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APHA Scientific Session and Event Listing

Diana Ramirez, MD, Ella Leers, MD, and Jean Burg, MD. Family Practice, Health Center at Tremont, 1826 Arthur Avenue 2nd Floor, Bronx, NY 10457, 718-918-8750, dianar69@aol.com

Depression is difficult to diagnose and treat in undeserved communities. Primary care providers are limited in treating poor, disenfranchised populations, particularly since structural issues like poverty, violence, isolation and inequality are directly linked to depression. From October 2003 to May 2004 primary care patients at a Southeast Bronx community public clinic were screened for depression using the PHQ-2 and PHQ-9 questionnaires –validated depression screening tools. Of the 236 patients screened 37% were found to be clinically depressed. This is more than double the life time prevalence of 16 % reported by the US National Institute of Mental Health. A program was implemented to address the patients with untreated depression. It consisted of multiple regular physician follow-up visits using a motivational interview model, anti-depressant medication, and bi-weekly group sessions. The group's curriculum is planned every three months along with the patients' input to address specific needs including learning about mental health diseases and treatment options as well as concrete workshops in life skills. Initially depression treatment outcomes will be measured using the PHQ 9 at weeks 4, 8, 12 and 24. A simple depression screening tool can detect high rates of undiagnosed depression in underserved communities, and can be reproduced in primary care settings.. Multiple physician follow-up visits can help patients to build a more effective and sustainable treatment plan, including anti-depressants if needed. Life-skill workshops, and group interventions have the potential of improving depression outcomes by having patients deal with contextual causes of depression like poverty, violence, and isolation.

Learning Objectives:

• Recognize the need to detect high levels of undiagnosed depression in underserved and disenfranchised communities.
• Identify the role of primary care providers in addressing novel ways to treat depression in underserved communities.
• Develop a plan to treat depression via motivational interviews and group sessions.

Keywords: Underserved Populations, Depression

Presenting author's disclosure statement:

Not Answered