title: Impact of motivational pharmacotherapy on treatment retention among depressed Latinos.
abstract: Compared to non-Latino Whites, U.S. racial/ethnic minority groups show higher non-adherence with outpatient antidepressant therapy, including lower retention, despite adjusting for sociodemographic and insurance covariates. Culturally salient concerns about antidepressants leading to ambivalence about treatment engagement may contribute to this discrepancy. To improve treatment adherence among depressed Latinos, we developed motivational pharmacotherapy, a novel approach that combines motivational interviewing, standard pharmacotherapy, and attention to Latino cultural concerns about antidepressants. This 12-week, open-trial, pre-post pilot study assessed the impact of motivational pharmacotherapy on antidepressant therapy retention, response (symptoms, functioning, and quality of life), and visit duration among n = 50 first-generation Latino outpatients with major depressive disorder. At study endpoint, 20% of patients discontinued treatment, with a mean therapy duration of 74.2 out of 84 days. Patients' symptoms, psychosocial functioning, and quality of life improved significantly. Mean visit length was 36.7 minutes for visit 1 and 24.3 minutes for subsequent visits, compatible with use in community clinics. Responder and remitter rates were 82% and 68%. Compared to published Latino proportions of non-retention (32-53%) and previous studies at our clinic with similar samples and medications (36-46%), Motivational pharmacotherapy appears to improve Latino retention in antidepressant therapy and should be investigated further in controlled designs.
authors: Department of Psychiatry, Columbia University, New York State Psychiatric Institute, USA.
authors: Roberto
authors: R
authors: Lewis-Fernández
authors: Iván C
authors: IC
authors: Balán
authors: Sapana R
authors: SR
authors: Patel
authors: J Arturo
authors: JA
authors: Sánchez-Lacay
authors: César
authors: C
authors: Alfonso
authors: Magdaliz
authors: M
authors: Gorritz
authors: Carlos
authors: C
authors: Blanco
authors: Andrew
authors: A
authors: Schmidt
authors: Huiping
authors: H
authors: Jiang
authors: Franklin
authors: F
authors: Schneier
authors: Theresa B
authors: TB
authors: Moyers
mesh_terms: D000069:Acculturation; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000208:ethnology / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008913:Minority Groups; D062405:Motivational Interviewing; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000208:ethnology* / Q000523:psychology; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D013997:Time Factors; D014481:United States
chemical_list: D000928:Antidepressive Agents
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