TY - JOUR
KW - collaborative care
KW - Depression
KW - language barriers
KW - limited English proficiency
KW - Systematic Review
AU - M. E. Garcia
AU - L. Ochoa-Frongia
AU - N. Moise
AU - A. Aguilera
AU - A. Fernandez
A1 - 
AB - BACKGROUND: Patients with limited English proficiency (LEP) have high rates of depression, yet face challenges accessing effective care in outpatient settings. We undertook a systematic review to investigate the effectiveness of the collaborative care model for depression for LEP patients in primary care. METHODS: We queried online PubMed, PsycINFO, CINAHL and EMBASE databases (January 1, 2000, to June 10, 2017) for quantitative studies comparing collaborative care to usual care to treat depression in adults with LEP in primary care. We evaluated the impact of collaborative care on depressive symptoms or on depression treatment. Two reviewers independently extracted key data from the studies and assessed risk of bias using the Cochrane bias and quality assessment tool (RCTs) and the Newcastle-Ottawa Quality Assessment Scale (non-RCTs). RESULTS: Of 86 titles identified, 15 were included (representing 9 studies: 5 RCTs, 3 cohort studies, and 1 case-control study). Studies included 4859 participants; 2679 (55%) reported LEP. The majority spoke Spanish (93%). The wide variability in study design and outcome definitions precluded performing a meta-analysis. Follow-up ranged from 3 months to 2 years. Three of four high-quality RCTs reported that 13-25% more patients had improved depressive symptoms when treated with culturally tailored collaborative care compared to usual care; the last had high treatment in the control arm and found equal improvement. Two non-RCT studies suggest that Spanish-speaking patients may benefit as much as, if not more than, English-speaking patients treated with collaborative care. The remaining studies reported increased receipt of preferred depression treatment (therapy vs. antidepressants) in the intervention groups. Eight of nine studies used bilingual providers to deliver the intervention. DISCUSSION: While limited by the number and variability of studies, the available research suggests that collaborative care for depression delivered by bilingual providers may be more effective than usual care among patients with LEP. Implementation studies of collaborative care, particularly among Asian and non-Spanish-speakers, are needed.
AD - Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA. maria.garcia@ucsf.edu.; Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.; School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA.; Zuckerberg San Francisco General Hospital, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.; Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
BT - Journal of general internal medicine
C5 - Healthcare Disparities
CP - 3
CY - United States
DO - 10.1007/s11606-017-4242-4
IS - 3
JF - Journal of general internal medicine
M1 - Journal Article
N2 - BACKGROUND: Patients with limited English proficiency (LEP) have high rates of depression, yet face challenges accessing effective care in outpatient settings. We undertook a systematic review to investigate the effectiveness of the collaborative care model for depression for LEP patients in primary care. METHODS: We queried online PubMed, PsycINFO, CINAHL and EMBASE databases (January 1, 2000, to June 10, 2017) for quantitative studies comparing collaborative care to usual care to treat depression in adults with LEP in primary care. We evaluated the impact of collaborative care on depressive symptoms or on depression treatment. Two reviewers independently extracted key data from the studies and assessed risk of bias using the Cochrane bias and quality assessment tool (RCTs) and the Newcastle-Ottawa Quality Assessment Scale (non-RCTs). RESULTS: Of 86 titles identified, 15 were included (representing 9 studies: 5 RCTs, 3 cohort studies, and 1 case-control study). Studies included 4859 participants; 2679 (55%) reported LEP. The majority spoke Spanish (93%). The wide variability in study design and outcome definitions precluded performing a meta-analysis. Follow-up ranged from 3 months to 2 years. Three of four high-quality RCTs reported that 13-25% more patients had improved depressive symptoms when treated with culturally tailored collaborative care compared to usual care; the last had high treatment in the control arm and found equal improvement. Two non-RCT studies suggest that Spanish-speaking patients may benefit as much as, if not more than, English-speaking patients treated with collaborative care. The remaining studies reported increased receipt of preferred depression treatment (therapy vs. antidepressants) in the intervention groups. Eight of nine studies used bilingual providers to deliver the intervention. DISCUSSION: While limited by the number and variability of studies, the available research suggests that collaborative care for depression delivered by bilingual providers may be more effective than usual care among patients with LEP. Implementation studies of collaborative care, particularly among Asian and non-Spanish-speakers, are needed.
PP - United States
PY - 2018
SN - 1525-1497; 0884-8734
SP - 347
EP - 357
EP - 
T1 - Collaborative Care for Depression among Patients with Limited English Proficiency: a Systematic Review
T2 - Journal of general internal medicine
TI - Collaborative Care for Depression among Patients with Limited English Proficiency: a Systematic Review
U1 - Healthcare Disparities
U2 - 29256085
U3 - 10.1007/s11606-017-4242-4
VL - 33
VO - 1525-1497; 0884-8734
Y1 - 2018
Y2 - Mar
ER -