Depression Treatment Preferences of Hispanic Individuals: Exploring the Influence of Ethnicity, Language, and Explanatory Models

The Journal of the American Board of Family Medicine

Erik Fernandez y Garcia³  Robert A. Bell¹  Anthony Jerant²  Richard L. Kravitz⁴  Peter Franks³ 

[1] Center for Healthcare Policy and Research (PF, RAB, RLK), University of California–Davis School of Medicine;Departments of Family and Community Medicine (PF, AJ), University of California–Davis School of Medicine;Department of Pediatrics, Division of General Pediatrics (EFyG), University of California–Davis School of Medicine;Internal Medicine (RLK), University of California–Davis School of Medicine

关键词: Depression;    Illness Representation Models;    Minority Health;    Treatment Preferences;   

DOI  :  10.3122/jabfm.2011.01.100118

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: There is uncertainty regarding Hispanic individuals’ depression treatment preferences, particularly regarding antidepressant medication, the most available primary care option. We assessed whether this uncertainty reflected heterogeneity among subgroups of Hispanic persons and investigated possible mechanisms. Specifically, we examined factors associated with medication preferences in non-Hispanic white and Spanish-speaking and English-speaking Hispanic persons.

Methods: We analyzed data from a follow-up telephone interview of 839 non-Hispanic white and 139 Hispanic respondents originally surveyed via the 2008 California Behavioral Risk Factor Surveillance System. Measures included treatment preferences (for treatment plans including vs not including antidepressants); depression history and current symptoms; sociodemographics; and psychological measures.

Results: Compared with non-Hispanic white respondents (adjusting for age, sex, history of depression diagnosis, and current depression symptoms), Spanish-speaking Hispanic (adjusted odds ratio [AOR] 0.41; 95% CI, 0.19–0.90) but not English-speaking Hispanic (AOR, 1.18; 95% CI, 0.60–2.33) respondents had a lower preference for antidepressant inclusive options. Endorsing a biomedical explanation of depression was associated with a preference for antidepressant inclusive options (AOR, 4.76; 95% CI, 3.13–7.14) for all respondents and accounted for the effect of Spanish-language interview. Accounting for other factors did not change these relationships, although older age and history of depression diagnosis remained significant predictors of antidepressant inclusive treatment preference for all respondents.

Conclusions: Spanish-language interview and less belief in a biomedical explanation for depression were associated with Hispanic respondents’ lower preferences for pharmacologic treatment of depression; ethnicity was not. Understanding treatment preferences and illness beliefs could help optimize depression treatment in primary care.

• Depression
• Illness Representation Models
• Minority Health
• Treatment Preferences

Disparities in depression care between Hispanic and non-Hispanic white patients, such as underdiagnosis and undertreatment, persist after adjusting for care access barriers.^1–3 People of Hispanic ethnicity represent a large and growing population in the United States⁴ and, when compared with other groups, receive a disproportionate amount of depression care in primary care settings.^5,6 Depression is a common diagnosis for primary care practitioners and depression care disparities are an especially salient problem. Because antidepressants are the most commonly offered therapy in primary care,^7,8 understanding Hispanic patients’ attitudes toward the treatment of depression with medication may facilitate optimal care.^9,10

Relatively few studies have examined the attitudes of Hispanic individuals toward depression treatment. Karasz and Watkins¹¹ found that Hispanic patients feel that both antidepressants and counseling would be helpful treatments, but that counseling would be more helpful. Cooper et al¹² found Hispanic and white patients mostly were accepting of both treatments, but Hispanic patients were relatively less accepting of antidepressants and more accepting of counseling. Other studies suggest that Hispanic individuals prefer a combination of antidepressants and counseling over either alone¹³ and prefer counseling over antidepressants^14–16 at rates equal to¹⁶ or greater than¹⁵ white individuals.

Having a clear understanding of Hispanic patients’ antidepressant treatment preferences is important because for some patients counseling may be more effective when combined with antidepressant medication,¹⁷ in primary care antidepressant therapy is far more widely available than counseling,¹⁸ and preferences for a treatment that is effectively rationed could widen disparities. Though previous studies suggest that Hispanic patients may prefer counseling, mixed findings and methodological limitations temper this conclusion. First, most previous studies involved small or homogeneous samples, precluding exploration of differences among subgroups of Hispanic individuals. This is a key limitation because Hispanic identity subsumes a number of cultural, racial, nativity, and generational groups, with differing patterns of mental health care use.^19,20 Language preference (English or Spanish) is a frequently measured identifier of heterogeneity among Hispanic persons in both research and clinical resource planning.^14,21–23 Language is not only a marker of acculturation²⁴; it also correlates with other important mediators of depression care preferences such as access to care.^25,26 Second, previous experiences with and current symptoms of depression (which may influence treatment attitudes^16,27) were inconsistently included in prior analyses. Third, some studies lacked a “no treatment” preference response option,^12,13 potentially biasing their findings. Finally, few studies explored the beliefs behind patient treatment preferences. Understanding such beliefs could be useful in guiding efforts to mitigate disparities in depression care.¹⁶

Based on the literature cited above and other literature about treatment attitudes,^16,25–36 we proposed a conceptual model for the relationship between predictors and mediators of predictors of a preference for treatment options that include antidepressant medication to address these limitations (illustrated in Figure 1). We then resurveyed a sample of respondents to the 2008 California Behavioral Risk Factor Surveillance System (BRFSS) to investigate 2 research questions in the context of the hypothesized model (Figure 1): (1) Is there significant heterogeneity in the preferences for treatment options that include antidepressants among English- or Spanish-speaking Hispanic respondents compared with non-Hispanic white respondents after adjusting for key potential correlates of treatment preference (age, sex, depression history, and current depression symptoms)? (2) To the extent that significant heterogeneity does exist, what factors mediate the differences in Hispanic respondent language subgroups’ preference for treatment options that include antidepressants? We examined the extent to which Hispanic respondents’ attitudes toward antidepressants might be mediated by socioeconomic, health care access–related, and psychological factors that have been shown in previous studies to influence attitudes toward medical treatments (depression illness representation models,^28–30 perceived stigma of depression,^31,32 toughness,^33–35 and religiosity^30,32,36) (Figure 1).

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Figure 1.

Hypothesized relationship of respondent characteristics and mediators of preferences for treatment options that include antidepressant medications.

【 授权许可】

Unknown   

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