Uptake of Depression Treatment among Latinos in Integrated Primary Care: A mixed methods analysisedit
Despite high lifetime risk for depressive disorder, Latinos under-utilize mental health services as compared to non-Latino Whites, and are more likely to seek treatment for depression in primary care medical settings. Integrated behavioral health (IBH) in primary care is a promising service model for facilitating access to mental health care among Latinos. Yet, while IBH is a mandate of the Affordable Care Act (ACA), research has not addressed whether IBH facilitates entry into needed behavioral health services for Latinos. The aims of this mixed methods study are: (1) To identify specific sociodemographic and contextual factors in the referral processes that predict psychotherapy initiation for depressed Latinos within an IBH setting; and (2) To qualitatively explore why Latino patients decide to follow-up or not with behavioral health treatment upon referral. To achieve Aim 1, predictor analysis was performed on medical records data (N=431). To achieve Aim 2, qualitative semi-structured interviews were conducted with a sub-sample of depressed Latino patients (N=16) referred for IBH depression treatment. Results point to differences in treatment uptake based on referral type between English-speaking and Spanish-speaking Latinos. English-speaking Latinos were four times less likely to attend an initial visit if they received a personal introduction from their medical provider to the behavioral health provider (“warm handoff”), as compared to those who did not receive a personal introduction during referral. Qualitative findings suggest that not all warm handoff referrals are experienced as “warm”, and that the strength of the patient-provider relationship is a key component affecting patients’ experience of the referral, and subsequent decision to engage in depression treatment or not. Future studies should explore specific dimensions contributing to the quality of referral to better address the spectrum of psychosocial and cultural needs of depressed Latinos and engage them into care.