title: The long-term trajectory of depression among Latinos in primary care and its relationship to depression care disparities.
abstract: OBJECTIVE
  Lower use of medication treatment, poorer doctor-patient communication (DPC) and depression stigma are key contributors to mental healthcare disparities among Latinos with depression. The current study investigated the relationship between these key variables and the long-term trajectory of depression in primary care among Latinos.
  
  
  METHODS
  Participants (N=220) were Latinos presenting to primary care who screened positive for depression. A repeated measures design was used to assess participants at baseline and 6, 25 and 30 months. Repeated measures included depression (Patient Health Questionnaire-9), self-reported quality of DPC and stigma pertaining to antidepressants. Using growth curve modeling, participants' depressive symptom trajectories were examined for a 30-month period. Self-reported utilization of antidepressants, DPC and antidepressant stigma were examined as predictors of the depressive symptom trajectory. In addition, rates of depression improvement/remission and recurrence/relapse were examined.
  
  
  RESULTS
  Improvement/remission was experienced by 69.4% of participants during a 30-month period. Among those who improved/remitted at 6 or 25 months, 63.4% maintained that improvement/remission by 30 months. The long-term trajectory of depressive symptoms demonstrated a significant positive association with antidepressant stigma and significant negative associations with use of antidepressant treatment and quality DPC.
  
  
  CONCLUSIONS
  While relapse/recurrence is common, most Latinos in this study experienced improvement in depression over 30 months. For many, there is a considerable time to reach improvement/remission. Also, these findings confirm the significance of antidepressant underutilization, DPC and stigma in the long-term outcome of depression among Latinos in primary care.
authors: Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, Lyons, NJ 08854, USA. alejandro.interian@va.gov
authors: Alejandro
authors: A
authors: Interian
authors: Alfonso
authors: A
authors: Ang
authors: Michael A
authors: MA
authors: Gara
authors: Michael A
authors: MA
authors: Rodriguez
authors: William A
authors: WA
authors: Vega
references: J Altern Complement Med. 2008 Jun;14(5):537-44
references: 18537468
references: Am J Psychiatry. 2007 Aug;164(8):1189-97
references: 17671281
references: Psychiatr Serv. 2007 Dec;58(12):1547-54
references: 18048555
references: Arch Gen Psychiatry. 2010 Jan;67(1):37-46
references: 20048221
references: Health Aff (Millwood). 2005 Mar-Apr;24(2):398-408
references: 15757923
references: JAMA. 2000 Jan 12;283(2):212-20
references: 10634337
references: Am J Community Psychol. 1999 Aug;27(4):567-95
references: 10573835
references: Health Serv Res. 2003 Apr;38(2):613-30
references: 12785564
references: Psychiatr Serv. 2010 Apr;61(4):373-9
references: 20360276
references: J Gen Intern Med. 2004 Feb;19(2):120-6
references: 15009791
references: J Gen Intern Med. 2001 Sep;16(9):606-13
references: 11556941
references: Compr Psychiatry. 2003 May-Jun;44(3):198-204
references: 12764707
references: Psychiatr Serv. 2005 Dec;56(12):1517-23
references: 16339612
references: Psychiatr Serv. 2001 Dec;52(12):1627-32
references: 11726754
references: Int J Neuropsychopharmacol. 2009 May;12(4):459-73
references: 18611293
references: Health Promot Pract. 2012 Nov;13(6):747-54
references: 21051325
references: J Immigr Minor Health. 2007 Jan;9(1):1-16
references: 17001516
references: Am J Psychiatry. 2006 Jan;163(1):101-8
references: 16390896
references: J Psychiatr Res. 2010 Nov;44(15):1043-51
references: 20537350
references: Cultur Divers Ethnic Minor Psychol. 2010 Apr;16(2):215-25
references: 20438160
references: J Affect Disord. 2003 Nov;77(2):97-108
references: 14607387
references: Med Care. 1999 Mar;37(3 Suppl):MS22-31
references: 10098556
references: Psychiatr Serv. 2008 Nov;59(11):1264-72
references: 18971402
references: Patient Educ Couns. 2007 Aug;67(3):324-32
references: 17509808
references: Arch Gen Psychiatry. 2009 Aug;66(8):848-56
references: 19652124
references: Psychiatr Serv. 2007 Dec;58(12):1591-4
references: 18048562
references: Med Care. 2003 Apr;41(4):479-89
references: 12665712
references: J Psychosom Res. 2005 Feb;58(2):163-71
references: 15820844
references: Psychiatr Serv. 2007 Mar;58(3):385-94
references: 17325113
references: Bull World Health Organ. 2000;78(4):439-45
references: 10885162
references: Psychiatr Serv. 2001 Dec;52(12):1621-6
references: 11726753
references: J Nerv Ment Dis. 2004 Apr;192(4):278-83
references: 15060401
references: Med Care. 2006 May;44(5):398-405
references: 16641657
references: Am J Public Health. 2007 Jan;97(1):76-83
references: 17138911
references: Arch Fam Med. 1998 Sep-Oct;7(5):443-9
references: 9755737
references: J Fam Pract. 1991 Feb;32(2):175-81
references: 1990046
references: Am J Psychiatry. 1999 Jun;156(6):928-34
references: 10360134
references: J Immigr Minor Health. 2007 Jan;9(1):17-28
references: 17006767
references: Med Care. 2003 Nov;41(11):1284-92
references: 14583691
references: J Gen Intern Med. 1999 Jul;14(7):409-17
references: 10417598
references: Med Care. 2008 Mar;46(3):247-56
references: 18388839
references: JAMA. 2002 Sep 18;288(11):1403-9
references: 12234237