Date of Graduation

8-2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Psychology (PhD)

Degree Level

Graduate

Department

Psychological Science

Advisor/Mentor

Ana Bridges

Committee Member

Lindsay S Ham

Second Committee Member

Matt Judah

Keywords

depression;disparities;Latinx;mental health;patient prespective;treatment preference

Abstract

Introduction: In the U.S., Latinxs with Spanish as their preferred language encounter two prominent structural barriers impacting access to treatment for major depressive disorder (MDD). The first is that MDD symptoms commonly go undetected in Latinxs with Spanish compared to English as their preferred language. This might be perhaps because commonly used MDD screeners lack somatic symptom survey items culturally specific in how MDD may present among Latinxs with Spanish as their preferred language. The second structural barrier is that treatment access and completion rates are lower in Spanish-speaking than English-speaking Latinxs, perhaps due to treatments lacking the structure and approaches favored by Spanish-speakers. Purpose: This study had two aims (1) Examining whether the sensitivity and specificity of the Patient Health Questionnaire (PHQ-9) could be enhanced by including a modified version of the Brief Symptom Inventiory-18 (BSI-18) somatic items; and (2) better understanding preferences for MDD treatment across linguistic groups. Together, these aims can potentially improve the recognition and treatment of depression in a largely underserved population. Design and Method: Participants were 50 Latinx adults who completed online self-report measures and a virtual MDD structured diagnostic and qualitative interview about their preferences for MDD treatment. Analytic Approach: Chi-square analyses were used to determine similarities in PHQ-9 responses between the Spanish and English-speaking subsamples. The area under the curve analyses (AUC) helped determine the cut-off in which the PHQ-9 best detected MDD in Spanish-speaking and English-speaking Latinxs and whether sensitivity and specificity improved when the somatic items were added to the screener. Thematic analyses summarized depression treatment preferences. Results: English-speaking participants endorsed more symptoms of MDD than Spanish-speaking Latinxs. Regardless of language preference, Latinx participants met diagnostic criteria for MDD according to the MDD MINI more often than on the PHQ-9 alone. The cut-off points for the PHQ-9, according to the AUC analyses, were substantially lower than the recommended cut-off. Adding the modified somatic items of the BSI-18 to the PHQ-9 did not increase the sensitivity and specificity of the PHQ-9. Qualitative interviews juxtapose differences in the description of depression based on language groups. Spanish- speakers focused on relational ways depression impacts a sense of community connectedness. English-speakers focused on debilitating individual experiences. Both language groups endorsed preferences for therapists versed in cultural considerations. Preferences for treatment placed counseling above medication and in-person above telehealth. Conclusions: Adding the modified somatic items of the BSI-18 to the PHQ-9 did not increase the sensitivity and specificity of the PHQ-9. Future work should investigate whether adding relationship quality questions should be included in depression screeners.

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