228907 Barriers and facilitators to depression treatment completion among low-income, minority patients seeking care within a public emergency department

Tuesday, November 9, 2010 : 12:45 PM - 1:00 PM

Anjanette Wells, PhD, MSW , George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO
Isabel Lagomasino, MD, MSHS , Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA
Diana Gonzalez, BA , Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA
Jeniffer Green, MSW , Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA
  
The Emergency Department (ED) is an initial point of contact for depression among low-income, minority patients accessing a public sector care system. This study explored barriers and facilitators to participation and completion of depression treatment among this population.

Semi-structured interviews were conducted with 24 predominately Latina patients with significant symptoms of depression who were randomized to a 12-week depression intervention, but attended less than 3 weekly treatment sessions with study social worker.

Using a grounded theory qualitative approach to code and analyze interview notes, five categories of emerging themes arose: Depression perspectives, readiness for depression care, treatment barriers, reasons for dropout or completion, and ways to reduce dropout. Eighteen (75%) were aware they were depressed and needed help, yet lacked motivation. Six (25%) were unaware they were depressed, were reluctant to initiate treatment, and noted no one had ever spoken about depression. Although consented and enrolled in study, 11 (46%) patients stated they were reluctant to engage in and continue treatment due to concerns about medication costs. Seven (29%) worried medication might be addictive; have significant side effects; or interact with other medications. Patients favored psychotherapy over medication. Barriers included transportation; employment; immigration documentation worries; provider-patient dissatisfaction. Patients valued social worker, but desired more consistency and telephone counseling. Patients were reluctant to discuss depression with physicians.

Findings highlight importance of social workers improving social justice issues for patients in a public ED by incorporating: culturally- and linguistically-sensitive psychosocial assessments; psycho-education, motivational intervention components; and improved access and depression care quality.

Learning Areas:
Administer health education strategies, interventions and programs
Clinical medicine applied in public health
Diversity and culture
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Identify the barriers and facilitators to low-income, minority Emergency Department patient participation and completion of depression treatment, within the context of a depression effectiveness treatment trial.

Keywords: Depression, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am a researcher with a major university and I do clinical cancer communication and related research on preventive and treamtent programs. My work attempts to improve adherence for medically and mentally ill patients and those in need of cancer preventive measures.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4217.0: Eliminating health and mental health disparities in access to care