Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Trials
Published in: Trials 1/2017

Open Access 01-12-2017 | Study protocol

Measurement, Education and Tracking in Integrated Care (METRIC): use of a culturally adapted education tool versus standard education to increase engagement in depression treatment among Hispanic patients: study protocol for a randomized control trial

Authors: Katherine Sanchez, Brittany H. Eghaneyan, Michael O. Killian, Leopoldo Cabassa, Madhukar H. Trivedi

Published in: Trials | Issue 1/2017

Login to get access

Abstract

Background

Significant mental health disparities exist for Hispanic populations, especially with regard to depression treatment. Stigma and poor communication between patients and their providers result in low use of antidepressant medications and early treatment withdrawal. Cultural factors which influence treatment decisions among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with co-morbid physical health conditions. Hispanics, in particular, are more likely to receive mental healthcare in primary care settings. Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for depression only if systems are in place to ensure adequate treatment and follow-up.

Methods

We are conducting a randomized controlled trial among 150 depressed adult Hispanics in a primary care safety net setting, testing the effectiveness of a culturally appropriate depression education intervention to reduce stigma and increase uptake in depression treatment among Hispanics, and implement a Measurement-Based Integrated Care (MBIC) model with collaborative, multidisciplinary treatment and culturally tailored care management strategies.

Discussion

This study protocol represents the first randomized control trial of the culturally adapted depression education fotonovela, Secret Feelings, among Hispanics in a primary care setting. The education intervention will be implemented after diagnosis using an innovative screening technology and enrolled in measurement-based integrated care for the treatment of depression, which will help build the evidence around cultural adaptations in treatment to reduce mental health disparities.

Trial registration

ClinicalTrials.gov, NCT02702596. Registered on 20 March 2016.
Appendix
Available only for authorised users
Literature
1.
Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, et al. Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22:391–5.CrossRefPubMedPubMedCentral
2.
3.
Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys. Epidemiol Psichiatr Soc. 2009;18(1):23–33.CrossRefPubMedPubMedCentral
4.
Unutzer J, Schoenbaum M, Druss BG, Katon WJ. Transforming Mental Health care at the interface with general medicine: Report for the President’s Commission. Psychiatr Serv. 2006;57(1):37–47.CrossRefPubMed
5.
Ell K, Katon W, Cabassa LJ, Xie B, Lee PJ, Kapetanovic S, et al. Depression and diabetes among low-income Hispanics: Design elements of a socio-culturally adapted collaborative care model randomized controlled trial. Int J Psychiatry Med. 2009;39(2):113–32.CrossRefPubMedPubMedCentral
6.
Kravitz RL, Ford DE. Introduction: chronic medical conditions and depression - the view from primary care. Am J Med. 2008;121(11):1–7.CrossRef
7.
Wassertheil-Smoller S, Arredondo EM, Cai JW, Castaneda SF, Choca JP, Gallo LC, et al. Depression, anxiety, antidepressant use, and cardiovascular disease among Hispanic men and women of different national backgrounds: results from the Hispanic Community Health Study/Study of Latinos. Ann Epidemiol. 2014;24(11):822–30.CrossRefPubMedPubMedCentral
8.
Li CY, Mokdad AH, Ford ES, Strine TW. Prevalence of depression among US adults with diabetes - Findings from the 2006 behavioral risk factor surveillance system. Diabetes Care. 2008;31(1):105–7.CrossRefPubMed
9.
Interian A, Ang A, Gara MA, Rodriguez MA, Vega WA. The long-term trajectory of depression among Latinos in primary care and its relationship to depression care disparities. Gen Hosp Psychiatry. 2011;33(2):94–101.CrossRefPubMedPubMedCentral
10.
Gonzalez HM, Tarraf W, Whitfield KE, Vega WA. The epidemiology of major depression and ethnicity in the United States. J Psychiatr Res. 2010;44(15):1043–51.CrossRefPubMedPubMedCentral
11.
Cabassa LJ, Hansen MC, Palinkas LA, Ell K. Azucar y nervios: Explanatory models and treatment experiences of Hispanics with diabetes and depression. Soc Sci Med. 2008;66(12):2413–24.CrossRefPubMedPubMedCentral
12.
Ell K, Xie B, Kapetanovic S, Quinn DI, Lee PJ, Wells A, et al. One-year follow-up of collaborative depression care for low-income, predominantly Hispanic patients with cancer. Psychiatr Serv. 2011;62(2):162–70.CrossRefPubMed
13.
Vega WA, Rodriguez MA, Ang A. Addressing stigma of depression in Latino primary care patients. Gen Hosp Psychiatry. 2010;32(2):182–91.CrossRefPubMed
14.
Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured - Findings from a national sample. Med Care. 2002;40(1):52–9.CrossRefPubMed
15.
Weinick RM, Jacobs EA, Stone LC, Ortega AN, Burstin H. Hispanic healthcare disparities - Challenging the myth of a monolithic Hispanic population. Med Care. 2004;42(4):313–20.CrossRefPubMed
16.
Bauer AM, Chen C-N, Alegría M. English language proficiency and mental health service use among Latino and Asian Americans with mental disorders. Med Care. 2010;48(12):1097–104.CrossRefPubMedPubMedCentral
17.
18.
Thielke S, Vannoy S, Unutzer J. Integrating mental health and primary care. Prim Care. 2007;34(3):571.CrossRefPubMed
19.
Bao YH, Alexopoulos GS, Casalino LP, Ten Have TR, Donohue JM, Post EP, et al. Collaborative depression care management and disparities in depression treatment and outcomes. Arch Gen Psychiatry. 2011;68(6):627–36.CrossRefPubMedPubMedCentral
20.
Eghaneyan BH, Sanchez K, Killian M. Integrated health care for decreasing depressive symptoms in Latina women: Initial findings. J Lat Psychol. 2017;5(2):118–25.CrossRef
21.
Holden K, McGregor B, Thandi P, Fresh E, Sheats K, Belton A, et al. Toward culturally centered integrative care for addressing mental health disparities among ethnic minorities. Psychol Serv. 2014;11(4):357–68.CrossRefPubMedPubMedCentral
22.
Sanchez K, Chapa T, Ybarra R, Martinez ON. Eliminating health disparities through culturally and linguistically centered integrated health care: consensus statements, recommendations, and key strategies from the field. J Health Care Poor Underserved. 2014;25(2):469–77.CrossRefPubMed
23.
Simmons LA, Wolever RQ, Bechard EM, Snyderman R. Patient engagement as a risk factor in personalized health care: a systematic review of the literature on chronic disease. Genome Med. 2014;6:13.CrossRef
24.
Siantz E, Aranda MP. Chronic disease self-management interventions for adults with serious mental illness: a systematic review of the literature. Gen Hosp Psychiatry. 2014;36(3):233–44.CrossRefPubMed
25.
Institute of Medicine. Health literacy: A prescription to end confusion. Washington: National Academies Press; 2004.
26.
27.
Cabassa LJ, Molina GB, Baron M. Depression fotonovela: development of a depression literacy tool for Latinos with limited English proficiency. Health Promot Pract. 2012;13(6):747–54.CrossRefPubMed
28.
Valle R, Yamada AM, Matiella AC. Fotonovelas: A health literacy tool for educating Latino older adults about dementia. Clin Gerontol. 2006;30(1):71–88.CrossRef
29.
Hinojosa MS, Nelson D, Hinojosa R, Delgado A, Witzack B, Gonzalez M, et al. Using fotonovelas to promote healthy eating in a Latino community. Am J Public Health. 2011;101(2):258.CrossRefPubMedPubMedCentral
30.
Cabassa LJ. Depression fotonovela: integrating cultural factors and entertainment-education to improve depression literacy in the Latino community. In: Schwartz SJ, Unger J, editors. The Oxford Handbook of Acculturation and Health. Oxford: Oxford University Press; 2016.
31.
32.
Unger JB, Cabassa LJ, Molina GB, Contreras S, Baron M. Evaluation of a fotonovela to increase depression knowledge and reduce stigma among Hispanic adults. J Immigr Minor Health. 2013;15(2):398–406.CrossRefPubMedPubMedCentral
33.
Hernandez MY, Organista KC. Entertainment–Education? A fotonovela? A new strategy to improve depression literacy and help-seeking behaviors in at-risk immigrant Latinas. Am J Community Psychol. 2013;52:224–35.CrossRefPubMed
34.
35.
Unutzer J, Katon W, Callahan CM, Williams JW, Hunkeler E, Harpole L, et al. Collaborative care management of late-life depression in the primary care setting - A randomized controlled trial. JAMA. 2002;288(22):2836–45.CrossRefPubMed
36.
Trivedi MH, Fava M, Marangell LB, Osser DN, Shelton RC. Use of treatment algorithms for depression. J Clin Psychiatry. 2006;67(9):1458–65.CrossRefPubMed
37.
MynorsWallis L. Problem-solving treatment: Evidence for effectiveness and feasibility in primary care. Int J Psychiatr Med. 1996;26(3):249–62.CrossRef
38.
Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006;74(4):658–70.CrossRefPubMed
39.
Kroenke K, Spitzer RL. The PHQ-9: A new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):509–15.CrossRef
40.
Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder - The GAD-7. Arch Intern Med. 2006;166(10):1092–7.CrossRefPubMed
41.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV. 4th ed. Washington: American Psychiatric Association; 1994.
42.
43.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMed
44.
Kroenke K, Spitzer RL, Williams JB. A new measure of depression severity: The PHQ-9. J Gen Intern Med. 2000;15:78.
45.
Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the patient health questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006;21(6):547–52.CrossRefPubMedPubMedCentral
46.
Trivedi MH. Tools and strategies for ongoing assessment of depression: a measurement-based approach to remission. J Clin Psychiatry. 2009;70:26–31.CrossRefPubMed
47.
Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression - Randomised controlled trial. Br J Psychiatry. 2004;185:342–9.CrossRefPubMed
48.
Griffiths KM, Bennett K, Walker J, Goldsmid S, Bennett A. Effectiveness of MH-Guru, a brief online mental health program for the workplace: A randomised controlled trial. Internet Interv. 2016;6:29–39.CrossRef
49.
Kiropoulos LA, Griffiths KM, Blashki G. Effects of a multilingual information website intervention on the levels of depression literacy and depression-related stigma in Greek-born and Italian-born immigrants living in Australia: a randomized controlled trial. J Med Internet Res. 2011;13(2):e34.CrossRefPubMedPubMedCentral
50.
Interian A, Ang A, Gara MA, Link BG, Rodriguez MA, Vega WA. Stigma and depression treatment utilization among Latinos: utility of four stigma measures. Psychiatr Serv. 2010;61(4):373–9.CrossRefPubMedPubMedCentral
51.
Nadeem E, Lange JM, Edge D, Fongwa M, Belin T, Miranda J. Does stigma keep poor young immigrant and US-born black and Latina women from seeking mental health care? Psychiatr Serv. 2007;58(12):1547–54.CrossRefPubMed
52.
Sussman LK, Robins LN, Earls F. Treatment-seeking for depression by black-and-white Americans. Soc Sci Med. 1987;24(3):187–96.CrossRefPubMed
53.
Corrigan PW, Green A, Lundin R, Kubiak MA, Penn DL. Familiarity with and social distance from people who have serious mental illness. Psychiatr Serv. 2001;52(7):953–8.CrossRefPubMed
54.
Link BG, Cullen FT, Frank J, Wozniak JF. The social rejection of former mental patients: understanding why labels matter. Am J Sociol. 1987;92(6):1461–500.CrossRef
55.
Link BG, Yang LH, Phelan JC, Collins PY. Measuring mental illness stigma. Schizophr Bull. 2004;30(3):511–41.CrossRefPubMed
56.
Gonzalez JM, Perlick DK, Mildowitz DJ, Kaczynski R, Hernandez M, Rosenheck RA, et al. Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study. Psychiatr Serv. 2007;58(1):41–8.CrossRefPubMed
57.
LaRocco-Cockburn A, Reed SD, Melville J, Croicu C, Russo JE, Inspektor M, et al. Improving depression treatment for women: integrating a collaborative care depression intervention into OB-GYN care. Contemp Clin Trials. 2013;36(2):362–70.CrossRefPubMedPubMedCentral
58.
Gunn J, Diggens J, Hegarty K, Blashki G. A systematic review of complex system interventions designed to increase recovery from depression in primary care. BMC Health Serv Res. 2006;6:11.CrossRef
59.
60.
HRSA Health Disparities Collaboratives: Depression Collaborative. Depression: percent of clinically significant depression patients with a 50 percent or greater reduction in Patient Health Questionnaire (PHQ). Rockville: Department of Health and Human Services; 2005.
61.
Siu AL, U.S. Preventive Services Task Force (USPSTF). Screening for depression in adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(4):380–7.CrossRefPubMed
Metadata
Title
Measurement, Education and Tracking in Integrated Care (METRIC): use of a culturally adapted education tool versus standard education to increase engagement in depression treatment among Hispanic patients: study protocol for a randomized control trial
Authors
Katherine Sanchez
Brittany H. Eghaneyan
Michael O. Killian
Leopoldo Cabassa
Madhukar H. Trivedi
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Trials / Issue 1/2017
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-017-2109-y

Other articles of this Issue 1/2017

Trials 1/2017 Go to the issue

Study protocol

A pragmatic randomised controlled trial assessing the non-inferiority of counselling for depression versus cognitive-behaviour therapy for patients in primary care meeting a diagnosis of moderate or severe depression (PRaCTICED): Study protocol for a randomised controlled trial

Update

Statistical analysis plan for the EuroHYP-1 trial: European multicentre, randomised, phase III clinical trial of the therapeutic hypothermia plus best medical treatment versus best medical treatment alone for acute ischaemic stroke

Study protocol

A fixed inhaled nitrous oxide/oxygen mixture as an analgesic for adult cancer patients with breakthrough pain: study protocol for a randomized controlled trial

Study protocol

Topical application of Jaungo in atopic dermatitis patients: study protocol for a randomized, controlled trial

Erratum

Erratum to: Effectiveness of pharmaceutical care for drug treatment adherence in patients with systemic lupus erythematosus in Rio de Janeiro, Brazil: study protocol for a randomized controlled trial

Study protocol

Maintenance tegafur-uracil versus observation following an adjuvant oxaliplatin-based regimen in patients with stage III colon cancer after radical resection: study protocol for a randomized controlled trial