title: Rationale and study protocol for a multi-component Health Information Technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting.
abstract: The prevalence rate of depression in primary care is high. Primary care providers serve as the initial point of contact for the majority of patients with depression, yet, approximately 50% of cases remain unrecognized. The under-diagnosis of depression may be further exacerbated in limited English-language proficient (LEP) populations. Language barriers may result in less discussion of patients' mental health needs and fewer referrals to mental health services, particularly given competing priorities of other medical conditions and providers' time pressures. Recent advances in Health Information Technology (HIT) may facilitate novel ways to screen for depression and other mental health disorders in LEP populations. The purpose of this paper is to describe the rationale and protocol of a clustered randomized controlled trial that will test the effectiveness of an HIT intervention that provides a multi-component approach to delivering culturally competent, mental health care in the primary care setting. The HIT intervention has four components: 1) web-based provider training, 2) multimedia electronic screening of depression and PTSD in the patients' primary language, 3) Computer generated risk assessment scores delivered directly to the provider, and 4) clinical decision support. The outcomes of the study include assessing the potential of the HIT intervention to improve screening rates, clinical detection, provider initiation of treatment, and patient outcomes for depression and post-traumatic stress disorder (PTSD) among LEP Cambodian refugees who experienced war atrocities and trauma during the Khmer Rouge. This technology has the potential to be adapted to any LEP population in order to facilitate mental health screening and treatment in the primary care setting.
authors.affiliation: Department of Medicine, University of California, Irvine, Irvine, CA, United States.
authors.forename: Kelly
authors.initials: K
authors.lastname: Biegler
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Mollica
authors.affiliation: Faculty of Information, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Susan Elliott
authors.initials: SE
authors.lastname: Sim
authors.affiliation: Department of Pediatrics, University of California, Irvine, Irvine, CA, United States; The Children's Clinic, Serving Children and Their Families, Long Beach, CA, United States.
authors.forename: Elisa
authors.initials: E
authors.lastname: Nicholas
authors.affiliation: Department of Pediatrics, University of California, Irvine, Irvine, CA, United States; The Children's Clinic, Serving Children and Their Families, Long Beach, CA, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Chandler
authors.affiliation: US Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, MD, United States.
authors.forename: Quyen
authors.initials: Q
authors.lastname: Ngo-Metzger
authors.affiliation: The Community Medical Wellness Center, Long Beach, CA, United States.
authors.forename: Kittya
authors.initials: K
authors.lastname: Paigne
authors.affiliation: The Community Medical Wellness Center, Long Beach, CA, United States.
authors.forename: Sompia
authors.initials: S
authors.lastname: Paigne
authors.affiliation: Department of Medicine, University of California, Irvine, Irvine, CA, United States; Biostatistics, Epidemiology and Research Design, University of California, Irvine, Irvine, CA, United States.
authors.forename: Danh V
authors.initials: DV
authors.lastname: Nguyen
authors.affiliation: Department of Medicine, University of California, Irvine, Irvine, CA, United States. Electronic address: dsorkin@uci.edu.
authors.forename: Dara H
authors.initials: DH
authors.lastname: Sorkin
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001213:Asian; D002160:Cambodia; D003144:Communication Barriers; D054521:Cultural Competency; D020000:Decision Support Systems, Clinical; D003863:Depression / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D020407:Internet; D007802:Language; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D012107:Research Design; D012959:Socioeconomic Factors; D012984:Software; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000628:therapy
keywords: Cambodian refugees; Depression; Health Information Technology; Limited English proficiency; Primary care; post-traumatic stress disorder (PTSD)