Clinical Implications of Depression-Based Stigma

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DESCRIPTION (provided by applicant): This grant examines stigma as it relates to depressive illness. Depressive disorders are among the most significant contributors to disability and reduced quality of life worldwide, but most patients don't receive appropriate care. This is particularly true of ethnic minorities and the poor. In this grant, we examine the extent to which stigma related concerns explain failure to receive appropriate care for depression. Specifically, we examine the extent to which concerns about depression-related stigma, such as fears about losing a job, insurance, or friends due to other people's awareness of illness or treatment, explain unmet need for depression care. We will also investigate if efforts to provide treatments or improve rates of treatment predict outcomes for both persons with and without stigma concerns. We use two existing data sets: (1) Partners in Care, a randomized, controlled trial of improving quality care for depression in primary health care settings and (2) We Care, a randomized controlled trial of providing access to guideline care (either CBT or paroxetine) for disadvantaged, young minority women. These studies allow us to examine the impact of stigma related concerns on acceptance and outcomes of depression care and include large samples of poor and ethnic minorities. Finally, we include stigma items in a nationally representative community study, Healthcare for Communities, funded by the Robert Wood Johnson Foundation that will allow us to estimate rates of depression-related stigma in a nationally representative sample. The specific aims of this grant are: 1) to assess rates of concerns about depression-related stigma in a nationally representative community sample; 2) to determine the impact of concerns about depression-related stigma on use of mental health services, controlling for need, predisposing, and enabling factors known to affect access to care; 3) to examine whether interventions to increase the use of guideline-concordant primary care treatments for depression are effective at improving the quality of care for both persons with high and low levels of concern about depression-related stigma; 4) to examine whether use of guideline-concordant treatments for depression (as opposed to quality improvement programs that promote access to those treatments) improve outcomes for both persons with high and low concerns about depression related stigma. Within each of the aims, we will explore the extent to which the findings vary by ethnicity.