Correlates of Complementary and Alternative Medicine Utilization in Depressed, Underserved African American and Hispanic Patients in Primary Care Settings

Abstract

Objectives: This study seeks to examine the correlates of complementary and alternative medicine (CAM) use in depressed underserved minority populations receiving medical care in primary care settings.Methods: A prospective study using interviewer-administered surveys and medical record reviews was conducted at 2 large outpatient primary care clinics providing care primarily to underserved African American and Hispanic individuals located in Los Angeles, California. A total of 2321 patients were screened for depression. Of these, 315 met the Patient Health Questionnaire-9 criteria for mild to severe depression.Results: Over 57% of the sample reported using CAM sometimes or often (24%) and frequently (33%) for treatment of their depressive symptoms. Controlling for demographic characteristics, lack of health care coverage remained one of the strongest predictors of CAM use. Additionally, being moderately depressed, using psychotherapeutic prescription medications, and poorer self-reported health status were all associated with increased frequency of CAM utilization for treating depression.Conclusions: The underserved African American and Hispanic individuals meeting the diagnostic criteria for depression or subsyndromal depression use CAM extensively for symptoms of depression. CAM is used as a substitute for conventional care when access to care is not available or limited. Since CAM is used so extensively for depression, understanding domains, types, and correlates of such use is imperative. This knowledge could be used to design interventions aimed at improving care for depression. 537

A Comparative Study of Complementary and Alternative Medicine Use Among Heterosexually and Lesbian Identified Women: Data from the ESTHER Project (Pittsburgh, PA, 2003–2006)

“…16 Aside from sexual orientation, the current multivariate results concurred with previous findings in that CAM use was associated with: white race 27,[33][34] ; increasing years of education 5,27,35 ; residence in a large city 5 ; perceived experience of discrimination in a health care setting 16 ; and having been previously diagnosed with a mental health condition. [36][37] Being very spiritual was also associated with CAM use, which was similar to other studies that found CAM use was associated with religiosity, 38 prayer for health-related reasons, 5,25,39 and spirituality. 25 The current multivariate results also showed that those who had providers of usual health care, compared to those who did not, had greater odds of CAM use within the past 12 months.…”

Mind–Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review

“…1,2,6,8,42,43 Despite lower rates of overall CHA use among racial/ethnic minorities, substantial proportions of racial/ethnic minorities use CHAs as health treatments. [44][45][46][47] Among CHA users, racial/ethnic minorities report higher rates of use of prayer, healers, and natural/ herbal remedies as treatments for depression, anxiety, and other chronic health conditions. 45,48,49 Barner et al (2010) 44 found that 69% of African-Americans in the general population used CHAs (including prayer) in the last 12 months.…”

“…[44][45][46][47] Among CHA users, racial/ethnic minorities report higher rates of use of prayer, healers, and natural/ herbal remedies as treatments for depression, anxiety, and other chronic health conditions. 45,48,49 Barner et al (2010) 44 found that 69% of African-Americans in the general population used CHAs (including prayer) in the last 12 months. Herbals, relaxation, and yoga were the CHAs most commonly used to treat health conditions.…”

“…African-Americans with higher levels of education and income were more likely to use CHAs; those with increased depression, anxiety, and more physician visits were also more likely to use CHAs. 44 Bazargan et al (2008) 45 found that among underserved depressed African-American and Hispanic individuals in primary care, 24%-33% reported using CHAs to treat depression. Of those that used CHAs, the majority (58%) used biologically based practices, followed by 47% who used mind-body approaches.…”

“…Patients who did not have health insurance, had moderate depression, used psychiatric medication, and had poorer self-reported health status were more likely to use CHAs. 45 Among African-American and Hispanic individuals in urban public housing, Bazargan et al (2005) found that prayer, over-the-counter medicine, and traditional remedies were the most often used CHAs to prevent or treat illness. Individuals with greater financial strain and poorer health status were more likely to use CHAs to treat an illness.…”