Abstract
Background: Persistent disparities in access and quality of mental health care for Latinos indicate a need for evidence-based, culturally adapted, and outside-the-clinic-walls treatments.
Objective: Evaluate treatment effectiveness of telephone (ECLAT) or face-to-face (ECLA-F) delivery of a 6-8 session cognitive behavioral therapy and care management intervention for low-income Latinos, as compared to usual care for depression.
Design: Multisite randomized controlled trial.
Setting: Eight community health clinics in Boston, Massachusetts and San Juan, Puerto Rico.
Participants: 257 Latino patients recruited from primary care between May 2011 and September 2012.
Main Outcome Measures: The primary outcome was severity of depression, assessed with the Patient Health Questionnaire-9 and the Hopkins Symptom Checklist-20. The secondary outcome was functioning over the previous 30 days, measured using the World Health Organization Disability Assessment Schedule (WHO-DAS 2.0).
Results: Both telephone and face-to-face versions of the Engagement and Counseling for Latinos (ECLA) were more effective than usual care. The effect sizes of both intervention conditions on Patient Health Questionnaire-9 were moderate when combined data from both sites are analyzed (0.56 and 0.64 for face-to-face and telephone, respectively). Similarly, effect sizes of ECLA-F and ECLA-T on the Hopkins Symptom Checklist were quite large in the Boston site (0.64 and 0.73. respectively) but not in Puerto Rico (0.10 and 0.03).
Conclusions: and Relevance: The intervention appears to help Latino patients reduce depressive symptoms and improve functioning. Of particular importance is the higher treatment initiation for the telephone versus face-to-face intervention (89.7% vs. 78.8%), which suggests that telephone-based care may improve access and quality of care.
Original language | English (US) |
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Pages (from-to) | 989-997 |
Number of pages | 9 |
Journal | Medical care |
Volume | 52 |
Issue number | 11 |
DOIs | |
State | Published - Nov 10 2014 |
Keywords
- CBT
- Cognitive behavioral therapy
- Depression
- Latino
- Telephone
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health