OBJECTIVES:To identify attitudes that influence patient help-seeking behavior and aspects of treatment that influence patient preferences for management of depression. DESIGN:Three focus group discussions (two patient groups stratified by race and one professional group). Questions addressed experience with depression, help-seeking behaviors, treatment preferences, and perceived barriers to mental health care. SETTING: Academic medical center. PATIENTS/PARTICIPANTS:Eight black patients and eight white patients with depression; seven health care professionals (four physicians and three social workers). MEASUREMENTS AND MAIN RESULTS:Discussions were audiotaped, transcribed, and reviewed independently by two investigators to identify and group distinct comments into categories with specific themes. Differences were adjudicated by a third investigator. Comments within categories were then checked for relevance and consistency by a health services researcher and a psychiatrist. More than 90% of the 806 comments could be grouped into one of 16 categories. Black patients raised more concerns than white patients regarding spirituality and stigma. Patients made more comments than professionals regarding the impact of spirituality, social support systems, coping strategies, life experiences, patientprovider relationships, and attributes of specific treatments. They discussed the role these factors played in their helpseeking behavior and adherence to treatment. epression is one of the most common major mental disorders, affecting approximately 5% of the general population, mostly young adults and women, in any one year. 1 Depressive disorders have a substantial effect on the individual, the family, and society and are associated with more functional disability than most chronic medical illnesses. 2,3 Individuals with depression utilize health care services in the general medical and mental health sector three times as often as nondepressed controls, even after controlling for medical comorbidity. 4 The majority of individuals with depression in the United States who seek care receive all or part of their CONCLUSIONS:

Cultural competence training shows promise as a strategy for improving the knowledge, attitudes, and skills of health professionals. However, evidence that it improves patient adherence to therapy, health outcomes, and equity of services across racial and ethnic groups is lacking. Future research should focus on these outcomes and should determine which teaching methods and content are most effective.

No abstract

No abstract