Mental Health Screening Differences in Non-English Speaking Patients: Results From a Retrospective Cohort Study

Abstract

Purpose: To assess differences in mental health screening based on patient’s preferred language. Methods: For this retrospective cohort study, data for 85 725 unique patients from 10 primary care clinics in West Michigan were analyzed if patients received at least 1 mental health screening with the Patient Health Questionnaire 4 (PHQ-4) within a 12-month period (10/15/2021-10/14/2022). A general linear regression model was used to assess the adjusted odds ratios (aOR) of being screened. Results: Patients having a preferred language other than English (n = 2755) had an 87.0% chance of receiving the recommended mental health screening, compared to 76.7% of English-speaking patients ( P < .001). A multivariable model revealed decreased screening odds for Kinyarwanda (aOR 0.29, 95% CI 0.19-0.45) and Persian/Dari/Pashto (aOR 0.46, 95% CI 0.23-0.91) speaking patients and higher screening odds for Spanish (aOR 1.45, 95% CI 1.19-1.77), Bosnian (aOR 2.13, 95% CI 1.11-4.11), and Vietnamese (aOR 2.25 95% CI 1.64-3.08) speaking patients compared to English speaking patients. Conclusions: Results highlight the inequities between the language groups that are probably the result of the challenges to access multilingual depression and anxiety screening instruments. Furthermore, providers may be prone to bias about who they think “needs” a mental health screening. We suggest that measures are implemented to ensure consistency in mental health screening regardless of a patients’ preferred language.

Association between sociodemographic factors, clinic characteristics and mental health screening rates in primary care

“…While this may reflect increased efforts of diversity equity and inclusion initiatives to address mental health disparities in minority populations, other researchers highlighted that implicit bias is a possible explanation that Black people have higher rates of being diagnosed with certain mental diagnoses [ 42 ]. Other studies also highlighted lower screening rates among some limited English language proficiency patient groups [ 16 , 43 ].…”

Translation, cultural adaption, and validation of the PHQ-9 and GAD-7 in Kinyarwanda for primary care in the United States

“…Studies validating psychometric instruments in a primary care situation for migrants and refugees are limited, especially for smaller language communities. The lack of availability of these instruments, however, is a key factor in insufficient mental health screening among refugee and migrant populations that are particularly affected by the trauma of relocation and mental health problems [30]. This work aimed to translate and culturally adapt the commonly used mental health screening instruments PHQ-9 and GAD-7 into the Kinyarwanda language and conduct a validation study by determining internal consistency, factorial structure, and discriminant validity in a cross-sectional sample of migrant and refugee patients seeking care in primary care clinics in the Midwest.…”