title: Association Between Stigma and Depression Outcomes Among Chinese Immigrants in a Primary Care Setting.
abstract: OBJECTIVE
  Stigma has been proposed to be a major underlying factor contributing to lower rates of mental health service utilization among racial/ethnic minorities in the United States. Yet, surprisingly little research has specifically explored associations between stigma, race/ethnicity, and psychiatric morbidity. This study aims to assess the impact of stigmatizing attitudes on depression outcomes among a psychiatrically underserved, immigrant Chinese population.
  
  
  METHODS
  Between 2009 and 2012, 190 Chinese immigrants with major depressive disorder as diagnosed by the Mini International Neuropsychiatric Interview were enrolled in a trial of culturally sensitive collaborative care for depression. Participants' self-reported stigma regarding their symptoms was assessed at study entry using the Explanatory Model Interview Catalogue, and depressive symptoms were assessed with the Hamilton Depression Rating Scale (HDRS) at baseline and follow-up. Hierarchical linear regression was used to assess the association between baseline stigma score and change in HDRS score, adjusting for potential confounders.
  
  
  RESULTS
  Higher stigma scores at baseline were significantly associated with attenuated improvement in both HDRS score and quality of life at 6 months (P < .05 for both).
  
  
  CONCLUSIONS
  Stigma has a directly harmful effect on depression outcomes, even after individuals have been accurately diagnosed within a culturally sensitive community health center and agreed to treatment. These results support further research into interventions targeting stigma to improve mental health outcomes among minority populations.
  
  
  BACKGROUND
  This study is a secondary analysis of prospectively collected data from the randomized controlled trial registered by ClinicalTrials.gov identifier: NCT00854542.
authors.affiliation: 1 Bowdoin Sq, 6th Floor, Boston, MA 02114. jchen37@partners.org.|Massachusetts General Hospital Depression Clinical and Research Program, Boston, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Chen
authors.affiliation: Massachusetts General Hospital Depression Clinical and Research Program, Boston, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Shapero
authors.affiliation: Massachusetts General Hospital Depression Clinical and Research Program, Boston, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nhi-Ha T
authors.initials: NT
authors.lastname: Trinh
authors.affiliation: Massachusetts General Hospital Depression Clinical and Research Program, Boston, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Trina E
authors.initials: TE
authors.lastname: Chang
authors.affiliation: Massachusetts General Hospital Depression Clinical and Research Program, Boston, Massachusetts, USA.
authors.forename: Susannah
authors.initials: S
authors.lastname: Parkin
authors.affiliation: Massachusetts General Hospital Depression Clinical and Research Program, Boston, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Alpert
authors.affiliation: Massachusetts General Hospital Depression Clinical and Research Program, Boston, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.affiliation: Massachusetts General Hospital Depression Clinical and Research Program, Boston, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.|South Cove Community Health Center, Boston, Massachusetts, USA.
authors.forename: Albert S
authors.initials: AS
authors.lastname: Yeung
mesh_terms: D000069:Acculturation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000208:ethnology; D065246:Culturally Competent Care / Q000208:ethnology; D003866:Depressive Disorder / Q000208:ethnology* / Q000523:psychology* / Q000628:therapy; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D011446:Prospective Studies; D057545:Social Stigma; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D017216:Telemedicine; D055815:Young Adult