Effectiveness of Culturally Based Congruent Care in Treating Hispanics With Major Depressive Disorder
Condition: Depression
MeSH terms: Depression; Depressive Disorder; Depressive Disorder, Major
Study type: Interventional

Summary: 
      This study will develop and evaluate the effectiveness of a culturally based program that
      aims to facilitate entry, retention, and successful treatment in specialized mental health
      services for Hispanics with major depressive disorder.
    

Detailed description: 
      Major depressive disorder (MDD) is a type of depression that is characterized by a
      combination of symptoms that can interfere with the ability to work, study, sleep, eat, and
      enjoy activities that were once pleasurable. Studies have shown that individuals of Hispanic
      descent underutilize specialized mental health care services (SMHS), despite their need for
      it. In addition, Hispanic individuals have been associated with lower rates of retention in
      specialized mental health treatment. In particular, dropout rates from medication therapy for
      the treatment of MDD within SMHS are two to three times higher in Hispanics than in
      non-Hispanic whites. This study will develop and evaluate the effectiveness of a
      culturally-based program that aims to facilitate entry, retention, and successful treatment
      in specialized mental health services for Hispanics with MDD.

      This open-label study will consist of four phases. Participants will be recommended for
      inclusion in the study upon receiving a diagnosis of MDD based on a standard health
      questionnaire completed in their primary care physician's office. Phase 1 of the study will
      entail an initial evaluation of the culturally congruent program of care for Hispanics with
      MDD (CCP-MDD). Participants will be placed in one of two focus groups, each composed of 8 to
      10 people. One group will include individuals referred by their primary care physician. The
      other group will include family members of Hispanics with MDD. Discussions will focus on
      participants' understandings of depression-like illness, their treatment expectations for
      these conditions, and their perceived barriers to SMHS utilization. Information gathered in
      the focus groups will be used to develop a second version of CCP-MDD. Phase 2 of the study
      will evaluate the revised version of CCP-MDD and will include additional treatments with
      antidepressant medication, weekly interpersonal psychotherapy, or a combination of the two.
      Following treatment, participants will take part in a focus group, which will involve
      participant feedback.

      Based on the information obtained in the focus groups and from clinical observations, a third
      version of CCP-MDD will be developed. In Phase 3, two sets of primary care offices will
      participate. One set will be assigned to the intervention arm, and receive the third version
      of the CCP-MDD intervention. A second set will be assigned to the control arm and receive
      usual referral to mental health services at the research site. All participants will be
      offered the same choice of treatments: antidepressant medication, weekly interpersonal
      psychotherapy, or a combination of the two. Treatment in both arms will be of the same
      duration, 18 wks. Focus groups will be held following treatment in order to obtain
      information about individuals' satisfaction or dissatisfaction with their care. Based on
      these findings, as well as clinical observations, a fourth and final version of CCP-MDD will
      be developed in Phase 4. All treatments will last a total of 18 weeks. A follow-up session
      will be held at Week 30 to assess depressive symptoms.
    

Intervention name(s): Culturally Congruent Assessment and Treatment
Intervention type(s): Behavioral
Intervention description(s): Referral, engagement, and treatment is done following the cultural formulation model in DSM-IV in which patients' views and expectations about depression treatment are included in the assessment and treatment process.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Major Depression; MDD; Hispanic; Primary Care; Cultural Congruence