DESEO: DEpression Screening and Education: Options to Reduce Barriers to Treatment (DESEO)

The purpose of this project is to implement 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.

Study Overview

• Status: Completed
• Conditions: Depression
• Intervention / Treatment: Behavioral: Depression Education Intervention

Detailed Description

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.

Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with comorbid physical health conditions. Hispanics, in particular, are more likely to receive mental health care 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.

Project Purpose, Goals and Objectives Purpose: The purpose of this project is to implement 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.

Goal #1: Patients who screen positive for depression will engage in the Depression Education Intervention (DEI) (two sessions) with a trained Depression Educator.

Objectives:

1. To increase knowledge of depression (signs/symptoms, causes, risk factors, treatment, cultural beliefs, and its role in chronic disease) among Hispanics in a primary care setting as measured by changes in scores from pre- to post- DEI on the Knowledge of Depression-MCQ scale.
2. To reduce perceived cultural stigma about depression and its treatment through a culturally and linguistically appropriate educational intervention as measured by changes in scores from pre- to post- DEI on the Stigma Checklist for Latinos in Primary Care.
3. To increase engagement in depression treatment in primary care by Hispanic patients as measured by the iPad Depression Screening application, which will record the treatment decision after the diagnosis and measure the number of patients engaged in depression treatment of any kind (pharmacotherapy, counseling, other behavioral intervention) at the time of the DEI and one month after completion of the DEI.

Goal #2: In order to identify patients with depression, all adult primary care patients will be screened for depression utilizing the 9-item Patient Health Questionnaire (PHQ-9) via the iPad Depression Screening application.

Objectives:

1. To systematically screen all adult primary care patients with an iPad Depression Screening application as measured by number of patients screened compared to the number eligible for screening.
2. To increase provider detection of depression in patients through the proper use and interpretation of the PHQ-9 as measured by depression diagnoses recorded in the EHR.

• Study Type: Interventional
• Enrollment (Actual): 350
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Adult primary care patients

Exclusion Criteria:

• previous diagnosis of depression and currently in treatment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Intervention; Depression Education Intervention	Behavioral: Depression Education Intervention; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The number of Hispanic patients diagnosed with depression who went on to begin depression treatment.	One month post DEI

Collaborators and Investigators

• Sponsor: The University of Texas at Arlington
• Collaborators: University of Texas Southwestern Medical Center
• Investigators: Principal Investigator: Katherine Sanchez, PhD, The University of Texas at Arlington

Publications and helpful links

General Publications

• 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 Fam Pract. 2019 Oct 21;20(1):140. doi: 10.1186/s12875-019-1031-7.
• Lopez V, Sanchez K, Killian MO, Eghaneyan BH. Depression screening and education: an examination of mental health literacy and stigma in a sample of Hispanic women. BMC Public Health. 2018 May 22;18(1):646. doi: 10.1186/s12889-018-5516-4.
• 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 Jul 29;16:322. doi: 10.1186/s12913-016-1575-3.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Actual): September 30, 2017
• Study Completion (Actual): September 30, 2017

Study Registration Dates

• First Submitted: July 2, 2015
• First Submitted That Met QC Criteria: July 6, 2015
• First Posted (Estimate): July 7, 2015

Study Record Updates

• Last Update Posted (Actual): July 10, 2018
• Last Update Submitted That Met QC Criteria: July 6, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Keywords: Depression; Hispanics; Stigma; Barriers to Treatment
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Mood Disorders; Depression; Depressive Disorder
• Other Study ID Numbers: 2015-0336

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No