Telephone-Based Depression Care for Rural Latino Primary Care Patients

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DESCRIPTION (provided by applicant): Among Latinos, depression is underdetected and undertreated. While specific manualized psychotherapies, such as cognitive behavioral therapy (CBT) have been shown effective for Latinos, and many Latinos prefer psychotherapy as first line treatment for depression, few Latinos receive such treatment. Latinos in rural areas face additional barriers to psychotherapy, including lack of available mental health providers and geographic isolation. In order to address these barriers, this proposed pilot will test a telephone-based CBT intervention for depressed low-income Latino primary care patients in rural Eastern Washington State. A manualized telephone CBT intervention shown effective in an urban managed care setting among English-speaking patients has been translated into Spanish and will be minimally adapted and then tested among 80 low-income Latino women and men with depressive disorder who will be identified through systematic screening and randomized to the study intervention vs. usual care. Outcomes will be measured at baseline, 6 weeks, and 3 and 6 months. We will examine the effect of the intervention on: depressive symptoms (the primary outcome) as well as patient-rated improvement, patient satisfaction, disability, and health risk behaviors (secondary outcomes). We will also estimate the direct costs of the intervention. Using qualitative exit interviews of patients and providers, the study will explore socio-cultural and practical barriers to depression care in this population and the need to further adapt the intervention to address these barriers. An expert panel guided by a conceptual model of culturally sensitive clinical interventions for Latino patients will use study results to further adapt and refine the intervention in regards to 8 key elements: language, persons, metaphors, content, concepts, goals, methods, and context. The study's ultimate objective is to develop a culturally appropriate, sustainable, and cost-effective depression treatment program that can be incorporated into routine primary care practices serving low-income rural Latinos and that can be tested in a full scale randomized controlled trial. To our knowledge, ours is the first study to examine the effectiveness of CBT in a rural Latino population. PERFORMANCE SITE(S) (organization, city, state) Yakima Valley Farmworkers Clinic's Family Medical Center, Walla Walla, Washington University of Washington, Seattle, Washington This pilot study tests a telephone-based cognitive behavioral therapy intervention for depressed low-income Latino primary care patients in rural Eastern Washington. It minimally adapts a manualized telephone CBT shown effective in an urban managed care setting. To our knowledge, ours is the first study to examine the effectiveness of CBT in a rural Latino population.