Specialized treatment improves mental health for depressed African American and Latino seniors

By Eve Harris

Integrating specialized depression care into primary care medicine can improve the mental health of African American and Latino seniors, according to a study by UCSF researchers.

Findings appear in the April 2005 issue of Medical Care.

In a randomized clinical trial, participants who were diagnosed as depressed and were white, Latino, or African American received either routine depression treatment from primary care providers (usual care) or treatment coordinated through a depression care manager working with the primary care provider (collaborative care). Collaborative care, also called specialized care, includes provider education, treatment monitoring and greater utilization of community resources and is not widely available to patients of any age, the researchers said.

In a study control group, patients were encouraged to continue the care they were receiving regardless of the setting.

All patients in the study who received specialized care demonstrated improvement in both their depressive symptoms and their physical functioning as measured by standard testing.

The UCSF research was part of Project IMPACT, which followed 1801 men and women ages 60 and older with major depressive symptoms for 12 months.  Sponsored by the California Healthcare Foundation and John A. Hartford Foundation, IMPACT is the largest clinical trial of late-life depression to date.  Participants were from 18 primary care clinics across the U.S.

“Our study findings show that by reducing barriers to specialized treatment, older Latinos and African Americans are more likely to make use of mental health services. This is one way to address the historical disparity in their care,” said first author Patricia Areán, PhD, associate professor in the UCSF Department of Psychiatry.

Very few cultural accommodations were made to the collaborative care group, and the researchers did not evaluate cultural competence among the providers. All participants were English speakers. “Results showed that a collaborative care model designed to meet patient needs is highly effective in treating depressed ethnic minority patients regardless of cultural adaptation,” Areán said.

According to the UCSF research team, depression affects as many as 10 percent of seniors in the U.S. and has a deleterious effect on physical health. Most Americans receive depression treatment through primary care physicians even though studies have shown that specialized care is more effective, whether provided in mental health settings or by specialists within primary care settings.

The researchers also note that although depression is a treatable disorder, age and ethnic minority status are documented barriers to care. Due to social stigma, socioeconomic factors and fragile health, a greater proportion of older African Americans and Latinos receive no specialized care.

According to the researchers, previous studies have shown that ethnic minority patients have worse mental health outcomes than non-minority patients and seniors have worse outcomes than younger people. It has also been previously demonstrated that improving access to care will improve outcomes for both groups. Therefore, the UCSF team postulated, removing barriers to care and supplementing the mental health resources available would benefit African American and Latino seniors in pursuit of depression care.

The collaborative care patients viewed a 20-minute video and received written information about late-life depression. They met with a clinical specialist, typically a nurse or psychologist trained in treating depression. Usually medication was prescribed or short- term therapy was provided, based on patient preference. Follow up care was provided for one year in accordance with Agency for Health Care Policy and Research guidelines.

The UCSF-led study was supported by grants from the John. A. Hartford Foundation, California Healthcare Foundation, Hogg Foundation, and Robert Wood Johnson Foundation.

The 18 study sites that were part of the IMPACT Project are Duke University, South Texas Veterans Health Care System, Central Texas Veterans Health Care System, San Antonio Preventive and Diagnostic Medicine Clinic, Indiana University School of Medicine, Health and Hospital Corporation of Marion County in Indiana, Group Health Cooperative of Puget Sound in cooperation with the University of Washington, Kaiser Permanente of Northern California, Kaiser Permanente of Southern California, and Desert Medical Group in Palm Springs, CA.

Additional authors are Liat Ayalon, PhD, UCSF; Enid Hunkeler, MA, Kaiser Permanente, Oakland, CA; Elizabeth H.B. Lin, MD, MPH, Center for Health Studies, Seattle; Lingqi Tang, PhD, UCLA; Linda Harpole, MD, Duke University; Hugh Hendrie, MD, Indiana University; John W. Willians, Jr., MD, MHSc, Department of Veterans Affairs and Duke University; and Jurgen Unutzer, MD, MPH, UCLA.