Joyce Y. Chung

One-Year Outcomes of a Randomized Clinical Trial Treating Depression in Low-Income Minority Women

This study examines 1-year depressive symptom and functional outcomes of 267 predominantly lowincome, young minority women randomly assigned to antidepressant medication, group or individual cognitive- behavioral therapy (CBT), or community referral. Seventy-six percent assigned to medications received 9 or more weeks of guideline-concordant doses of medications; 36% assigned to psychotherapy received 6 or more CBT sessions. Intent-to-treat, repeated measures analyses revealed that medication (p=.001) and CBT (p=.02) were superior to community referral in lowering depressive symptoms across 1-year follow-up. At Month 12, 50.9% assigned to antidepressants, 56.9% assigned to CBT, and 37.1% assigned to community referral were no longer clinically depressed. These findings suggest that both antidepressant medications and CBT result in clinically significant decreases in depression for low-income minority women.

The Diagnosis of Major Depression in End-Stage Renal Disease

BACKGROUND Although major depression commonly occurs in medically ill patients, it can be difficult to diagnose since depression and many medical illnesses share common physical symptoms. METHODS This study was designed to evaluate patients with end-stage renal disease (ESRD) for major depressive disorder using three diagnostic approaches, to assess the Beck Depression Inventory as a screening instrument for major depression, and to examine the association of anhedonia with a diagnosis of major depression in ESRD patients who deny depressed mood. RESULTS Rates of major depression varied from 6 to 34% according to the criteria that were used. The sensitivity of the Beck Depression Inventory was found to be modest. Anhedonia was a helpful clue for diagnosing depression in patients who denied depressed mood. CONCLUSIONS The findings illustrate the current difficulties in applying DSM criteria for major depression to medical patients and underscore the need for more specific guidelines.

Evaluating the Cultural Validity of the Stressful Life Events Screening Questionnaire

Measures of psychological trauma are rarely evaluated for validity with disadvantaged populations. The authors used three qualitative methods to assess the cultural validity of the Stressful Life Events Screening Questionnaire (SLESQ) with low-income African American women. Focus groups (n = 17), cognitive interviews (n = 20), and videotape reviews of SLESQ interviews were conducted (n = 16). Focus group participants spontaneously used similar language to the SLESQ items and tended to identify SLESQ events as traumatic. Most items were well understood in the interviews, with some criticism of wording. Tape reviews indicated little wording modification by interviewers. One item showed consistent problems. The interview was revised accordingly.

A Qualitative Evaluation of Barriers to Care for Trauma-Related Mental Health Problems Among Low-Income Minorities in Primary Care

Abstract This study aimed to identify barriers and facilitators of mental health care for patients with trauma histories via qualitative methods with clinicians and administrators from primary care clinics for the underserved. Individual interviews were conducted, followed by a combined focus group with administrators from three jurisdictions; there were three focus groups with clinicians from each clinic system. Common themes were identified, and responses from groups were compared. Administrators and clinicians report extensive trauma histories among patients. Clinician barriers include lack of time, patient resistance, and inadequate referral options; administrators cite reimbursement issues, staff training, and lack of clarity about the term trauma. A key facilitator is doctor-patient relationship. There were differences in perceived barriers and facilitators at the institutional and clinical levels for mental health care for patients with trauma. Importantly, there is agreement about better access to and development of trauma-specific interventions. Findings will aid the development and implementation of trauma-focused interventions embedded in primary care.