worked hard to attain economic self-sufficiency. As for cross-boundary COC, poor communication between psychiatrists and providers offering psychiatric rehabilitation services was a barrier. PDS in general had difficulties locating needed psychiatric rehabilitation services in the community. The lack of COC appeared to arise from particular sociocultural contexts, including poor self-determination in consumer-provider relationships, families' lack of knowledge and support, and discrimination and prejudice. Despite experiences with discrimination, no participants appeared to have internalised messages that they are 'less than' those without mental illnesses. Findings highlight the significance of multi-pronged approaches to increase COC, which can effectively link PDS, families, psychiatrists and psychiatric rehabilitation service providers.

Social Networks and Chronic Illness Management among Low-Income Tenants in Publicly Subsidized Housing: Findings from a Pilot Study.

Low-income tenants in publicly subsidized housing (PSH) have higher rates of chronic illnesses than non-PSH-based residents, making the implementation of chronic illness management (CIM) essential. Based on the person-in-environment framework used in social work practice, which emphasizes the importance of interactions between clients and their social environment, this pilot study used personal network analysis (PNA), a variant of social network analysis, to explore what attributes of social networks are relevant to CIM among 26 low-income tenants independently living in a PSH in the Southwest United States. Tenants with a smaller network size and effective size presented better self-efficacy to manage chronic disease (SEMCD) and lower levels of depressive symptoms. Being connected to a higher proportion of alters (i.e., network members) with whom they discussed health matters was also associated with high SEMCD. As for CIM implementation, being connected to a doctor and a lower proportion of alters who have chronic illnesses were associated with doing aerobic exercise. Tenants with a larger proportion of alters serving multiple functions reported more frequent vegetable and fruit consumption, while those with a higher share of kin alters and lower share of alters living in the same PSH reported less frequent high-fat food consumption. Our findings help social workers discover relevant social networks and dynamics that low-income tenants at PSH capitalize to locate resources for CIM. Further studies are recommended to adopt PNA to expand practice-related knowledge that social workers can use for health promotion among low-income tenants with chronic illness.

Gender and stress-buffering of social capital toward depression among precarious workers in South Korea.

BACKGROUND: Precarious work is featured with disadvantaged job conditions such as to employment contract, job description, and occupational environment, and has been recognized as an emerging social risk for mental health. Social capital deserves further attention, believed to buffer stress produced by precarious employment. Yet, recent evidence suggests that the mental health benefits of social capital vary by gender, as gender norms that oblige women to assume a caregiving burden may nullify the benefits of a richer social capital. OBJECTIVE: Our study focused on two types of social capital, bonding and bridging, testing their stress-buffering effects, as focusing on the posited gender-moderated effects of social capital. METHODS: We analyzed 333 precarious workers in South Korea. Chi-square tests and t-tests are used to compare socio-demographic factors, depressive symptoms, and daily stressors by gender. Multiple regression analyses were used to test significance of an interaction term between daily stress and sub-domains of social capital by gender. RESULTS: Male workers with higher bonding and higher bridging social capital reported lower depressive symptoms. Yet, female workers gained no direct benefit from higher bonding social capital and those with higher bridging social capital reported even higher depressive symptoms when their daily stress was lower. CONCLUSIONS: Our findings support the notion that social capital is not universally beneficial and female precarious workers lacking resources seem to suffer despite increased social participation.

The Bidirectional Relationship Between Depressive Symptoms and Homebound Status Among Older Adults.

OBJECTIVES: This study aimed to examine the bidirectional relationship between depressive symptoms and homebound status among older adults. METHOD: The study sample included 7,603 community-dwelling older adults from the National Health and Aging Trends Study. A bivariate latent state-trait model of depressive symptoms and homebound status was estimated via structural equation modeling. RESULTS: The model fit the data well (Root Mean Square Error of Approximation = .02, Comparative Fit Index = .97, Standardized Root Mean Square Residual = .06). The relationship between homebound status and depressive symptoms can be decomposed into three parts: a moderate correlation between the stable trait components (r = .56, p <.001); a contemporary association of the state components (b = .17, p <.001); and bidirectional lagged effects between the state components. Change in homebound status was as a stronger predictor of depressive symptoms (b = .19, p < .001) than change in depressive symptoms was of homebound status (b = .06, p < .001; test of difference: Δ scaled χ2(1) = 24.2, p < .001). DISCUSSION: Homebound status and depressive symptoms form a feedback loop to influence each other. Improving the outdoor mobility of older adults may have immediate benefits for reducing depressive symptoms.

Mental illness discrimination and support experienced by people who are of color and/or LGB: Considering intersecting identities.

Little is known about mental illness discrimination toward and supports for people with mental health conditions (MHCs) who are of color and/or lesbian, gay, or bisexual (LGB). Informed by an intersectionality framework that facilitates an understanding of intragroup dynamics, this exploratory qualitative study used in-depth interviews to ask 20 people with MHCs and family members of people with MHCs who also identified as of color and/or LGB about their experiences (a) with mental illness discrimination and supports within their identity communities and (b) in peer- and family-run programs. Participants of color reported that their racial-ethnic communities commonly deny that MHCs exist and shame people with MHCs, and LGB participants said that LGB communities often exclude and stereotype them. Interactions with others with MHCs and affirmation of lesbian and gay identities serve as recovery supports within identity communities. Peer- and family-run programs provide a sense of humanization and education, respectively but are sites of heterosexism and may not address the needs of people of color; identity-specific programs are therefore desired. We describe variations in experiences related to race, ethnicity, and sexuality intersections; no differences in descriptions of mental illness discrimination in the focal identity communities emerged between people with MHCs versus family members. Implications include that efforts are needed to address discrimination in identity communities and peer- and family-run programs, and service providers need to recognize that identity intersections affect experiences with discrimination and supports. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Associations Between Changes in Depressive Symptoms and Social Support and Diabetes Management Among Low-Income, Predominantly Hispanic Patients in Patient-Centered Care.

OBJECTIVE: This study examined whether changes in depressive symptoms and social support prospectively predicted diabetes management among Hispanic patients with probable depression in patient-centered medical homes at safety-net clinics in East Los Angeles, CA. RESEARCH DESIGN AND METHODS: Data were collected from 251 patients enrolled in a randomized clinical trial testing the effectiveness of a self-management intervention assisted by a promotora (Hispanic community health worker). Cross-lagged analyses examined associations between changes in depression symptoms and social support between baseline and 6-month follow-up and self-efficacy and adherence to diabetes management at the 6- and 12-month follow-ups. RESULTS: Changes in depressive symptoms predicted self-efficacy and level of adherence at the 6- and 12-month follow-ups. Changes in total social support and emotional social support were correlated only with self-efficacy regarding diabetes management at 6-month follow-up. CONCLUSIONS: Decline in depressive symptoms is a reliable predictor of improvement in self-efficacy and adherence to diabetes management. Further studies are recommended to study psychosocial mechanisms related to social relationships other than social support that affect diabetes management.

Korean immigrants don't buy health insurance: The influences of culture on self-employed Korean immigrants focusing on structure and functions of social networks.

Culture has been pinpointed as a culprit of disparities in health insurance coverage between Korean immigrants and other ethnic groups. This study explored specific mechanisms by which culture influences a decision to buy health insurance among self-employed Korean immigrants living in ethnic enclaves by focusing on the structure and functions of social networks. Between March and June 2015, we recruited 24 Korean immigrant adults (aged 18 or older) who identified as self-employed and being uninsured for substantial periods before 2014 in Southern California. Interviews were conducted in Korean, and Korean transcripts were translated into English by two bilingual interpreters. Using constant comparative analysis, we explored why participants didn't purchase health insurance after migrating to the United States and how their social networks influenced their decisions whether to purchase health insurance. Results indicate Korean immigrants sought health information from dense and homogeneous social networks whose members are mostly Korean immigrants embedded in similar social contexts. Social learning was frequently observed when people sought health care while uninsured. However, respondents often noted social ties do not provide helpful information about benefits, costs, and ways to use health insurance. "Koreans don't buy health insurance" was a dominant social norm reported by most respondents. Findings indicate that social learning and normative influence occur inside social networks and these mechanisms seemingly prevent purchasing of health insurance. In addition to the individual mandate in the Patient Protection and Affordable Care Act, more targeted approaches that consider the structure and functions of social networks could improve the public health of Korean immigrants.

Promotora assisted depression and self-care management among predominantly Latinos with concurrent chronic illness: Safety net care system clinical trial results.

The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score≥10) were enrolled, randomized to AHH (n=178) or UC (n=170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors. Comprehensive assessments were repeated at 6 and 12months by an independent interviewer blind to the study group. Patients (85% diabetes, 4% heart disease, 11% both) were predominantly female (85%), Latino (99%), born outside of the US (91%). Study attrition at 12months was 30% (AHH 31%, UC 28%, P=0.51). No baseline characteristics were associated with attrition. Half of AHH patients received 4 or more sessions. Intend-to-treat analysis found study groups did not vary significantly at 6 and 12months. Before-after paired t-tests showed significant improvements in most measures in each group. During the trial, LAC-DHS activated healthcare improvements including depression screening, referral to clinic staff including community health workers (with the same role as the promotoras) to improve patient care management. Both patient groups performed equally well which may be a function of the enhanced healthcare model. Future research should replicate the promotora-integrated care model with other groups and care settings with similar comorbid conditions.

Self-care behavior change and depression among low-income predominantly Hispanic patients in safety-net clinics.

This study examined whether changes in self-care behaviors during a 12-month period predicted the likelihood of screening positive for depression concurrently and prospectively among low-income Hispanic patients with diabetes. Secondary analyses were conducted with longitudinal data collected from a randomized controlled trial that had tested effectiveness of collaborative depression care. We examined whether changes in self-care behaviors observed during the 12 months after baseline predicted the likelihood of screening positive for depression at 12-, 18-, and 24-month follow-up. Self-care behaviors included healthy diet, exercise, self-blood glucose monitoring, and foot care, which were measured by a validated self-reported instrument. Logistic regression analyses indicated that patients with more frequent healthy diet during the 12 months after baseline had significantly lower likelihood of depression. Patients with more frequent exercise had a lower likelihood of screening for depression at 18- and 24-month follow-up. No significant association was found with self-blood glucose monitoring and foot care. These findings suggest the importance of integrated care that emphasizes healthy diet and exercise, together with traditional depression treatment, when helping low-income Hispanic patients with diabetes and comorbid depression.

Depression remission, receipt of problem-solving therapy, and self-care behavior frequency among low-income, predominantly Hispanic diabetes patients.

OBJECTIVE: This study explored whether depression remission and problem-solving therapy (PST) receipt are associated with more frequent self-care behaviors via cross-sectional and prospective analyses. METHOD: We analyzed data from a randomized clinical trial (N=387) that tested collaborative depression care among predominantly Hispanic patients with diabetes in safety-net clinics. Data at 12-month follow-up, measured with the Patient Health Questionnaire-9 and Hopkins Symptom Checklist-20, were used to define depression remission. PST was provided by a bilingual social worker. Multivariate regression analysis was used to examine associations between predictors and frequency change of each self-care behavior (healthy diet, exercise, self-blood glucose monitoring, and foot care between baseline and 12-month (N=281), 18-month (N=249), and 24-month (N=235) follow-up surveys. RESULTS: Inconsistent relationships were observed depending on the instrument to identify depression remission, type of self-care behaviors, and time when self-care behavior was measured. Significant associations were more likely to be observed in cross-sectional analyses. PST receipt was not associated with self-care behaviors. CONCLUSIONS: Depression remission or the receipt of PST may not be a reliable antecedent for more frequent self-care behaviors among this group. A few recommendations for studies were offered to enhance existing depression care for diabetes patients.

Promotora assisted depression care among predominately Hispanic patients with concurrent chronic illness: Public care system clinical trial design.

Depression frequently negatively affects patient overall self-care and social stress management within United States safety net care systems. Rates of major depression are significantly high among low-income predominantly Hispanic/Latino with chronic illness, such as diabetes and heart disease. The study design of the A Helping Hand to Activate Patient-Centered Depression Care among Low-income Patients (AHH) randomized clinical trial aims to enhance patient depression care receipt and overall bio-psychosocial self-care management. The AHH trial is conducted in collaboration with three Los Angeles County Department of Health Services (DHS) safety net clinics that provide Patient-Centered Medical Home (PCMH) care. The study compares AHH intervention (AHH) in which community-based bilingual promotoras provide in-person or telephone patient engagement and intervention aimed to reduce the burden and strain on patients, families, and care providers by assessing, enhancing, and facilitating patient depression and co-morbid illness self-care management skill, and activating patient communication with clinic medical providers versus DHS PCMH team usual care (PCMHUC). AHH independent bilingual recruiters screened 1957 and enrolled 348 predominantly Hispanic/Latino patients, of whom 296 (85%) had diabetes, 14 (4%) with heart disease, and 38 (11%) with both diseases. Recruiters identified depressed patients by baseline Patient Health Questionnaire-9 scores of 10 or more, completed baseline assessments, and randomized patients to either AHH or PCMHUC study group. The comprehensive assessments will be repeated at 6 and 12months by an independent bilingual follow-up interviewer. Baseline and outcome data include mental health assessment and treatment receipt, co-morbid illness self-care, social relationships, and environmental stressor assessments.