Treating Depression and Anxiety Disorders in Latino Immigrants in Primary Care Settings

Authors: Stacey Kaltman, PhD, Carol Alter, MD, & Marianne Borelli, PhD

Background:
Primary care (PC) clinics represent an ideal setting for the treatment of common mental health disorders including depression and anxiety disorders. Collaborative care (CC) models which provide direct evidence-based treatment and care management with coordination of care between mental health professionals and the PC team have proven to be effective in the treatment of mental health disorders in the PC setting. However, little is known about the application of these models in the treatment of Latino immigrants in indigent care settings.

Method:
An adapted CC model is currently being implemented in a network of indigent care clinics in the Washington DC area that serve primarily immigrants from Central and South America. Patients meeting diagnostic criteria for depression, generalized anxiety disorder, and/or posttraumatic stress disorder (PTSD) were offered algorithm-based treatment. Treatment largely involved pharmacological intervention, care management, support/behavioral activation. In some cases, short-term cognitive behavioral therapy was offered. Patients were regularly assessed with objective assessment tools to monitor treatment effectiveness.

Results:
Preliminary data from two clinics suggested that patients were largely immigrants from Central and South America (74 %). Of patients referred to the program, 79% met screening criteria for major depression and 58% met screening criteria for generalized anxiety disorder. The prevalence of exposure to interpersonal and political violence was high (65 %), with 53% of those exposed to trauma meeting screening criteria for PTSD. In a subsample of patients with multiple assessments, the intervention was effective in reducing symptoms of depression (p < .001) and generalized anxiety (p < .05).

Conclusions:
The adapted CC model appears to be effective in treating common mental health disorders in Latino immigrants in indigent care clinics. Despite this initial success, more information regarding the cultural competence and acceptability of the interventions offered is needed to guide the expansion of this program.