A University of Texas at Arlington researcher hopes to dispel myths about depression and its treatment, as well as reduce the stigma associated with receiving mental health care among Hispanics.
Katherine Sanchez, assistant professor in the School of Social Work, recently won a two-year $200,000 grant from the Centers for Medicare and Medicaid Services (CMS) to screen Hispanic patients for depression and educate them about the disease and the treatment options available.
The highly competitive Hispanic Health Services Research Grant Program was open to health services/disparities researchers seeking to improve health-related attitudes, knowledge, beliefs and practices related to chronic health conditions such as heart disease and diabetes among Hispanics. Sanchez said mental health was on the list, but at the bottom.
"I made a compelling case for depression's significant impact on chronic disease and overall health, but more importantly, the stigma associated with seeking treatment for mental heath disorders in Latino populations," she said.
"The stigma is primarily perpetuated due to inadequate disease literacy and cultural factors. Common concerns among Latinos include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills or worry over what those in the home environment might say."
Sanchez said reactions from family members typically include questions such as, "What are you taking the medicine for? You're not depressed. What do you mean the doctor said you're depressed?"
"There's just a lot of stigma around mental illness," she said.
Dr. Madhukar Trivedi is a professor of psychiatry, director of the Depression Center at UT Southwestern Medical Center and a world-renowned depression researcher. He serves as Sanchez's collaborator on the project and encouraged her to apply for the CMS grant.
"Improving the education for depression in the Hispanic population is a major need and it is a tribute to Dr. Sanchez for having obtained funding for this highly competitive project," Trivedi said. "Compelling research has shown that a lack of awareness of the toll depression takes in the lives of patients with depression remains the biggest hurdle in improving the outcomes for this serious medical illness."
Through her health services research, Sanchez will use an iPad Depression Screening technology developed by Dr. Trivedi to screen patients at the North Texas Area Community Health Center in Fort Worth, which serves a large number of Latino patients. The tablet-based screening tool will check for the nine symptoms of major depressive disorder based on responses to the Patient Health Questionnaire known as PHQ-9.
"In answering these questions, patients might not recognize that the fatigue or their sense of feeling down might be depression as opposed to a physical illness," Sanchez said. "Because of the trusted relationship that patients have with their primary care provider, they are more likely to seek help there first. They might tell of their loss of interest or pleasure, lack of hope or changes in appetite."
For patients who screen positive for depression, the primary care provider will immediately connection them with a depression educator, a practice known as a "warm hand off," which establishes rapport and instills a sense of trust.
The patient will be invited to participate in the Depression Education Intervention (DEI) with a clinical social worker who will receive specialized training as a depression educator. The DEI is designed to enhance the awareness and understanding of depression, its role in chronic disease, its impact on Hispanic populations and the multitude of barriers to effective treatment.
The DEI will be provided in one individual session in the presence of support by family members or loved ones, if desired. The DEI will be provided in English or Spanish depending on patient preference, to reduce stigma and enhance the comfort of patients to ask questions and discuss fears.
Sanchez said that in primary care settings, even the physicians are not always aware that depression exists or what to do about it.
"They're very busy, treating multiple chronic conditions and depression might not even be on their radar," she said. "But if we can screen patients with the PHQ-9 and facilitate a warm hand off to a social worker who will educate them on what depression is, then it puts the decision in their hands about what's next. Treatment doesn't have to be medication. If they want counseling, hopefully we can get them access to that. Maybe it's about changing their lifestyle."
Liz Trevino Dawson, chief executive officer of North Texas Area Community Health Center, Inc., said the clinics welcome "the opportunity to provide this depression screening and depression education intervention to those patients in need of mental health education and treatment."
Once the technology is in place, Sanchez will begin meeting with providers at the clinic about the two-year project. Dr. Trivedi and Sanchez will train the physicians, nurse practitioners and other clinic staff about the depression screening technology. The Centers for Medicare and Medicaid Services grant will be used to hire a social worker and project coordinator, purchase the technology platform and develop patient education materials about depression.