direction of improving care for Americans with depression studies Chinese immigrants

Two recent studies conducted by the Massachusetts General Hospital (MGH) psychiatrists have investigated ways of improving the treatment of depression in Chinese American immigrants, a group that tends to avoid treatment of mental health due to traditional cultural beliefs . A study evaluates the effectiveness of telepsychiatry based on a model previously developed for the treatment of cultural sensitivity version, and the other examines the impact of stigma on the results of treatment of depression. Both studies have been published in Journal of Clinical Psychiatry .

“We know that stigma tends to lead underground diseases and leads to delays in seeking treatment, which has been shown in diseases such as HIV / AIDS, disorders of substance use and physical disabilities, “Justin says Chen, MD, MPH, of the MGH Department of Psychiatry, who led the study stigma. “The Chinese traditional beliefs stigmatize immigrants largely mental illness, they often equated with moral fault of the sick and fearing contagion.”

To help combat the reluctance of the Chinese to seek treatment for depression, a team led by Albert Yeung, MD, ScD, also of MGH Psychiatry and the leader of telepsychiatry study, previously developed treatment Collaboration American immigrants cultural sensitivity (CSCT) model that includes screening all patients primary care for depression symptoms before a doctor’s visit and for which screening a particularly positive designed evaluation that focuses on the beliefs of patients about their symptom.

A study led by Yeung and published in December 2010 American Journal of Public Health assay CSCT conducted at Creek Community Health Center South, which serves Chinatown community of Boston described . The study found that the use of CSCT was feasible and effective in helping patients recognize and seek treatment for depression, increased nearly sevenfold treatment participation.

For their study, which was designed to address the shortage of professionals with cultural knowledge and language skills necessary to treat these patients health, Yeung added a telepsychiatry CSCT component model. Carried out in the South Cove 2009-2012, the study randomized a group of 190 patients who do not speak English who tested positive for depression to receive the usual treatment, which did not include CSCT, or based version of telepsychiatry CSCT.

While both groups had a videoconferenced initial interview at the South Cove with a bilingual psychiatrist, he was given the special charge CSCT only the telemedicine group. Participants were also assigned a bilingual case manager, which controls and consolidates its treatment and regular phone made “visits” during the entire study period of six months. During those calls attention manager evaluated the symptoms of the participants and discuss how well they adhere to their recommended treatment and whether those taking antidepressants were experiencing any adverse side effects.

At the end of the study period, participants in the telemedicine group-CSCT had significantly higher depression symptoms than the usual care group. “Our results show that telepsychiatry is technologically feasible and acceptable to this population,” said Yeung, who is associate professor of psychiatry at Harvard Medical School professor. “Telepsiquiatry could allow this type of services delivered to patients in geographically remote areas, and combining it with CSCT provides a model to overcome the limited availability of bilingual and bicultural doctors in this country.”

Chen conducted their study on the same group of patients who were enrolled in the study Yeung. Among the initial assessments of both groups in the study were telepsychiatry measures of disease beliefs participants, including questions designed to assess stigmatizing attitudes towards their own symptoms. As part of this study, all participants had bi-monthly evaluations conducted by telephone symptoms of depression and quality of life in general.

At the end of the study period of six months, participants who had exhibited the highest levels of stigma to their symptoms at first showed less improvement in symptoms of depression and quality of life those with the lowest scores initial stigma. The association between baseline stigmatizing attitudes and the result of treatment of depression was observed in both telemedicine and control groups Yeung study.

An instructor in psychiatry at the School of Medicine at Harvard, Chen said, “Chinese traditional communities stigmatize largely mental illness, partly because the concept of” face “, reflecting a person’s or moral position of a family within the community. However, the effect of stigma on actual results in the treatment of depression has never been studied before and certainly not in minority populations. Our study suggests that beliefs stigmatizing may exercise one negative independent effect on the results of depression. As a separate but related matter, we hypothesized that cultural sensitivity treatment could modify the effects of stigma on depression outcomes, but our results suggest that culturally sensitive diagnosis and care management alone are not sufficient to mitigate the harmful effects of stigma. “

Yeung added: “While patients benefit from telepsychiatry-augmented CSCT, those with higher levels of stigma tend to have worse results Future research should include more education and demystify mental illness to help reduce stigma. along with the investigation of patient characteristics that can help reduce the stigma or. also we are hoping to spread the telepsychiatry-CSCT different populations and groups in different geographic locations model, which will require the training of doctors mental health and care managers, education of primary care providers and support of local primary care clinics. ”

The telepsychiatry study, which was published in the August issue of Journal of Clinical Psychiatry was supported by the National Institutes of Health grant RO1 MH079831.

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