Primary care depression screening and management among a multilingual patient population in a public safety net hospital

Background: The Cambridge Health Alliance has adopted the “Planned Care” model for primary care depression management that includes screening eligible patients with the PHQ-9 and algorithm-guided management. Methods: To examine disparities associated with the “Planned Care” program, patients who speak English, Spanish, Portuguese, and other languages were compared on several parameters including screening rates, PHQ-9 scores, depression diagnosis and management. Results: As of 12/07, 8669 patients completed the PHQ-9. Of eligible patients, 67.4% were screened (monitored 7/07-9/07), with similar screening rates for English- and non-English speakers. Overall, 17.8% of patients scored 10 or above, the cutoff for identifying probable depressive-spectrum disorder (monitored 10/07-12/07). The percentage above threshold differed significantly by language (χ² = 7.94, 3df, p<0.05). Chart review of 70 patients scoring above threshold revealed that 57.1% received a depression diagnosis, 75.7% had a plan documented, 57.1% received active treatment (medication or mental health referral), and 18.6% were monitored. Within 12 weeks, 45.7% had at least 1 follow-up visit and 22.8% had at least 2 visits. There were no significant differences in these parameters among English-, Spanish-, or Portuguese-speakers. Conclusions: The proportion of patients screening positive for depression varied by language. Among the subsample audited, the “Planned Care” program was not associated with significant disparities in depression diagnosis or management. This program may improve depression detection among linguistic minorities in primary care and help overcome mental health disparities. Further analyses are needed to confirm findings in the entire population screened and to evaluate depression outcomes associated with this program.