Effectiveness of Telepsychiatry-based Culturally Sensitive Collaborative Treatment of Depressed Chinese Americans

Telepsychiatry-based CSCT (T-CSCT):

Live and interactive Telepsychiatry (using videoconferencing) brings tremendous
opportunities to clinical care, education, research, and administration. In the U.S. to
date, telepsychiatry has been implemented in rural areas where people lack access to
psychiatrists (Baer et al, 1997), in the Prison System with service users constrained from
traveling (Brecht et al., 1996), in rural native American resettlement areas (Shore & Spero,
2005), and in Alaska where residents are faced with both distance and a shortage of mental
health professionals. In this proposed study, we plan to investigate the effectiveness of
telepsychiatry-based CSCT (T-CSCT) to provide culturally sensitive collaborative management
of MDD to monolingual Chinese Americans. For this group of patients, telepsychiatry
consultation could be a necessity both in urban as well as rural primary care clinics that
are not staffed with bilingual psychiatrists. T-CSCT plans to utilize the advanced
telemedicine technology in major academic centers to connect the scarce resource of
bilingual and bicultural mental health professionals to underserved Chinese Americans to
improve their access to treatment of MDD.

T-CSCT will explore the usefulness and effectiveness of recognizing MDD subjects through
consumer-initiated depression self-screening using the validated CB-PHQ-9, which will be
made available in community newspapers, journals, and on the internet. To facilitate care
management for Chinese Americans, a Depression Toolkit for Chinese Americans will be
developed, which will include information on the nature and treatment of MDD, the CB-PHQ-9
for depression self-screening, a bilingual instrument to monitor progress of depressive
symptoms, strategies for patients to negotiate with health professionals for individually
tailored treatment for depression, and answers to frequently asked questions (FAQs) by Asian
American immigrants on MDD and its treatment. If shown to be effective, the T-CSCT can be
the prototype of a telemedicine-based Multiracial Mental Health Resource Center to provide
services to other minority populations to reduce disparities in mental health treatment.

Inclusion Criteria:

1. Individuals with Chinese ethnicity, defined as people who self-identify as being
Chinese based upon having either one or both parents being ethnic Chinese.

2. Monolingual Chinese American immigrants, defined as people who require or prefer to
be interviewed in Chinese (including Cantonese, Taiwanese, Mandarin, and Toisanese
dialects).

3. Men or women age 18 or older, who live in the greater Boston area.

4. Individuals who are competent to consent and have completed a written consent form.

5. Individuals who have a PCP.

6. Patients who screen positive for MDD, current according to the fourth version of the
Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) as diagnosed by the
Mini International Neuropsychiatric Interview (MINI; Sheehan et al, 1998)

7. Individuals who are willing to receive phone interviews for monitoring of symptoms
and for additional support (care management) if available.

Exclusion Criteria:

1. Patients with serious suicidal risk.

2. Patients with unstable medical illnesses requiring imminent hospitalization or
rendering patients unsuitable for clinical interview.

d. Patients with comorbid severe mental disorders including:

1. Organic mental disorders.

2. Alcohol or substance abuse disorders active within the last year.

3. Schizophrenia.

4. Delusional disorder.

5. Psychotic disorders not elsewhere classified.

6. Bipolar disorder. e. Patients with history of treatment by a psychiatrist in the past
4 months.