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Yang KG, Blackmore MA, Cook BL, Chung H. Collaborative Care for Depression and Anxiety: Racial-Ethnic Differences in Treatment Engagement and Outcomes. Psychiatr Serv 2024:appips20230482. [PMID: 38693836 DOI: 10.1176/appi.ps.20230482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE This study aimed to examine racial-ethnic differences in engagement with and clinical outcomes of a collaborative care model (CoCM) implemented in primary care outpatient clinics in an urban academic medical center. METHODS Adult patients (N=4,911) who screened positive for symptoms of depression, anxiety, or both on the Patient Health Questionnaire-9 or the Generalized Anxiety Disorder-7 scale and who identified as non-Hispanic Black, Hispanic, or non-Hispanic White were offered participation in a CoCM implementation. The primary outcome was treatment engagement, defined as receipt of any follow-up visit, minimally adequate 4-week follow-up (at least one visit), and minimally adequate 16-week follow-up (at least three visits) after initial assessment. Secondary outcomes were response and remission of depression or anxiety. RESULTS After adjustment of analyses for sociodemographic covariates, Black and Hispanic participants were significantly less likely than White participants to have received any or minimally adequate follow-up. Black and Hispanic participants who received any or minimally adequate 16-week follow-up were more likely than White participants to demonstrate depression symptom response and remission of anxiety symptoms. CONCLUSIONS This CoCM implementation appears to have been effective in treating depression and anxiety among Black and Hispanic patients. However, significant disparities in receipt of follow-up care were observed. Efforts must be made to improve the retention of patients from racial-ethnic minority groups in collaborative care.
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Affiliation(s)
- Kelly Guanhua Yang
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
| | - Michelle A Blackmore
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
| | - Benjamin Lê Cook
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
| | - Henry Chung
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
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Borrayo EA, Juarez-Colunga E, Kilbourn K, Waxmonsky J, Jacobson M, Okuyama S, Swaney R, Wamboldt FS, Karam S, Lopez Alvarez S, Jin X, Nguyen J. Stepped-care to improve mental health outcomes among underserved patients with lung and head and neck cancer. Psychooncology 2023; 32:1718-1726. [PMID: 37772984 DOI: 10.1002/pon.6223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The comparative effectiveness study (ClinicalTrials.gov, NCT03016403) assessed the effects of a stepped-care intervention versus usual care on mental health outcomes, including anxiety, depression, coping self-efficacy, emotional distress (anxiety and depression combined), health-related quality of life (HRQoL), and perceived stress among underserved patients (i.e., low-income, uninsured, underinsured) with lung cancer (LC) and head-and-neck cancer (HNC). METHODS In a randomized controlled trial, we investigated if 147 patients who received the stepped-care intervention had better mental health outcomes compared to 139 patients who received usual care. Using an intent-to-treat approach, we analyzed outcomes with linear mixed models. RESULTS For the primary outcomes estimated mean differences (denoted by "Δ"), depression (Δ = 1.75, 95% CI = 0.52, 2.98, p = 0.01) and coping self-efficacy (Δ = -15.24, 95% CI = -26.12, -4.36, p = 0.01) were better for patients who received the intervention compared to patients who received usual care, but anxiety outcomes were not different. For secondary outcomes, emotional distress (Δ = 1.97, 95% CI: 0.68, 3.54, p =< 0.01) and HRQoL (Δ = -4.16 95% CI: -7.45, -0.87, p = 0.01) were better for patients who received the intervention compared to usual care patients, while perceived stress was not different across groups. CONCLUSIONS The stepped-care intervention influenced depression and coping self-efficacy, important outcomes for patients with acute illnesses like LC and HNC. Although differences in emotional distress met the minimally important differences (MID) previously reported, depression and HRQoL were not above the MID threshold. Our study is among a few to report differences in mental health outcomes for underserved LC and HNC patients after receiving a psychological intervention. CLINICALTRIALS GOV IDENTIFIER NCT03016403.
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Affiliation(s)
- Evelinn A Borrayo
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, Colorado, USA
- Latino Research and Policy Center, Colorado School of Public Health, Denver, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Kristin Kilbourn
- Department of Psychology, College of Liberal Arts and Sciences, Denver, Colorado, USA
| | - Jeanette Waxmonsky
- Department of Family Medicine, School of Medicine, Aurora, Colorado, USA
| | - Marty Jacobson
- Veterans Administration Medical Center, Grand Junction, Colorado, USA
| | - Sonia Okuyama
- Hematology-Oncology, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Robert Swaney
- Medical Oncology, Ascension St. Vincent Evansville Cancer Center, Newburgh, IN, USA
| | | | - Sana Karam
- Radiation Oncology, School of Medicine, Aurora, Colorado, USA
| | - Samantha Lopez Alvarez
- Latino Research and Policy Center, Colorado School of Public Health, Denver, Colorado, USA
| | - Xin Jin
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jennifer Nguyen
- Latino Research and Policy Center, Colorado School of Public Health, Denver, Colorado, USA
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Lui F, Lewicka M, Bao GC, Moyer A, Boyce L, Leng J. A systematic review and meta-analysis of psychosocial interventions for immigrant and limited English proficient cancer patients. Psychooncology 2023; 32:516-557. [PMID: 36792931 PMCID: PMC10410571 DOI: 10.1002/pon.6110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Immigrants, particularly those who are less acculturated and limited English proficient (LEP), often lack access to culturally and linguistically appropriate psychosocial care in cancer survivorship. We sought to determine what psychosocial interventions are available for immigrant and/or LEP cancer patients and to assess treatment and patient factors that may correlate with better psychosocial outcomes for this population. METHODS We conducted a systematic review and meta-analysis of studies published through August 2022 of interventions conducted with immigrant and/or LEP cancer patients aimed at improving psychosocial outcomes (i.e., quality of life, depression, cancer-related distress, and anxiety). Using Covidence, a software program for systematic review management, four independent raters screened 16,123 records with a systematic process for reconciling disagreement, yielding 48 articles (45 studies) for systematic review and 21 studies for meta-analysis. RESULTS Most studies were conducted with Spanish-speaking patients with breast cancer. Study participants (N = 5400) were primarily middle-aged (mean = 53 years old), female (90.0%), and Hispanic (67.0%). The weighted average effect size (g) across studies was 0.14 (95% CI 0.03-0.26) for quality of life (18 studies), 0.04 (95% CI -0.08 to 0.17) for depression (8 studies), 0.14 (95% CI -0.03 to 0.31) for cancer-related distress (6 studies), and 0.03 (95% CI -0.11 to 0.16) for anxiety (5 studies). CONCLUSION The interventions under review had small but beneficial effects on psychosocial outcomes for immigrant and LEP cancer patients. Notably, effect sizes were smaller than those found in previous meta-analyses of psychosocial interventions conducted in majority U.S.-born, non-Hispanic White, English-speaking cancer patient samples. More research is needed to identify key components and adaptations of interventions that benefit immigrant and LEP cancer patients to strengthen their effects for this growing yet underserved population.
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Affiliation(s)
- Florence Lui
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center; Department of Psychiatry, Weill Cornell Medical College
| | - Malwina Lewicka
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - George C. Bao
- Department of Medicine, Weill Cornell Medical College
| | - Anne Moyer
- Department of Psychology, Stony Brook University
| | - Lindsay Boyce
- Medical Library, Memorial Sloan Kettering Cancer Center
| | - Jennifer Leng
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center; Department of Healthcare Policy and Research, Weill Cornell Medical College
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4
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Kunz-Lomelin A, Killian M, Eghaneyan BH, Sanchez K. Antidepressant Adherence Among Hispanics: Patients in an Integrated Health Care Model. J Multidiscip Healthc 2022; 15:3029-3037. [PMID: 36605408 PMCID: PMC9809177 DOI: 10.2147/jmdh.s387218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose We report on antidepressant (AD) adherence among Hispanics seeking mental health services in a community primary care clinic in Texas as an ancillary outcome from a National Institutes of Health-funded study that collected data on Hispanic AD adherence over a period of two years (February 2016-February 2018). Adherence to AD medications was measured throughout the year-long trial and compared across various demographic characteristics. Since Hispanic individuals often experience stigma and cultural barriers related to AD treatment, we sought to understand what factors may increase the likelihood of non-adherence in this population. Patients and Methods This study focused on 69 patients who were prescribed AD medications while receiving treatment through an integrated health care model. Adherence was measured with the Patient Adherence Questionnaire, a validated 2-item questionnaire that asks patients about their medication use (missed medications or dosage changes) over the past week. We looked at patient adherence at two key time points (4-weeks and 13-weeks) and utilized logistic regression to identify factors that may increase or decrease the likelihood of adherence in Hispanic patients at a community primary care clinic. Results Non-adherence to AD medication was 49.3% at 4-weeks and 57% at 13-weeks post-treatment initiation. Logistic regression analyses revealed that age was the only significant predictor of AD non-adherence. As age increased, the likelihood of adherence increased by 12.2% at 13-weeks post-treatment initiation and by 11.1% at 4-weeks post-treatment initiation. Conclusion The likelihood of Hispanic patients to adhere to AD therapy increased with the age of the patient. Since primary care is the most likely place to be prescribed an AD for Hispanic patients, further research to better understand adherence is essential. Integrated health care interventions designed to help identify, reduce, or eliminate barriers to adherence and improve cultural understanding may help address issues of non-adherence in primary care settings.
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Affiliation(s)
- Alan Kunz-Lomelin
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA,Correspondence: Alan Kunz-Lomelin, 3825 Hunters Trail, Carrollton, TX, 75007, USA, Tel +1 (972) 358-0575, Email
| | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | | | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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Doose M, Verhoeven D, Sanchez JI, Livinski AA, Mollica M, Chollette V, Weaver SJ. Team-Based Care for Cancer Survivors With Comorbidities: A Systematic Review. J Healthc Qual 2022; 44:255-268. [PMID: 36036776 PMCID: PMC9429049 DOI: 10.1097/jhq.0000000000000354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coordination of quality care for the growing population of cancer survivors with comorbidities remains poorly understood, especially among health disparity populations who are more likely to have comorbidities at the time of cancer diagnosis. This systematic review synthesized the literature from 2000 to 2022 on team-based care for cancer survivors with comorbidities and assessed team-based care conceptualization, teamwork processes, and outcomes. Six databases were searched for original articles on adults with cancer and comorbidity, which defined care team composition and comparison group, and assessed clinical or teamwork processes or outcomes. We identified 1,821 articles of which 13 met the inclusion criteria. Most studies occurred during active cancer treatment and nine focused on depression management. Four studies focused on Hispanic or Black cancer survivors and one recruited rural residents. The conceptualization of team-based care varied across articles. Teamwork processes were not explicitly measured, but teamwork concepts such as communication and mental models were mentioned. Despite team-based care being a cornerstone of quality cancer care, studies that simultaneously assessed care delivery and outcomes for cancer and comorbidities were largely absent. Improving care coordination will be key to addressing disparities and promoting health equity for cancer survivors with comorbidities.
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Affiliation(s)
- Michelle Doose
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Dana Verhoeven
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Janeth I. Sanchez
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alicia A. Livinski
- National Institutes of Health Library, Office of Research Services, OD, National Institutes of Health, Bethesda, MD, USA
| | - Michelle Mollica
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Veronica Chollette
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Sallie J. Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Sanchez K, Eghaneyan BH, Killian MO, Cabassa LJ, Trivedi MH. Depression education fotonovela for engagement of Hispanic patients in treatment: a randomized clinical trial. BMC Psychiatry 2021; 21:635. [PMID: 34949169 PMCID: PMC8705454 DOI: 10.1186/s12888-021-03641-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/06/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We report the primary outcomes from a randomized clinical trial testing a novel culturally-adapted patient education intervention to increase engagement of Hispanic patients in depression treatment. The Depression Education Fotonovela (DEF), Secret Feelings, incorporates popular images, cultural norms, and vivid pictures embedded within a soap opera narrative to increase depression knowledge and dispel myths about treatment. We then assessed engagement in a integrated care treatment model in response to the education intervention and subsequent changes in depression symptoms in a large community-based clinic whose patient population is majority Hispanic. METHOD The sample included 150 adult Hispanic patients with a confirmed diagnosis of depression who were randomly assigned to either: [1] integrated care + fotonovela; or [2] integrated care + standard education. Differences between treatment groups were examined as were changes in depression, anxiety, depression knowledge, and stigma scores over time and engagement in treatment. RESULTS Results indicated that while depression scores significantly decreased over time for participants (F [2.811, 416.054] = 197.69, p < .001, η2 = .572), no differences between the two education groups were found (F [1, 148] = 0.70, p = .403, η2 = .005). At 12-month follow-up, 101 patients (80.8%) reported a 50% of greater reduction in depression scores from baseline. CONCLUSIONS We found little difference between the two education groups, suggesting that either may helpful for engaging Hispanic patients into care. Better tailoring of patient education, with the fotonovela or similarly adapted tools, will require more directly addressing the stigma associated with antidepressant medication. TRIAL REGISTRATION The study was registered with www.clinicaltrials.gov : NCT02702596 , on 03/20/2016. Retrospectively registered.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, Texas, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 6363 Forest Park Rd, Dallas, TX, 75235, USA.
| | - Brittany H. Eghaneyan
- grid.253559.d0000 0001 2292 8158Department of Social Work, California State University, Fullerton, USA
| | - Michael O. Killian
- grid.255986.50000 0004 0472 0419College of Social Work, Florida State University, 296 Champions Way, UCC 2500, Tallahassee, FL 32306 USA
| | - Leopoldo J. Cabassa
- grid.4367.60000 0001 2355 7002George Warren Brown School of Social Work, Washington University in St. Louis, Goldfarb Hall, Room 358, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
| | - Madhukar H. Trivedi
- grid.267313.20000 0000 9482 7121Department of Psychiatry, UT Southwestern Medical Center, 6363 Forest Park Rd, Dallas, TX 75235 USA
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Steel JL, Reyes V, Zandberg DP, Nilsen M, Terhorst L, Richards G, Pappu B, Kiefer G, Johnson J, Antoni M, Vodovotz Y, Spring M, Walker J, Geller DA. The next generation of collaborative care: The design of a novel web-based stepped collaborative care intervention delivered via telemedicine for people diagnosed with cancer. Contemp Clin Trials 2021; 105:106295. [PMID: 33556589 DOI: 10.1016/j.cct.2021.106295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The NIH consensus statement on cancer-related symptoms concluded the most common and debilitating were depression, pain and fatigue [1-6]. Although the comorbidity of these symptoms is well known and may have similar underlying biological mechanisms no intervention has been developed to reduce these symptoms concurrently. The novel web-based stepped collaborative care intervention delivered by telemedicine is the first to be tested in people diagnosed with cancer. METHODS We plan to test a web-based stepped collaborative care intervention with 450 cancer patients and 200 caregivers in the context of a randomized controlled trial. The primary endpoint is quality of life with other primary outcomes including patient-reported depression, pain, fatigue. Secondary outcomes include patient serum levels of pro-inflammatory cytokines and disease progression. We also will assess informal caregiver stress, depression, and metabolic abnormalities to determine if improvements in patients' symptoms also relate to improvement in caregiver outcomes. RESULTS The trial is ongoing and a total of 382 patients have been randomized. Preliminary analyses of the screening tools used for study entry suggest that Center for Epidemiological Studies-Depression (CESD) scale has good sensitivity and specificity (0.81 and 0.813) whereas the scale used to assess pain (0.47 and 0.91) and fatigue (0.11 and 0.91) had poor sensitivity but excellent specificity. Using the AUROC, the best cut point for the CES-D was 19, for pain was 4.5; and for fatigue was 2.5. Outcomes not originally proposed included health care utilization and healthcare charges. The first 100 patients who have been followed a year post-treatment, and who were less than 75 years and randomized to the web-based stepped collaborative care intervention, had lower rates of complications after surgery [χ2 = 5.45, p = 0.02]. For patients who survived 6 months or less and were randomized to the web-based stepped collaborative care intervention, had lower rates of 90-day readmissions when compared to patients randomized to the screening and referral arm [χ2 = 4.0, p = 0.046]. Patients randomized to the collaborative care intervention arm had lower overall health care activity-based costs of $16,758 per patient per year when compared to the screening and referral arm. DISCUSSION This novel web-based stepped stepped collaborative care intervention, delivered via telemedicine, is expected to provide a new strategy to improve the quality of life in those diagnosed with cancer and their caregivers. TRIAL REGISTRATION ClinicalTrials.govNCT02939755.
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Alananzeh I, Lord H, Fernandez R. Social Support for Arab People with Chronic Conditions: A Scoping Review. Clin Nurs Res 2020; 30:380-391. [PMID: 32501107 DOI: 10.1177/1054773820932262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Social support can play a crucial role in psycho-social well-being of people with chronic conditions. There is limited information about the experiences, barriers and sources of social support of Arab people affected by chronic conditions. The purpose of this review is to explore the experiences, barriers and sources of social support of Arab people affected by chronic conditions. A scoping review of the literature, based on Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines. Articles (n = 13) were identified for appraisal based on a group of inclusion and exclusion criteria. Eight articles were included in the final analysis. Three broad themes were identified: (a) Social support benefits-physical, emotional and financial benefits; (b) Source of social support-family and friends support, and (c) Support services utilization-cultural barrier, Arab migrants language and unfamiliarity with the health system barriers. Appropriate future support programs should be tailored based on Arab cultural beliefs and the inherent responsibility of the family together inside the Arab community.
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Affiliation(s)
| | - Heidi Lord
- Centre for Research in Nursing and Health St George Hospital, Kogarah, NSW, Australia.,Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Centre of Excellence, Wollongong, New South Wales, Australia
| | - Ritin Fernandez
- University of Wollongong, NSW, Australia.,Centre for Research in Nursing and Health St George Hospital, Kogarah, NSW, Australia.,Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Centre of Excellence, Wollongong, New South Wales, Australia
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Sanchez K, Killian MO, Eghaneyan BH, Cabassa LJ, Trivedi MH. Culturally adapted depression education and engagement in treatment among Hispanics in primary care: outcomes from a pilot feasibility study. BMC FAMILY PRACTICE 2019; 20:140. [PMID: 31638915 PMCID: PMC6802339 DOI: 10.1186/s12875-019-1031-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 09/25/2019] [Indexed: 01/23/2023]
Abstract
Background Low use of anti-depressant medication, poor doctor-patient communication, and persistent stigma are key barriers to the treatment of depression in Hispanics. Common concerns include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications and seeking mental health treatments. In 2014, the Center for Medicare and Medicaid Services (CMS) funded the Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO) project to implement an education intervention designed to increase disease literacy and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement. Methods The DESEO study utilized a one-group pretest-posttest design to assess the effects a culturally-adapted Depression Education Intervention’s (DEI) on depression knowledge, stigma, and engagement in treatment in a sample of 350 Hispanic primary care patients with depression. The DEI utilized a fotonovela, a health education tool available in English and Spanish that uses posed photographs, captions, and soap opera narratives to raise awareness about depression and depression treatments. Results Participants reported significant decreases in depression symptoms and reported stigma about mental health care. Additionally, participants reported increased knowledge of depression yet greater negative perceptions about antidepressant medication. Finally, 89.5% of participants reported entering some form of treatment at follow-up. Conclusions Culturally adapted depression education shows promise in increasing understanding of depression, decreasing stigma, and increasing treatment engagement among Hispanic patients in a community-based health center. Results have implications for practice in addressing common concerns about depression treatments which include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. Trial registration The study was retrospectively registered with www.clinicaltrials.gov: NCT02491034 July 2, 2015.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Michael O Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
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10
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Badger TA, Sikorskii A, Segrin C. Contextual and Cultural Influences on Caregivers of Hispanic Cancer Survivors. Semin Oncol Nurs 2019; 35:359-362. [DOI: 10.1016/j.soncn.2019.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Ruiz-Pérez I, Rodríguez-Gómez M, Pastor-Moreno G, Escribá-Agüir V, Petrova D. Effectiveness of interventions to improve cancer treatment and follow-up care in socially disadvantaged groups. Psychooncology 2019; 28:665-674. [PMID: 30695816 DOI: 10.1002/pon.5011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify and characterize the interventions that aimed to improve cancer treatment and follow-up care in socially disadvantaged groups. To summarize the state of the art for clinicians and researchers. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were randomized controlled trials and quasi-experimental studies with a control group (usual care or enhanced usual care) conducted in Organization for Economic Co-operation and Development (OECD) member countries and published until 2016. RESULTS Thirty-one interventions were identified, the majority of which were conducted in the United States in patients with breast cancer. Most interventions aimed to decrease social inequalities based on ethnicity/race and/or socioeconomic level, with fewer interventions targeting inequalities based on geographical area. The most frequently assessed outcomes were quality of life (n = 20) and psychosocial factors (n = 20), followed by treatment adherence or satisfaction (n = 12,), knowledge (n = 11), pain management (n = 10), and lifestyle habits (n = 3). CONCLUSIONS The impact of interventions designed to improve cancer treatment and follow-up care in socially disadvantages groups is multifactorial. Multicomponent-intervention approaches and cultural adaptations are common, and their effectiveness should be evaluated in the populations of interest. More interventions are needed from outside the Unite States and in patients with cancers other than breast cancer, targeting gender or geographical inequalities and addressing key outcomes such as treatment adherence or symptom management.
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Affiliation(s)
- Isabel Ruiz-Pérez
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain.,Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
| | | | - Guadalupe Pastor-Moreno
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain
| | - Vicenta Escribá-Agüir
- Department of Nursing, University of Valencia, Valencia, Spain.,Fundación para el fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Dafina Petrova
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain.,Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
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12
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Acceptability of the Stepped Care Model of Depression Treatment in Primary Care Patients and Providers. J Clin Psychol Med Settings 2019; 26:402-410. [DOI: 10.1007/s10880-019-09599-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Warmoth K, Yeung NCY, Xie J, Feng H, Loh A, Young L, Lu Q. Benefits of a Psychosocial Intervention on Positive Affect and Posttraumatic Growth for Chinese American Breast Cancer Survivors: A Pilot Study. Behav Med 2019; 46:34-42. [PMID: 30657442 PMCID: PMC6639149 DOI: 10.1080/08964289.2018.1541862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Breast cancer survivors report persistent psychological and physical symptoms, which affect their quality of life and may challenge the recovery process. Due to social, cultural, and linguistic barriers, culturally sensitive care is largely unavailable for Chinese Americans, and their psychological needs are not often addressed. We aimed to investigate whether the Joy Luck Academy (JLA), a psychosocial intervention providing both information and peer support, was associated with positive adjustment among Chinese American breast cancer survivors. Thirty-nine Chinese American breast cancer survivors participated in a pilot psychosocial intervention. The educational materials and lectures were delivered in the participants' native language of Chinese. All of the educators and mentors shared the same linguistic and cultural background with the participants. The program utilized a community-based participatory research (CBPR) approach to further enhance the cultural sensitivity of the intervention. Participants' post-traumatic growth and positive affect were assessed before and after the intervention. The JLA showed an improvement in positive affect, and they had a greater appreciation for life. The intervention was found to be feasible, well-accepted, and beneficial for this population. Chinese American breast cancer survivors reported improved psychological health after attending the intervention. These findings encourage the development and implementation of psychosocial interventions for Chinese breast cancer survivors. Similar programs could be integrated into other ethnic or cultural communities.
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Affiliation(s)
- Krystal Warmoth
- University of Exeter Medical School, University of Exeter, Exeter, UK ()
| | - Nelson C. Y. Yeung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sino Building, Chung Chi Rd, Sha Tin, Hong Kong, China ()
| | - Jing Xie
- Culture & Health Research Center, University of Houston, Department of Psychology, Fred J. Heyne Building Rm 126, 3695 Cullen Boulevard, Houston, TX, USA 77204-5022 (; ; )
| | - Hannah Feng
- Culture & Health Research Center, University of Houston, Department of Psychology, Fred J. Heyne Building Rm 126, 3695 Cullen Boulevard, Houston, TX, USA 77204-5022 (; ; )
| | - Alice Loh
- Herald Cancer Association, Chinese Christian Herald Crusades, 715 E. Mission Road, San Gabriel, CA, USA 91776 (; )
| | - Lucy Young
- Herald Cancer Association, Chinese Christian Herald Crusades, 715 E. Mission Road, San Gabriel, CA, USA 91776 (; )
| | - Qian Lu
- Culture & Health Research Center, University of Houston, Department of Psychology, Fred J. Heyne Building Rm 126, 3695 Cullen Boulevard, Houston, TX, USA 77204-5022 (; ; ),Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (),Correspondence Qian Lu, PhD, MD, Department of Health Disparities Research, the University of Texas MD Anderson Cancer Center.
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Hay JW, Lee PJ, Jin H, Guterman JJ, Gross-Schulman S, Ell K, Wu S. Cost-Effectiveness of a Technology-Facilitated Depression Care Management Adoption Model in Safety-Net Primary Care Patients with Type 2 Diabetes. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:561-568. [PMID: 29753353 PMCID: PMC5953558 DOI: 10.1016/j.jval.2017.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 11/02/2017] [Accepted: 11/11/2017] [Indexed: 05/16/2023]
Abstract
BACKGROUND The Diabetes-Depression Care-Management Adoption Trial is a translational study of safety-net primary care predominantly Hispanic/Latino patients with type 2 diabetes in collaboration with the Los Angeles County Department of Health Services. OBJECTIVES To evaluate the cost-effectiveness of an information and communication technology (ICT)-facilitated depression care management program. METHODS Cost-effectiveness of the ICT-facilitated care (TC) delivery model was evaluated relative to a usual care (UC) and a supported care (SC) model. TC added automated low-intensity periodic depression assessment calls to patients. Patient-reported outcomes included the 12-Item Short Form Health Survey converted into quality-adjusted life-years (QALYs) and the 9-Item Patient Health Questionnaire-calculated depression-free days (DFDs). Costs and outcomes data were collected over a 24-month period (-6 to 0 months baseline, 0 to 18 months study intervention). RESULTS A sample of 1406 patients (484 in UC, 480 in SC, and 442 in TC) was enrolled in the nonrandomized trial. TC had a significant improvement in DFDs (17.3; P = 0.011) and significantly greater 12-Item Short Form Health Survey utility improvement (2.1%; P = 0.031) compared with UC. Medical costs were statistically significantly lower for TC (-$2328; P = 0.001) relative to UC but not significantly lower than for SC. TC had more than a 50% probability of being cost-effective relative to SC at willingness-to-pay thresholds of more than $50,000/QALY. CONCLUSIONS An ICT-facilitated depression care (TC) delivery model improved QALYs, DFDs, and medical costs. It was cost-effective compared with SC and dominant compared with UC.
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Affiliation(s)
- Joel W Hay
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | - Pey-Jiuan Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Haomiao Jin
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey J Guterman
- Los Angeles County Department of Health Services, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Kathleen Ell
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Shinyi Wu
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA; Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
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15
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Wu S, Ell K, Jin H, Vidyanti I, Chou CP, Lee PJ, Gross-Schulman S, Sklaroff LM, Belson D, Nezu AM, Hay J, Wang CJ, Scheib G, Di Capua P, Hawkins C, Liu P, Ramirez M, Wu BW, Richman M, Myers C, Agustines D, Dasher R, Kopelowicz A, Allevato J, Roybal M, Ipp E, Haider U, Graham S, Mahabadi V, Guterman J. Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial. J Med Internet Res 2018; 20:e147. [PMID: 29685872 PMCID: PMC5938593 DOI: 10.2196/jmir.7692] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/10/2017] [Accepted: 01/13/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. OBJECTIVE The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. METHODS DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. RESULTS DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). CONCLUSIONS Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality.
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Affiliation(s)
- Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States.,Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Kathleen Ell
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Haomiao Jin
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States.,Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Irene Vidyanti
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Policy Analysis Unit, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Chih-Ping Chou
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Pey-Jiuan Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | | | - Laura Myerchin Sklaroff
- Los Angeles County Department of Health Services, Los Angeles, CA, United States.,College of Social and Behavioral Sciences, California State University, Northridge, Los Angeles, CA, United States
| | - David Belson
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Arthur M Nezu
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Joel Hay
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Chien-Ju Wang
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Geoffrey Scheib
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Paul Di Capua
- Caremore Medical Group, East Haven, CT, United States.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Caitlin Hawkins
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Pai Liu
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Magaly Ramirez
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Brian W Wu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mark Richman
- Department of Emergency Medicine, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, United States
| | - Caitlin Myers
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Davin Agustines
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Robert Dasher
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Alex Kopelowicz
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Joseph Allevato
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Mike Roybal
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Eli Ipp
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.,Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, United States.,Los Angeles Biomedical Research Institute, Los Angeles, CA, United States
| | - Uzma Haider
- Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, United States
| | - Sharon Graham
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Vahid Mahabadi
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Jeffrey Guterman
- Los Angeles County Department of Health Services, Los Angeles, CA, United States.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
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Collaborative Care for Depression among Patients with Limited English Proficiency: a Systematic Review. J Gen Intern Med 2018; 33:347-357. [PMID: 29256085 PMCID: PMC5834967 DOI: 10.1007/s11606-017-4242-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/13/2017] [Accepted: 11/17/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) have high rates of depression, yet face challenges accessing effective care in outpatient settings. We undertook a systematic review to investigate the effectiveness of the collaborative care model for depression for LEP patients in primary care. METHODS We queried online PubMed, PsycINFO, CINAHL and EMBASE databases (January 1, 2000, to June 10, 2017) for quantitative studies comparing collaborative care to usual care to treat depression in adults with LEP in primary care. We evaluated the impact of collaborative care on depressive symptoms or on depression treatment. Two reviewers independently extracted key data from the studies and assessed risk of bias using the Cochrane bias and quality assessment tool (RCTs) and the Newcastle-Ottawa Quality Assessment Scale (non-RCTs). RESULTS Of 86 titles identified, 15 were included (representing 9 studies: 5 RCTs, 3 cohort studies, and 1 case-control study). Studies included 4859 participants; 2679 (55%) reported LEP. The majority spoke Spanish (93%). The wide variability in study design and outcome definitions precluded performing a meta-analysis. Follow-up ranged from 3 months to 2 years. Three of four high-quality RCTs reported that 13-25% more patients had improved depressive symptoms when treated with culturally tailored collaborative care compared to usual care; the last had high treatment in the control arm and found equal improvement. Two non-RCT studies suggest that Spanish-speaking patients may benefit as much as, if not more than, English-speaking patients treated with collaborative care. The remaining studies reported increased receipt of preferred depression treatment (therapy vs. antidepressants) in the intervention groups. Eight of nine studies used bilingual providers to deliver the intervention. DISCUSSION While limited by the number and variability of studies, the available research suggests that collaborative care for depression delivered by bilingual providers may be more effective than usual care among patients with LEP. Implementation studies of collaborative care, particularly among Asian and non-Spanish-speakers, are needed.
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17
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Black DR. Preparing the workforce for integrated healthcare: A systematic review. SOCIAL WORK IN HEALTH CARE 2017; 56:914-942. [PMID: 28862917 DOI: 10.1080/00981389.2017.1371098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. This literature review was conducted to identify the knowledge and skills required for behavioral health consultants in integrated settings. A review from 1999 to 2015 identified 68 articles. Eligible studies examined care to the U.S. adult population at the highest level of integration. The results provide evidence of specific knowledge of medical and mental health diagnoses, screening instruments, and intervention skills in integrated primary care, specialty medical, and specialty mental health. Further research is required to identify methods to develop knowledge/skills in the workforce.
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Affiliation(s)
- Denise R Black
- a College of Social Work , University of Tennessee , Knoxville , TN , USA
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18
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Thompson LMA, Bobonis Babilonia M. Distinguishing Depressive Symptoms From Similar Cancer-Related Somatic Symptoms: Implications for Assessment and Management of Major Depression after Breast Cancer. South Med J 2017; 110:667-672. [PMID: 28973709 DOI: 10.14423/smj.0000000000000705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prevalence rates of major depressive disorder (MDD) following breast cancer diagnosis are estimated to be ~5% to >20%, and these rates range from slightly below to somewhat above the expected prevalence rate for MDD in the general population of women in the United States. Women with a history of MDD are at increased risk for recurrence of MDD after breast cancer and need to be monitored closely. To properly diagnose and treat MDD, healthcare providers must be able to recognize depressive symptoms and distinguish them from similar somatic symptoms that are associated with breast cancer and breast cancer treatment. The National Comprehensive Cancer Network and the American Society of Clinical Oncology have published guidelines for the screening, assessment, and care of adult cancer patients with depressive symptoms. Use of a standardized and validated screening measure may help healthcare providers identify patients in need of further assessment or treatment. Evidence-based nonpharmacological interventions such as cognitive behavioral therapy and antidepressant medications are recommended treatment options.
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Affiliation(s)
- Lora M A Thompson
- From the Supportive Care Medicine Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Margarita Bobonis Babilonia
- From the Supportive Care Medicine Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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McNulty J, Kim W, Thurston T, Kim J, Larkey L. Interventions to Improve Quality of Life, Well-Being, and Care in Latino Cancer Survivors: A Systematic Literature Review. Oncol Nurs Forum 2017; 43:374-84. [PMID: 27105198 DOI: 10.1188/16.onf.374-384] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Hispanic/Latino cancer survivors are at risk for increased psychosocial burden, in part, because of lower survival rates and lower quality of life (QOL) when compared with other populations. Despite this, very few interventional studies have been conducted in this population. This review synthesizes research on supportive care interventions to improve QOL, well-being, and cancer care in Hispanic/Latino cancer survivors.
. LITERATURE SEARCH Data sources included MEDLINE®, CINAHL®, and PsycINFO®. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was employed.
. DATA EVALUATION This review includes studies conducted with cancer survivors from diagnosis to survivorship and addresses any type of intervention for Hispanic/Latino survivors of all cancer types and sites. Studies were written in English and had a sample of at least 25% Hispanics/Latinos. Key study attributes were extracted and tabled.
. SYNTHESIS Of the 15 studies reviewed, types of interventions included were psychosocial (n = 6), educational (n = 4), exercise/diet (n = 4), and navigational (n = 1). Most studies were pilot and feasibility studies, and nine were randomized, controlled trials (RCTs).
. CONCLUSIONS Interventional studies for Hispanic/Latino cancer survivors are at the very early stages of scientific development and are feasible and accepted by the Hispanic/Latino population. Culturally relevant psychosocial support and educational, exercise, and navigational interventions are beneficial for this population.
. IMPLICATIONS FOR RESEARCH To advance the science, as the Hispanic/Latino population rapidly increases, a great need exists for additional research in this area. A theoretical basis for interventions is needed for development of additional research. Efficacy of culturally relevant supportive care interventions needs to be tested through RCTs, replication, and multisite studies. A need exists for these developing interventions to be translated into practice to improve QOL and well-being for Hispanic/Latino cancer survivors.
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Sanchez K, Eghaneyan BH, Killian MO, Cabassa L, Trivedi MH. 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. Trials 2017; 18:363. [PMID: 28774339 PMCID: PMC5543442 DOI: 10.1186/s13063-017-2109-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/15/2017] [Indexed: 12/02/2022] Open
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. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2109-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
| | - Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Michael O Killian
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Leopoldo Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
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Costas-Muñiz R, Hunter-Hernández M, Garduño-Ortega O, Morales-Cruz J, Gany F. Ethnic differences in psychosocial service use among non-Latina white and Latina breast cancer survivors. J Psychosoc Oncol 2017; 35:424-437. [PMID: 28332946 DOI: 10.1080/07347332.2017.1310167] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study examined the use of psychosocial services (i.e., social work, psychiatric, psychological, and spiritual/pastoral services) among Latina and Non-Latina white breast cancer survivors. METHODS Survivors who received treatment in a Comprehensive Cancer Center in New York completed a mailed questionnaire about interest in help for distress, and psychosocial service use. Descriptive and non-parametric statistics were used to explore ethnic differences in use of, and interest in, psychosocial services. RESULTS Thirty-three percent of breast cancer survivors reported needing mental health or psychosocial services after their cancer diagnosis (33% Latinas, 34% whites); 34% of survivors discussed with their oncologist or cancer care provider their emotional problems or needs after the diagnosis (30% Latinas, 36% whites). Only 40% of the survivors who reported needing services received a referral for psychosocial services (42% Latinas, 39% whites). Sixty-six percent of survivors who reported needing services had contact with a counselor or mental health professional (psychiatrist, psychologist, or social worker) after their diagnosis (57% Latinas, 71% whites), and 61% of those needing services reported receiving psychosocial services (53% Latinas, 67% whites). Whites were significantly more likely than Latinas to have contact with a social worker (33% vs. 17%, respectively) and to receive psychotropic medication (15% vs. 0%, respectively). However, Latinas were significantly more likely to receive spiritual counseling than whites (11% vs. 3%, respectively). CONCLUSION Our study revealed gaps for both groups; however, the gaps differed by group. It is crucial to study and address potential differences in the psychosocial services availability, acceptability, and help-seeking behaviors of ethnically diverse cancer patients and survivors.
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Affiliation(s)
- Rosario Costas-Muñiz
- a Department of Psychiatry & Behavioral Sciences , Immigrant Health & Cancer Disparities Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | | | - Olga Garduño-Ortega
- a Department of Psychiatry & Behavioral Sciences , Immigrant Health & Cancer Disparities Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Jennifer Morales-Cruz
- c Center for Evaluation and Sociomedical Sciences , University of Puerto Rico, Medical Sciences Campus , San Juan , PR , USA
| | - Francesca Gany
- a Department of Psychiatry & Behavioral Sciences , Immigrant Health & Cancer Disparities Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA
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Self-management education interventions for patients with cancer: a systematic review. Support Care Cancer 2017; 25:1323-1355. [PMID: 28058570 DOI: 10.1007/s00520-016-3500-z] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/14/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments. METHODS Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include 'self-management patient education' or 'patient education'. RESULTS Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review. CONCLUSION Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.
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Owusu Y, Medakkar P, Akinnawo EM, Stewart-Pyne A, Ashu EE, Hammond R, Plata J, Pierre K, Farag E. Emigration of skilled healthcare workers from developing countries: can team-based healthcare practice fill the gaps in maternal, newborn and child healthcare delivery? Int J MCH AIDS 2017; 6:130-138. [PMID: 29367888 PMCID: PMC5777387 DOI: 10.21106/ijma.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND INTRODUCTION Emigration of healthcare workers from developing countries is on the rise and there is an urgent need for policies that increase access to and continuity of healthcare. In this commentary, we highlight some of the negative impacts of emigration on maternal and child health and discuss whether team-based healthcare delivery could possibly mitigate the shortfall of maternal and child health professionals in developing countries. METHODOLOGY We cross-examine the availability of supporting structures to implement team-based maternal and child healthcare delivery in developing countries. We briefly discuss three key supporting structures: culture of sharing, telecommunication, and inter-professional education. Supporting structures are examined at system, organizational and individual levels. We argue that the culture of sharing, limited barriers to inter-professional education and increasing access to telecommunication will be advantageous to implementing team-based healthcare delivery in developing countries. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Although most developing countries may have notable supporting structures to implement team-based healthcare delivery, the effectiveness of such models in terms of cost, time and infrastructure in resource limited settings is still to be evaluated. Hence, we call on usual stakeholders, government, regulatory colleges and professional associations in countries with longstanding emigration of maternal and child healthcare workers to invest in establishing comprehensive models needed to guide the development, implementation and evaluation of team-based maternal and child healthcare delivery.
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Affiliation(s)
- Yaw Owusu
- Registered Nurses' Association of Ontario, 158 Pearl St., Toronto, Ontario, CANADA M5H-1L3
| | - Prerana Medakkar
- York University, 158 St. George Street, Toronto, ON, M5S 2V8 CANADA
| | - Elizabeth M Akinnawo
- GlaxoSmithKline, 7333 Mississauga Road North, Mississauga, Ontario, L5N 6L4, CANADA
| | - Althea Stewart-Pyne
- Registered Nurses' Association of Ontario, 158 Pearl St., Toronto, Ontario, CANADA M5H-1L3
| | - Eta E Ashu
- The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., PO Box 234, Riverdale, Maryland 20738, USA
| | - Rodney Hammond
- Department of Public Health, Montclair State University, 1 Normal Avenue, University Hall Room 4162, Montclair NJ 07043, USA
| | - Jesus Plata
- Department of Public Health, Montclair State University, 1 Normal Avenue, University Hall Room 4162, Montclair NJ 07043, USA
| | - Kimberly Pierre
- Department of Public Health, Montclair State University, 1 Normal Avenue, University Hall Room 4162, Montclair NJ 07043, USA
| | - Ehsan Farag
- Department of Public Health, Montclair State University, 1 Normal Avenue, University Hall Room 4162, Montclair NJ 07043, USA
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Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, Green E. Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer. Psychooncology 2016; 26:573-587. [PMID: 27643388 DOI: 10.1002/pon.4286] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/17/2016] [Accepted: 09/15/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous systematic reviews have found limited evidence for the effectiveness of pharmacological and psychological interventions for the management of depression in patients with cancer. This paper provides the first meta-analysis of newer collaborative care interventions, which may include both types of treatment, as well as integrated delivery and follow-up. Meta-analyses of pharmacological and psychological interventions are included as a comparison. METHODS A search of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library from July 2005 to January 2015 for randomized controlled trials of depression treatments for cancer patients diagnosed with a major depressive disorder, or who met a threshold on a validated depression rating scale was conducted. Meta-analyses were conducted using summary data. RESULTS Key findings included eight reports of four collaborative care interventions, eight pharmacological, and nine psychological trials. A meta-analysis demonstrated that collaborative care interventions were significantly more effective than usual care (standardized mean difference = -0.49, p = 0.003), and depression reduction was maintained at 12 months. By comparison, short-term (up to 12 weeks), but not longer-term effectiveness was demonstrated for both pharmacological and psychological interventions. CONCLUSIONS Collaborative care interventions have newly emerged as multidisciplinary care delivery models, which may result in more long-term depression remission. This review also updates previous findings of modest evidence for the effectiveness of both pharmacological and psychological interventions for threshold depression in cancer patients. Research designs focusing on combined treatments and delivery systems may best further the limited evidence-base for the management of depression in cancer.
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Affiliation(s)
- Madeline Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Erin B Kennedy
- Cancer Care Ontario, Program in Evidence-based Care/McMaster University, Hamilton, Ontario, Canada
| | - Nelson Byrne
- Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga, Ontario, Canada
| | | | - Mark R Katz
- Stronach Regional Cancer Centre, Southlake Regional Health Centre, Ontario, Canada
| | - Homa Keshavarz
- Cancer Care Ontario, Program in Evidence-based Care/McMaster University, Hamilton, Ontario, Canada
| | - Scott Sellick
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Esther Green
- Nursing and Psychosocial Oncology, Cancer Care Ontario, Toronto, Ontario, Canada
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Yen NTK, Weiss B, Trung LT. Caseness rates and risk factors for depression among Vietnamese cancer patients. Asian J Psychiatr 2016; 23:95-98. [PMID: 27969088 PMCID: PMC5160994 DOI: 10.1016/j.ajp.2016.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/31/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Research suggests that rates of depression among general population samples in Asia may be significantly lower than in much of the rest of the world. However, whether this applies to depression among cancer patients is unclear, which is important to determine in order to identify depression treatment needs among cancer patients in this region. The purpose of the present study was to assess caseness rates of serious depression among general cancer patients in the Southeast Asian nation of Viet Nam. METHOD A total of 695 adult cancer patients from three hospitals in Da Nang, Viet Nam served as study participants. They were assessed at one time point for (a) demographic and (b) cancer characteristics, and (c) depression symptoms. RESULTS The overall caseness rate for serious depression was 28%. Although rates of depression in general population samples usually are significantly higher in women than men, rates of depression among men and women did not differ significantly among our cancer patients. Higher levels of depressive symptoms were found, however, as a function of lower patient income and education, occupation, cancer stage, and type of cancer, but not marital status or age. CONCLUSIONS Caseness rates of depression are significantly elevated by a factor of 10-15 among Vietnamese cancer patients relative to general population epidemiological studies in the same region. Although a number of studies have found that rates of depression tend to be lower in Asian as compared to Western general population samples, depression rates among our Vietnamese cancer patients were similar to those reported among Western cancer patients. This suggests that whatever factors are responsible for the relatively low rates of depression observed in Asian general population samples may not be operating in regards to cancer-related depression. Overall, the value of these findings are not only that they provide information for policy makers in Viet Nam to support depression treatment among cancer patients, but also that they suggest that despite the apparent relatively low overall rates of depression it may be useful for cancer and mental health researchers in the region to conduct similar assessments for their policy makers.
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Affiliation(s)
- N T K Yen
- Da Nang Department of Health, 23rd Floor Da Nang Administrative Centre Building, 24 Tran Phu Street, Da Nang, Viet Nam.
| | - B Weiss
- Clinical Sciences Program, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA
| | - L T Trung
- Da Nang Psychiatric Hospital, 193 Nguyen Luong Bang Street, Da Nang, Viet Nam
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Sanchez K, Eghaneyan BH, Trivedi MH. Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO): protocol for an educational intervention study. BMC Health Serv Res 2016; 16:322. [PMID: 27473569 PMCID: PMC4966863 DOI: 10.1186/s12913-016-1575-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/21/2016] [Indexed: 11/14/2022] Open
Abstract
Background Barriers to depression treatment among Hispanic populations include persistent stigma, inadequate doctor patient communication (DPC) and resultant sub-optimal use of anti-depressant medications. Stigma is primarily perpetuated due to inadequate disease literacy and cultural factors. Common concerns about depression treatments among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. The current manuscript presents the study protocol for the Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO) study funded by the Center for Medicare and Medicaid Services (CMS) Grants to Support the Hispanic Health Services Research Grant Program. Methods/Design DESEO will implement universal screening with a self-report depression screening tool (the 9-item Patient Health Questionnaire (PHQ-9)) that is presented through a customized web application and a Depression Education Intervention (DEI) designed to increase disease literacy, and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement. This project will be conducted at one community health center whose patient population is majority Hispanic. The target enrollment for recruitment is 350 patients over the 24-month study period. A one-group, pretest-posttest design will be used to asses knowledge of depression and its treatment and related stigma before, immediately after, and one month post intervention. Discussion Primary care settings often are the gateway to identifying undiagnosed mental health disorders, particularly for people with comorbid physical health conditions. This study is unique in that it aims to examine the specific role of patient education as an intervention to increase engagement in depression treatment. By participating in the DEI, it is expected that patients will have time to understand treatment options, participate in shared decision-making with their provider, and increase engagement in treatment of depression which might lead to improved overall health. It is also expected that implementation of the iPad Depression Screening application will increase provider awareness of the incidence and prevalence of depression in their own practice and improve the performance and care the clinic provides. Trial registration The study was registered with: NCT02491034 July 2, 2015.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
| | - Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
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Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, Green E. Management of Depression in Patients With Cancer: A Clinical Practice Guideline. J Oncol Pract 2016; 12:747-56. [PMID: 27382000 DOI: 10.1200/jop.2016.011072] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This report updates the Cancer Care Ontario Program in Evidence-Based Care guideline for the management of depression in adult patients with cancer. This guideline covers pharmacologic, psychological, and collaborative care interventions, with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer. METHODS Recommendations were developed by synthesizing information from extant guidelines and reviews and searching for randomized controlled trials from the date of database inception (1964 for MEDLINE and 1974 for EMBASE) to January 2015. Quality assessment of guidelines and systematic reviews were conducted by using the Appraisal of Guidelines for Research and Evaluation II (AGREE II), Assessment of Multiple Systematic Reviews (AMSTAR), and Cochrane Risk of Bias tools. Final recommendations were developed through a standardized Program in Evidence-Based Care multidisciplinary expert and knowledge user review process. RESULTS Two high-quality relevant clinical practice guidelines, eight pharmacologic trials, nine psychological trials, and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed. Eight specific recommendations were made to establish a standard of care for the management of depression in patients with cancer. The recommendations and practical management tools were reviewed as being well organized and helpful, although systemic barriers to implementation were identified. CONCLUSION This updated guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and/or pharmacologic interventions, without evidence for the superiority of any specific treatment over another. New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression.
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Affiliation(s)
- Madeline Li
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Erin B Kennedy
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Nelson Byrne
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Caroline Gérin-Lajoie
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Mark R Katz
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Homa Keshavarz
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Scott Sellick
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Esther Green
- Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
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Le HN, Hipolito MMS, Lambert S, Terrell-Hamilton F, Rai N, McLean C, Kapetanovic S, Nwulia E. Culturally Sensitive Approaches to Identification and Treatment of Depression among HIV Infected African American Adults: A Qualitative Study of Primary Care Providers' Perspectives. JOURNAL OF DEPRESSION & ANXIETY 2016; 5:223. [PMID: 27347445 PMCID: PMC4916768 DOI: 10.4172/2167-1044.1000223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent among HIV-infected (HIV+) individuals, and is associated with non-adherence to antiretroviral therapy (ART), and accelerated disease progression. MDD is underdiagnosed and undertreated among low-income African Americans, who are disproportionately impacted by the HIV epidemic. To improve detection and treatment of depression among African Americans living with HIV/AIDS, it is important to understand culturally and contextually relevant aspects of MDD and attitudes about mental health treatment. METHODS A focus group session was conducted with seven providers and staff at a primary care center that serves a largely African-American community heavily impacted by the HIV epidemic in Washington, DC. Data were analyzed using an inductive approach to distill prominent themes, perspectives, and experiences among participating providers. RESULTS Five themes emerged to characterize the lived experiences of HIV+ African-American patients: (a) Changes in perceptions of HIV over time; (b) HIV is comorbid with mental illness, particularly depression and substance abuse; (c) Stigma is associated with both HIV and depression; (d) Existing mental health services vary and are insufficient and (e) Suggestions for optimal treatment for comorbid HIV and depression. LIMITATION This study reflects the views of providers from one clinic in this community. CONCLUSION Substantial economic disadvantage, pervasive childhood adversity, limited education and limited resources jointly put members of this community at risk for acquisition of HIV and for development of depression and addictions. These contextual factors provide an important reminder that any patient-level depression identification or intervention in this community will have to be mindful of such circumstances.
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Affiliation(s)
- Huynh-Nhu Le
- Department of Psychology, George Washington University, Washington, D.C., USA
| | - Maria Mananita S Hipolito
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
| | - Sharon Lambert
- Department of Psychology, George Washington University, Washington, D.C., USA
| | | | - Narayan Rai
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
| | - Charlee McLean
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
| | | | - Evaristus Nwulia
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
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Ell K, Aranda MP, Wu S, Oh H, Lee PJ, Guterman J. Promotora assisted depression care among predominately Hispanic patients with concurrent chronic illness: Public care system clinical trial design. Contemp Clin Trials 2015; 46:39-47. [PMID: 26600285 DOI: 10.1016/j.cct.2015.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
Depression frequently negatively affects patient overall self-care and social stress management within United States safety net care systems. Rates of major depression are significantly high among low-income predominantly Hispanic/Latino with chronic illness, such as diabetes and heart disease. The study design of the A Helping Hand to Activate Patient-Centered Depression Care among Low-income Patients (AHH) randomized clinical trial aims to enhance patient depression care receipt and overall bio-psychosocial self-care management. The AHH trial is conducted in collaboration with three Los Angeles County Department of Health Services (DHS) safety net clinics that provide Patient-Centered Medical Home (PCMH) care. The study compares AHH intervention (AHH) in which community-based bilingual promotoras provide in-person or telephone patient engagement and intervention aimed to reduce the burden and strain on patients, families, and care providers by assessing, enhancing, and facilitating patient depression and co-morbid illness self-care management skill, and activating patient communication with clinic medical providers versus DHS PCMH team usual care (PCMHUC). AHH independent bilingual recruiters screened 1957 and enrolled 348 predominantly Hispanic/Latino patients, of whom 296 (85%) had diabetes, 14 (4%) with heart disease, and 38 (11%) with both diseases. Recruiters identified depressed patients by baseline Patient Health Questionnaire-9 scores of 10 or more, completed baseline assessments, and randomized patients to either AHH or PCMHUC study group. The comprehensive assessments will be repeated at 6 and 12months by an independent bilingual follow-up interviewer. Baseline and outcome data include mental health assessment and treatment receipt, co-morbid illness self-care, social relationships, and environmental stressor assessments.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California, United States.
| | - María P Aranda
- School of Social Work, University of Southern California, United States.
| | - Shinyi Wu
- School of Social Work, University of Southern California, United States; Edward R. Roybal Institute on Aging, University of Southern California, United States; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States.
| | - Hyunsung Oh
- School of Social Work, Arizona State University, United States.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, United States.
| | - Jeffrey Guterman
- Los Angeles County Department of Health Services, Research and Innovation, David Geffen School of Medicine, University of California Los Angeles, United States.
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Wenzel L, Osann K, Hsieh S, Tucker JA, Monk BJ, Nelson EL. Psychosocial telephone counseling for survivors of cervical cancer: results of a randomized biobehavioral trial. J Clin Oncol 2015; 33:1171-9. [PMID: 25713429 DOI: 10.1200/jco.2014.57.4079] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Survivors of cervical cancer experience quality-of-life (QOL) disruptions that persist years after treatment. This study examines the effect of a psychosocial telephone counseling (PTC) intervention on QOL domains and associations with biomarkers. PATIENTS AND METHODS We conducted a randomized clinical trial in survivors of cervical cancer, who were ≥ 9 and less than 30 months from diagnosis (n = 204), to compare PTC to usual care (UC). PTC included five weekly sessions and a 1-month booster. Patient-reported outcomes (PROs) and biospecimens were collected at baseline and 4 and 9 months after enrollment. Changes in PROs over time and associations with longitudinal change in cytokines as categorical variables were analyzed using multivariable analysis of variance for repeated measures. RESULTS Participant mean age was 43 years; 40% of women were Hispanic, and 51% were non-Hispanic white. Adjusting for age and baseline scores, participants receiving PTC had significantly improved depression and improved gynecologic and cancer-specific concerns at 4 months compared with UC participants (all P < .05); significant differences in gynecologic and cancer-specific concerns (P < .05) were sustained at 9 months. Longitudinal change in overall QOL and anxiety did not reach statistical significance. Participants with decreasing interleukin (IL) -4, IL-5, IL-10, and IL-13 had significantly greater improvement in QOL than those with increasing cytokine levels. CONCLUSION This trial confirms that PTC benefits mood and QOL cancer-specific and gynecologic concerns for a multiethnic underserved population of survivors of cancer. The improvement in PROs with decreases in T-helper type 2 and counter-regulatory cytokines supports a potential biobehavioral pathway relevant to cancer survivorship.
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Affiliation(s)
- Lari Wenzel
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ.
| | - Kathryn Osann
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Susie Hsieh
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Jo A Tucker
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Bradley J Monk
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Edward L Nelson
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
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Petersen JJ, König J, Paulitsch MA, Mergenthal K, Rauck S, Pagitz M, Schmidt K, Haase L, Gerlach FM, Gensichen J. Long-term effects of a collaborative care intervention on process of care in family practices in Germany: a 24-month follow-up study of a cluster randomized controlled trial. Gen Hosp Psychiatry 2014; 36:570-4. [PMID: 25135191 DOI: 10.1016/j.genhosppsych.2014.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aims of this study were (1) to assess the long-term effects of a collaborative care intervention for patients with depression on process of care outcomes, and (2) to describe whether case management was continued after the end of the original one-year intervention. METHODS This 24-month follow-up of a randomized controlled trial took place 12 months after the end of the 1-year intervention. Data collection occurred by means of self-rating questionnaires and from medical records. We calculated linear mixed and logistic generalized estimating equation models. RESULTS Of the 626 patients included at baseline, 439 (70.1%) participated in this follow-up. Intervention recipients gave higher ratings than control recipients in terms of mean overall Patient Assessment of Chronic Illness Care (PACIC) scores (3.12 vs. 2.86; P = .019), but no difference was found in medication adherence (mean Morisky score 2.59 vs. 2.65, P = .56), prescribed antidepressant medications (60.2% vs. 55.1%; P = .25), visits to the family physician (15.96 vs. 14.46, P = .58) or mental health specialist (3.01 vs. 2.94, P = .94) over the 12 month follow-up period. Case management was continued for 47 (22.5%) selected intervention patients after the original intervention had ended. CONCLUSION At 24 months, intervention and control recipients had different PACIC ratings, but other process of care outcomes did not differ. PRACTICE IMPLICATIONS The main effects of the intervention are apparent at 12 months.
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Affiliation(s)
- Juliana J Petersen
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
| | - Michael A Paulitsch
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Sandra Rauck
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Manuel Pagitz
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany
| | - Lydia Haase
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Jochen Gensichen
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany; Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany
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Wu B, Jin H, Vidyanti I, Lee PJ, Ell K, Wu S. Collaborative depression care among Latino patients in diabetes disease management, Los Angeles, 2011-2013. Prev Chronic Dis 2014; 11:E148. [PMID: 25167093 PMCID: PMC4149319 DOI: 10.5888/pcd11.140081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes–Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes. Methods A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes. Results Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment. Conclusion Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system.
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Affiliation(s)
- Brian Wu
- School of Social Work and Epstein Department of Industrial and Systems Engineering, University of Southern California, 669 W 34th St, Montgomery Ross Fisher Bldg, Los Angeles, CA 90089-0411. E-mail:
| | - Haomiao Jin
- University of Southern California, Los Angeles, California
| | | | - Pey-Jiuan Lee
- University of Southern California, Los Angeles, California
| | - Kathleen Ell
- University of Southern California, Los Angeles, California
| | - Shinyi Wu
- RAND Corporation, Santa Monica, California
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Wen J, Schulman KA. Can team-based care improve patient satisfaction? A systematic review of randomized controlled trials. PLoS One 2014; 9:e100603. [PMID: 25014674 PMCID: PMC4094385 DOI: 10.1371/journal.pone.0100603] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 05/29/2014] [Indexed: 02/05/2023] Open
Abstract
Background Team-based approaches to patient care are a relatively recent innovation in health care delivery. The effectiveness of these approaches on patient outcomes has not been well documented. This paper reports a systematic review of the relationship between team-based care and patient satisfaction. Methods We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, and PSYCHOINFO for eligible studies dating from inception to October 8, 2012. Eligible studies reported (1) a randomized controlled trial, (2) interventions including both team-based care and non-team-based care (or usual care), and (3) outcomes including an assessment of patient satisfaction. Articles with different settings between intervention and control were excluded, as were trial protocols. The reference lists of retrieved papers were also evaluated for inclusion. Results The literature search yielded 319 citations, of which 77 were screened for further full-text evaluation. Of these, 27 articles were included in the systematic review. The 26 trials with a total of 15,526 participants were included in this systematic review. The pooling result of dichotomous data (number of studies: 10) showed that team-based care had a positive effect on patient satisfaction compared with usual care (odds ratio, 2.09; 95% confidence interval, 1.54 to 2.84); however, combined continuous data (number of studies: 7) demonstrated that there was no significant difference in patient satisfaction between team-based care and usual care (standardized mean difference, −0.02; 95% confidence interval, −0.40 to 0.36). Conclusions Some evidence showed that team-based care is better than usual care in improving patient satisfaction. However, considering the pooling result of continuous data, along with the suboptimal quality of included trials, further large-scale and high-quality randomized controlled trials comparing team-based care and usual care are needed.
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Affiliation(s)
- Jin Wen
- Department of Hospital Management and Health Policy, Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Kevin A. Schulman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- * E-mail:
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Abstract
PURPOSE OF REVIEW In the field of global mental health, an enormous gap between what we know and what we do exists in the delivery of clinical care. Creative and effective strategies that surmount the barriers to provision of mental healthcare are essential to improve the lives of millions affected by mental illness. This article provides a review of three classes of innovative strategies currently being developed and implemented to diminish the mental health treatment gap globally. RECENT FINDINGS This review provides recent evidence related to the feasibility of implementation and efficacy for the following three classes of innovation that show promise for building clinical capacity and expanding mental health coverage: integration of mental health services into primary care; expansion of human capacity through task sharing and training of nonspecialists; and innovative use of technological platforms to enhance access, cut costs, and reduce stigma. SUMMARY The strategies outlined in this review hold great potential for enhancing mental health treatment services, and address some of the major barriers globally to accessing mental healthcare, such as scarcity of resources (infrastructure, capacity, and funding) and stigma. Despite much evidence supporting the efficacy of these models, thorough studies that test their feasibility, acceptability, utility, and effectiveness in various contexts, including low-income and middle-income countries, are required. Moreover, these innovations require social support and political will in order to be successfully implemented and scaled-up such that they have a meaningful impact on the burden of disease associated with mental illness worldwide.
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Wells AA, Palinkas LA, Shon EJ, Ell K. Low-income cancer patients in depression treatment: dropouts and completers. J Behav Health Serv Res 2014; 40:427-41. [PMID: 23868016 DOI: 10.1007/s11414-013-9354-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study aims to explore reasons for depression treatment dropout among low-income, minority women with depression and cancer. Semi-structured telephone interviews are conducted with 20, predominately Latina, patients who dropped out of depression treatment and 10 who completed. Transcripts analyzed using techniques rooted in grounded theory. Treatment completion barriers cluster according to Meichenbaum and Turk's (Facilitating treatment adherence: A practitioner's guidebook, Plenum Press, New York, 1987) five adherence dimensions: (a) Barriers to Treatment (informational, instrumental, cultural [language, discrimination]); (b) Disease Features (emotional burden of cancer/depression); (c) Cancer/Depression Treatment Regimens; (d) Provider-Patient Relationship (depression treatment dissatisfaction); and (e) Clinical Setting (hospital organizational issues). Although both groups describe multiple overlapping dimensions of barriers, completers seem more motivated and satisfied with treatment, possibly due to completers experiencing the positive treatment effects after the first several sessions. More research should be conducted to determine the most effective clinical treatment methods for this population.
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Affiliation(s)
- Anjanette A Wells
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130-4899, USA.
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Ishikawa RZ, Cardemil EV, Alegría M, Schuman CC, Joseph RC, Bauer AM. Uptake of depression treatment recommendations among Latino primary care patients. Psychol Serv 2014; 11:421-32. [PMID: 24512538 DOI: 10.1037/a0035716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Primary care providers (PCP) are the entry point for public sector depression treatment for many Latino patients. However, many Latino patients do not initiate their PCPs' recommended treatment, which likely contributes to ethnic disparities in depression treatment. This study examined factors related to Latino patients' uptake of their PCPs' recommendations for depression treatment. METHOD Ninety Latino primary care patients who received a depression treatment recommendation from their PCP participated in a telephone interview. Patients rated their working alliance with their PCP and their PCP's cultural competence. They also reported their treatment preference, the type of recommendation, and their intended and actual uptake of the recommendation. Patients were contacted at two time points (Time 1: M = 14 days after PCP appointment; Time 2: M = 84 days after PCP appointment) to report their uptake status. RESULTS At Time 1, 23% of patients had initiated uptake of the treatment recommendation, increasing to 53% at Time 2. Patients who received a medication recommendation were more likely to have followed though on the recommendation, compared with patients who received a psychotherapy recommendation. The working alliance was positively associated with intention to follow up on a treatment recommendation, and also mediated the relationship between cultural competence and intention of following up on the recommendation. CONCLUSION PCP's treatment recommendation and the PCP-patient alliance play a role in Latino primary care patients intention to follow a treatment recommendation for depression. An improved understanding of this role could enhance efforts to improve depression treatment uptake.
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Affiliation(s)
| | | | - Margarita Alegría
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Harvard Medical School
| | | | - Robert C Joseph
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School
| | - Amy M Bauer
- Department of Psychiatry, University of Washington
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Wu S, Ell K, Gross-Schulman SG, Sklaroff LM, Katon WJ, Nezu AM, Lee PJ, Vidyanti I, Chou CP, Guterman JJ. Technology-facilitated depression care management among predominantly Latino diabetes patients within a public safety net care system: comparative effectiveness trial design. Contemp Clin Trials 2013; 37:342-54. [PMID: 24215775 DOI: 10.1016/j.cct.2013.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 01/15/2023]
Abstract
Health disparities in minority populations are well recognized. Hispanics and Latinos constitute the largest ethnic minority group in the United States; a significant proportion receives their care via a safety net. The prevalence of diabetes mellitus and comorbid depression is high among this group, but the uptake of evidence-based collaborative depression care management has been suboptimal. The study design and baseline characteristics of the enrolled sample in the Diabetes-Depression Care-management Adoption Trial (DCAT) establishes a quasi-experimental comparative effectiveness research clinical trial aimed at accelerating the adoption of collaborative depression care in safety net clinics. The study was conducted in collaboration with the Los Angeles County Department of Health Services at eight county-operated clinics. DCAT has enrolled 1406 low-income, predominantly Hispanic/Latino patients with diabetes to test a translational model of depression care management. This three-group study compares usual care with a collaborative care team support model and a technology-facilitated depression care model that provides automated telephonic depression screening and monitoring tailored to patient conditions and preferences. Call results are integrated into a diabetes disease management registry that delivers provider notifications, generates tasks, and issues critical alerts. All subjects receive comprehensive assessments at baseline, 6, 12, and 18 months by independent English-Spanish bilingual interviewers. Study outcomes include depression outcomes, treatment adherence, satisfaction, acceptance of assessment and monitoring technology, social and economic stress reduction, diabetes self-care management, health care utilization, and care management model cost and cost-effectiveness comparisons. DCAT's goal is to optimize depression screening, treatment, follow-up, outcomes, and cost savings to reduce health disparities.
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Affiliation(s)
- Shinyi Wu
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States; RAND Corporation, United States.
| | - Kathleen Ell
- School of Social Work, University of Southern California, United States.
| | | | | | - Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States.
| | - Art M Nezu
- Drexel University College of Arts and Sciences, United States.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, United States.
| | - Irene Vidyanti
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States.
| | - Chih-Ping Chou
- Keck School of Medicine, Department of Preventive Medicine, University of Southern California, United States.
| | - Jeffrey J Guterman
- Los Angeles County Department of Health Services, United States; David Geffen School of Medicine at UCLA, United States.
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Molina Y, Thompson B, Espinoza N, Ceballos R. Breast cancer interventions serving US-based Latinas: current approaches and directions. ACTA ACUST UNITED AC 2013; 9:335-48; quiz 349-50. [PMID: 23826775 DOI: 10.2217/whe.13.30] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite efforts to reduce morbidity and mortality in breast cancer, Latinas continue to have lower 5-year survival rates than their non-Latina white counterparts. All along the cancer continuum from screening to follow-up of abnormal screening to diagnosis and treatment to survivorship, Latinas fare poorer than non-Latina whites. To close this gap, a number of research projects across the continuum have attempted to improve breast cancer outcomes. In this review, we examine studies that have been carried out in breast cancer along the cancer continuum. We focus not only on randomized, controlled trials, but also on quasi-experimental, and pre- and post-test studies that provided interventions for positive breast cancer outcomes. We examine not only the intervention outcomes, but also the type of intervention targets and type of intervention implementation. In future breast cancer research among Latinas, more emphasis should be placed on the steps in detection and treatment that occur after screening.
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Affiliation(s)
- Yamile Molina
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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Depression and family interaction among low-income, predominantly hispanic cancer patients: a longitudinal analysis. Support Care Cancer 2013; 22:427-34. [PMID: 24091718 DOI: 10.1007/s00520-013-1993-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Among cancer patients, family interaction has been associated with depression. According to the stress generation theory, depression among cancer patients triggers stressful interpersonal events that contribute to poor family interactions and additional depression. This conflict may occur with a spouse/partner or other family member, including extended family. This study evaluated the longitudinal association between depression and marital and family conflict among low-income, predominantly Hispanic cancer patients. METHODS Data were collected during a randomized controlled clinical trial of depression treatment among 472 low-income cancer patients with baseline depression scores of 10 or more on the Patient Health Questionnaire-9 and whose depression symptoms and negative family interactions were assessed at baseline and at 6, 12, 18, and 24 months. Considering that not all participants were in an intimate relationship, only 237 participants were included in the analysis of marital conflict. Mixed linear modeling with and without decomposition of between- and within-person variability was conducted to examine the longitudinal association between family interaction and depression. RESULTS Overall, family conflict was significantly associated with changes in depression over time, and marital conflict was significantly associated with mean depression levels over 2 years. In addition, within-subject change in both marital and family conflict was significantly associated with within-patient deviation from average depression levels. CONCLUSIONS Findings provide evidence of an association between depression and negative family interaction among depressed cancer patients. Cancer patients with clinically significant depressive symptoms may benefit from clinical assessment and psychotherapy relevant to family interaction.
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Costas R, Gany F. Depressive symptoms in a sample of Afro-Caribbean and Latino immigrant cancer patients: a comparative analysis. Support Care Cancer 2013; 21:2461-8. [PMID: 23604454 DOI: 10.1007/s00520-013-1813-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aims to describe the depressive symptoms in a sample of African-Caribbean and Latino cancer patients and examine differences in specific symptoms between the two groups. METHODS The sample included immigrant Afro-Caribbean (n = 44) and Latino (n = 145) underserved cancer patients recruited from five hospitals in New York City. Participants completed a questionnaire comprised of measures of depression (Patient Health Questionnaire-9), health-related quality of life (EuroQol 5D), sociodemographic, and health-related questions. RESULTS Results of the comparison of mean scores and percentage of patients meeting the cutoff scores showed that Afro-Caribbean patients reported comparable depressive symptoms to the Latino patients. But, upon closer inspection of specific symptoms and other self-report variables, Latino patients reported more frequently depressed mood, having a history of a depressive disorder, and overall higher psychological distress than Afro-Caribbean patients. CONCLUSIONS Different presentation of symptoms associated with depression is expressed by Afro-Caribbean and Latino cancer patients. Studies analyzing in detail the presentation of psychological responses of different cultural groups with chronic medical conditions are greatly needed.
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Affiliation(s)
- Rosario Costas
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022, USA.
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Butow PN, Aldridge L, Bell ML, Sze M, Eisenbruch M, Jefford M, Schofield P, Girgis A, King M, Duggal-Beri P, McGrane J, Goldstein D. Inferior health-related quality of life and psychological well-being in immigrant cancer survivors: a population-based study. Eur J Cancer 2013; 49:1948-56. [PMID: 23465493 DOI: 10.1016/j.ejca.2013.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
This study compared health-related quality of life (QOL) and psychological morbidity in a population-based sample of first generation immigrant and Anglo-Australian cancer survivors. Eligible participants, recruited via three State Cancer Registries, included those: with a new diagnosis of one of 12 most incident cancers (all stages) 1-6years earlier; aged 18-80 at diagnosis; born in a Chinese, Arabic, or Greek speaking country and able to speak one of these languages. A random sample of English-speaking Anglo-Australian-born controls frequency matched for cancer diagnosis was recruited. 596 patients (277 of whom were immigrants) participated (a 26% response rate). In multiple linear regression models adjusted for age, sex, education, marital status, socio-economic status, time since diagnosis and type of cancer, immigrants had clinically significantly worse QOL (5.4-8.5 points on Functional Assessment of Cancer Therapy - General (FACT-G), P<0·0001), higher depression (P<0·0001) and higher incidence of clinical depression (P<0·01) than Anglo-Australians. Understanding the health system partially mediated this relationship for depression (P=0·0004) and QOL (P=0·001). Immigrant survivors of cancer have worse psychological and QOL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information and cultural competency training for health professionals.
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Affiliation(s)
- Phyllis N Butow
- Psycho-oncology Co-operative Research Group (PoCoG), and School of Psychology, University of Sydney, Sydney, NSW, Australia.
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Watson LC, Amick HR, Gaynes BN, Brownley KA, Thaker S, Viswanathan M, Jonas DE. Practice-Based Interventions Addressing Concomitant Depression and Chronic Medical Conditions in the Primary Care Setting. J Prim Care Community Health 2013; 4:294-306. [DOI: 10.1177/2150131913484040] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Depression concomitant with chronic medical conditions is common and burdensome in primary care. Objective: To assess the effectiveness of practice-based interventions for improving depression and chronic medical outcomes. Data Sources: MEDLINE, Embase, the Cochrane Library, CINAHL, and PsycINFO from inception to June 11, 2012. Study Selection, Appraisal, and Synthesis: Two reviewers independently selected, extracted data from, and rated the quality of trials and systematic reviews. Strength of evidence (SOE) was graded using established criteria. Results: Twenty-four published articles reported data from 12 studies, all at least 6 months long. All studies compared a form of collaborative care with usual or enhanced usual care. Studies evaluated adults with arthritis, cancer, diabetes, heart disease, HIV, or multiple medical conditions. Meta-analyses found that intervention recipients achieved greater improvement than controls in depression symptoms, response, remission, and depression-free days (moderate SOE); satisfaction with care (moderate SOE); and quality of life (moderate SOE). Few data were available on outcomes for chronic medical conditions. Meta-analyses revealed that patients with diabetes receiving collaborative care exhibited no difference in diabetes control compared with control groups (change in HbA1c: weighted mean difference 0.13, 95% confidence interval = −0.22 to 0.48 at 6 months; 0.24, 95% confidence interval = −0.14 to 0.62 at 12 months; low SOE). The only study to use HbA1c as a predefined outcome measure and a “treat-to-target” intervention for diabetes as well as depression, TEAMcare, reported significant reductions in HbA1c (7.42 vs 7.87 at 6 months; 7.33 vs 7.81 at 12 months; overall P < .001). Limitations: Few relevant trials reported on medical outcomes. Conclusions: Collaborative care interventions improved outcomes for depression and quality of life in primary care patients with varying medical conditions. Few data were available on medical outcomes. Future studies of concomitant depression and chronic medical conditions should consider measures of medical outcomes as primary outcomes.
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Affiliation(s)
- Lea C. Watson
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Halle R. Amick
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Samruddhi Thaker
- Research Triangle Institute (RTI) International, Research Triangle Park, NC, USA
| | - Meera Viswanathan
- Research Triangle Institute (RTI) International, Research Triangle Park, NC, USA
| | - Daniel E. Jonas
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sullivan G, Sherbourne C, Chavira DA, Craske MG, Gollineli D, Han X, Rose RD, Bystritsky A, Stein MB, Roy-Byrne P. Does a quality improvement intervention for anxiety result in differential outcomes for lower-income patients? Am J Psychiatry 2013; 170:218-25. [PMID: 23377641 PMCID: PMC3826816 DOI: 10.1176/appi.ajp.2012.12030375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the effects of a collaborative care intervention for anxiety disorders in primary care on lower-income participants relative to those with higher incomes. They hypothesized that lower-income individuals would show less improvement or improve at a lower rate, given that they would experience greater economic stress over the treatment course. An alternative hypothesis was that lower-income participants would improve at a higher rate because the intervention facilitates access to evidence-based treatment, which typically is less available to persons with lower incomes. METHOD Baseline demographic and clinical characteristics of patients with lower (N=287) and higher (N=717) income were compared using t tests and chi-square tests for continuous and categorical variables, respectively. For the longitudinal analysis of intervention effects by income group, the outcome measures were jointly modeled at baseline and at 6, 12, and 18 months by study site, income, time, intervention, time and intervention, income and time, income and intervention, and time, intervention, and income. RESULTS Although lower-income participants were more ill and had greater disability at baseline than those with higher incomes, the two income groups were similar in clinical response. The lower-income participants experienced a comparable degree of clinical improvement, despite receiving fewer treatment sessions, less relapse prevention, and less continuous care. CONCLUSIONS These findings contribute to the ongoing discussion as to whether or not, and to what extent, quality improvement interventions work equally well across income groups or require tailoring for specific vulnerable populations.
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Affiliation(s)
- Greer Sullivan
- Department of Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, North Little Rock, AR, USA.
| | | | - Denise A. Chavira
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Child and Adolescent Services Research Center, San Diego, CA
| | | | | | - Xiaotong Han
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Raphael D. Rose
- Department of Psychology, University of California, Los Angeles, CA
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | - Peter Roy-Byrne
- Department of Psychiatry, University of Washington School of Medicine, Seattle, WA,Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations, Seattle, WA
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Ngo VK, Rubinstein A, Ganju V, Kanellis P, Loza N, Rabadan-Diehl C, Daar AS. Grand challenges: Integrating mental health care into the non-communicable disease agenda. PLoS Med 2013; 10:e1001443. [PMID: 23690753 PMCID: PMC3653779 DOI: 10.1371/journal.pmed.1001443] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In the third article of a five-part series providing a global perspective on integrating mental health, Victoria Ngo and colleagues discuss the benefits and requirements of collaborative care models, where non-communicable disease and mental health care are integrated and provided in the primary care setting. Please see later in the article for the Editors' Summary
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Affiliation(s)
- Victoria K Ngo
- RAND Corporation, Santa Monica, California, United States of America.
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 456] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Hart SL, Hoyt MA, Diefenbach M, Anderson DR, Kilbourn KM, Craft LL, Steel JL, Cuijpers P, Mohr DC, Berendsen M, Spring B, Stanton AL. Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. J Natl Cancer Inst 2012; 104:990-1004. [PMID: 22767203 DOI: 10.1093/jnci/djs256] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk for depression compared with individuals with no cancer diagnosis, yet few interventions target depressed cancer patients. METHODS Efficacy of psychotherapeutic and pharmacologic interventions for depression in cancer patients who met an entry threshold for depressive symptoms was examined by meta-analysis. Five electronic databases were systematically reviewed to identify randomized controlled trials meeting the selection criteria. Effect sizes were calculated using Hedges' g and were pooled to compare pre- and postrandomization depressive symptoms with a random effects model. Subgroup analyses tested moderators of effect sizes, such as comparison of different intervention modalities, with a mixed effects model. All statistical tests were two-sided. RESULTS Ten randomized controlled trials (six psychotherapeutic and four pharmacologic studies) met the selection criteria; 1362 participants with mixed cancer types and stages had been randomly assigned to treatment groups. One outlier trial was removed from analyses. The random effects model showed interventions to be superior to control conditions on reducing depressive symptoms postintervention (Hedges' g = 0.43, 95% confidence interval = 0.30 to 0.56, P < .001). In the four psychotherapeutic trials with follow-up assessment, interventions were more effective than control conditions up to 12-18 months after patients were randomly assigned to treatment groups (P < .001). Although each approach was more effective than the control conditions in improving depressive symptoms (P < .001), subgroup analyses showed that cognitive behavioral therapy appeared more effective than problem-solving therapy (P = .01), but not more effective than pharmacologic intervention (P = .07). CONCLUSIONS Our findings suggest that psychological and pharmacologic approaches can be targeted productively toward cancer patients with elevated depressive symptoms. Research is needed to maximize effectiveness, accessibility, and integration into clinical care of interventions for depressed cancer patients.
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Affiliation(s)
- Stacey L Hart
- Department of Psychology, University of California Los Angeles, CA 90095-1563, USA
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Nedjat-Haiem FR, Lorenz KA, Ell K, Hamilton A, Palinkas L. Experiences with advanced cancer among Latinas in a public health care system. J Pain Symptom Manage 2012; 43:1013-24. [PMID: 22575719 DOI: 10.1016/j.jpainsymman.2011.06.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 06/16/2011] [Accepted: 06/23/2011] [Indexed: 11/21/2022]
Abstract
CONTEXT Cultural dimensions related to illness are triggered at significant times in an illness trajectory, such as at illness onset or when death approaches. These factors influence views on how illness is understood and managed, which is likely more difficult for minority populations. Although Latinos experience barriers to high-quality health care, late-stage cancer diagnoses, and poor health outcomes, little is known about their experiences with advanced, life-threatening cancers. OBJECTIVES We examined Latinas' experiences with advanced, metastatic cancers to identify sociocultural beliefs that influenced their care. METHODS We interviewed 24 Latinas taking part in a randomized controlled trial focused on improving quality-of-life outcomes for co-occurring cancer and depression and explored their beliefs about the cause, course, and cure of cancer. This study used a phenomenological analytical approach to explore women's lived experiences of having advanced cancer. RESULTS Themes revealed issues about experiencing advanced cancer that included the following: initial reactions to cancer, disbelief about the lack of pain, economic impact, beliefs about the cause, coping with cancer, beliefs about the cure, and confusion about cancer severity. Sociocultural factors influence misunderstanding and confusion about cancer care but also can be a source of strength. CONCLUSION Providers need to become culturally sensitive to the needs of underserved Latinas. Denial or ignorance of these issues can create other problems, such as gaps in patient-centered decision making from diagnosis through the end of life.
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Affiliation(s)
- Frances R Nedjat-Haiem
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA.
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Abstract
Despite substantial evidence that patients with cancer commonly have significant psychosocial problems, for which we have evidence-based treatments, many patients still do not receive adequate psychosocial care. This means that we risk prolonging life without adequately addressing the quality of that life. There are many challenges to improving the current situation, the major one of which is organizational. Many cancer centers lack a system of psychosocial care that is integrated with the cancer care of the patient. Psychosocial care encompasses a range of problems (emotional, social, palliative, and logistical). The integration must occur with the cancer care of the patient at all stages (from screening to palliative care) and across all clinical sites of care (inpatient and outpatient cancer services as well as primary care). In this article, we consider the challenges we face if we are to provide such integrated psychosocial services. We focus on the collaborative care service model. This model comprises systematic identification of need, integrated delivery of care by care managers, appropriate specialist supervision, and the stepping of care based on systematic measurement of outcomes. Several trials of this approach to the management of depression in patients with cancer have found it to be both feasible to deliver and effective. It provides a model for services to meet other psychosocial needs. We conclude by proposing the key components of an integrated psychosocial service that could be implemented now and by considering what we need to do next if we are to succeed in providing better and more comprehensive care to our patients.
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Affiliation(s)
- Jesse R Fann
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA.
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Ell K, Katon W, Xie B, Lee PJ, Kapetanovic S, Guterman J, Chou CP. One-year postcollaborative depression care trial outcomes among predominantly Hispanic diabetes safety net patients. Gen Hosp Psychiatry 2011; 33:436-42. [PMID: 21774987 PMCID: PMC3175272 DOI: 10.1016/j.genhosppsych.2011.05.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/25/2011] [Accepted: 05/27/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to determine sustained effectiveness in reducing depression symptoms and improving depression care 1 year following intervention completion. METHOD Of 387 low-income, predominantly Hispanic diabetes patients with major depression symptoms randomized to 12-month socioculturally adapted collaborative care (psychotherapy and/or antidepressants, telephone symptom monitoring/relapse prevention) or enhanced usual care, 264 patients completed 2-year follow-up. Depression symptoms (Symptom Checklist-20 [SCL-20], Patient Health Questionnaire-9 [PHQ-9]), treatment receipt, diabetes symptoms and quality of life were assessed 24 months postenrollment using intent-to-treat analyses. RESULTS At 24 months, more intervention patients received ongoing antidepressant treatment (38% vs. 25%, χ(2)=5.11, df=1, P=.02); sustained depression symptom improvement [SCL-20 <0.5 (adjusted odds ratio=2.06, 95% confidence interval=1.09-3.90, P=.03), SCL-20 score (adjusted mean difference -0.22, P=.001) and PHQ-9 ≥50% reduction (adjusted odds ratio=1.87, 95% confidence interval =1.05-3.32, P=.03)]. Over 2 years, improved effects were found in significant study group by time interaction for Short Form-12 mental health, Sheehan Disability Scale (SDS) functional impairment, diabetes symptoms, anxiety and socioeconomic stressors (P=.02 for SDS; P<.0001 for all others); however, group differences narrowed over time and were no longer significant at 24 months. CONCLUSIONS Socioculturally tailored collaborative care that included maintenance antidepressant medication, ongoing symptom monitoring and behavioral activation relapse prevention was associated with depression improvement over 24 months for predominantly Hispanic patients in primary safety net care.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, MRF 102R (MC 0411), University of Southern California, Los Angeles, CA 90089-0411, USA.
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California
| | - Suad Kapetanovic
- National Institute of Mental Health, National Institutes of Health
| | - Jeffery Guterman
- David Geffen School of Medicine at UCLA and the Los Angeles County Department of Health Services
| | - Chih-Ping Chou
- Keck School of Medicine, Department of Preventive Medicine, University of Southern California
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