Effectiveness of Culturally Based Congruent Care in Treating Hispanics With Major Depressive Disorder

Major depressive disorder (MDD) is a type of depression that is characterized by a
combination of symptoms that can interfere with the ability to work, study, sleep, eat, and
enjoy activities that were once pleasurable. Studies have shown that individuals of Hispanic
descent underutilize specialized mental health care services (SMHS), despite their need for
it. In addition, Hispanic individuals have been associated with lower rates of retention in
specialized mental health treatment. In particular, dropout rates from medication therapy
for the treatment of MDD within SMHS are two to three times higher in Hispanics than in
non-Hispanic whites. This study will develop and evaluate the effectiveness of a
culturally-based program that aims to facilitate entry, retention, and successful treatment
in specialized mental health services for Hispanics with MDD.

This open-label study will consist of four phases. Participants will be recommended for
inclusion in the study upon receiving a diagnosis of MDD based on a standard health
questionnaire completed in their primary care physician's office. Phase 1 of the study will
entail an initial evaluation of the culturally congruent program of care for Hispanics with
MDD (CCP-MDD). Participants will be placed in one of two focus groups, each composed of 8 to
10 people. One group will include individuals referred by their primary care physician. The
other group will include family members of Hispanics with MDD. Discussions will focus on
participants' understandings of depression-like illness, their treatment expectations for
these conditions, and their perceived barriers to SMHS utilization. Information gathered in
the focus groups will be used to develop a second version of CCP-MDD. Phase 2 of the study
will evaluate the revised version of CCP-MDD and will include additional treatments with
antidepressant medication, weekly interpersonal psychotherapy, or a combination of the two.
Following treatment, participants will take part in a focus group, which will involve
participant feedback.

Based on the information obtained in the focus groups and from clinical observations, a
third version of CCP-MDD will be developed. In Phase 3, two sets of primary care offices
will participate. One set will be assigned to the intervention arm, and receive the third
version of the CCP-MDD intervention. A second set will be assigned to the control arm and
receive usual referral to mental health services at the research site. All participants
will be offered the same choice of treatments: antidepressant medication, weekly
interpersonal psychotherapy, or a combination of the two. Treatment in both arms will be of
the same duration, 18 wks. Focus groups will be held following treatment in order to obtain
information about individuals' satisfaction or dissatisfaction with their care. Based on
these findings, as well as clinical observations, a fourth and final version of CCP-MDD will
be developed in Phase 4. All treatments will last a total of 18 weeks. A follow-up session
will be held at Week 30 to assess depressive symptoms.