Problem-solving Treatment for Depression among Mexican Americans in Primary Care

Abstract

The need to identify and improve access to evidence-based treatments for depressive disorders and other mental health problems is a public health priority, particularly in relation to racial/ethnic minorities and other underserved groups. One hundred forty-six Mexican American primary care patients who met diagnostic criteria for major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified (NOS) were offered eight sessions of an evidence-based behavioral treatment, problem-solving treatment for primary care (PST-PC). Among participants who agreed to treatment (N=117), depressive symptom scores decreased over time; a minority of participants completed four or more sessions of PST-PC (N=55), and those participants had greater decreases in depressive symptom severity than participants who completed three or fewer PST-PC sessions (N=62) (Hopkins Symptom Checklist-20 scores declined on average 0.86+/-0.97 and 0.40+/-0.66 points for these groups, respectively, p<.05). More work is needed to enhance the engagement in treatments for depression, especially among Latinos in primary care.

Efficacy of depression treatments for immigrant patients: results from a systematic review

“…Of the 15 studies, nine were quantitative [51-54,56,57,60,63,64], five employed mixed methods [50,55,58,59,62] and one case study presented qualitative data [61]. Nine studies reported on culturally sensitive/culturally adapted psychological treatments (Table 1).…”

“…The major ethnic groups represented in the studies were Latino immigrants living in the United States (US) (53.3%) [51,54-58,60,62] followed by Chinese-American immigrants (33.3%) [50,61,63,64]. The remaining studies focused on Chinese-Australians (7.1%) [53], Korean-Americans (6.7%) [52] and Turkish immigrants living in Austria (6.7%) [59].…”

“…It was difficult to ascertain the representativeness of the setting and samples in relation to target populations as most studies recruited participants through various health and community organizations and hence only individuals already engaged with health or community services were included [50,55,57,58,60]. …”

“…Schmaling et al [60] likewise reported significant improvement in depression scores in Mexican Americans as a result of time-limited Problem Solving Therapy for Primary Care (PST-PC), delivered by bilingual therapists, in a dose-dependent manner; four or more PST-PC sessions resulted in greater reduction in Hopkins Symptom Checklist-20 (HSCL-20) scores relative to three or less PST-PC sessions ( t (85) = -2.54, p  = .05). Interestingly, while the treatment resulted in improvement in depression symptoms, it was not culturally adapted but rather provided as a generic intervention applicable to all cultural groups.…”

“…Interestingly, while the treatment resulted in improvement in depression symptoms, it was not culturally adapted but rather provided as a generic intervention applicable to all cultural groups. Although a reasonable sample size was obtained, the lack of control group and attrition are limitations [60]. …”