Project Summary
Depression is a leading cause of disability in the United States. Patients with limited English proficiency (LEP),
particularly Asians and Latinos, who represent the largest demographics with LEP in the country, are at
increased risk of poor provider recognition of depressive symptoms and under-treatment of depression.
Universal depression screening in primary care, with a focus on initial depression treatment, may be a way to
systematically identify patients with LEP who could benefit from treatment. However, barriers to depression
care are likely multifactorial and are still poorly understood. The objective of this application is to understand
whether universal approaches to depression screening and initial care for depression are equally effective for
all groups, or whether targeted efforts are needed to increase depression screening, diagnosis and treatment
in primary care among patients with LEP. Within the context of a primary care setting, the specific aims are to
(1) evaluate differences in depression screening and initial treatment by patient preferred language after
adoption of annual universal depression screening, (2) examine patterns of patient-provider communication
about depressive symptoms, and (3) to involve key stakeholders to develop a patient- and provider-facing,
practice-based intervention prototype to improve annual depression screening, elicit patient concerns and
treatment preferences, foster improved communication and patient empowerment about initial treatment, and
increase engagement in depression care.
These aims will be achieved using mixed methods and health disparities research frameworks, and they
address the NIMHD research priority areas of developing healthcare interventions to reduce health disparities
and to improve patient-clinician communication and shared-decision making. The studies are novel in their
focus on the mental health needs of primary care patients with LEP as well as the proposed use of mixed
methods to develop a theory-driven intervention prototype. The proposed studies are informed by Dr. Maria
Esteli Garcia’s experience as an internist working in diverse, urban primary care settings. Dr. Garcia’s long-
term career goal is to improve depression care for patients with LEP in primary care. During the course of this
award, Dr. Garcia will undertake didactic and experiential training to improve knowledge and skills in three
areas: (1) mixed methods, (2) evidence-based depression care, and (3) experimental designs for use in real
world settings. Dr. Garcia has assembled a mentorship team with expertise in mixed methods, health services
and implementation science research, evidence-based depression treatment, and intervention design to
ensure completion of the proposed research and training and successful transition to independence.
Ultimately, these projects are expected to provide the foundation for future R34 and R01 applications and
further refinement of an intervention to reduce mental health disparities by improving depression screening and
initial depression care for patients with LEP.