Comparison of integrated behavioral health treatment for internalizing psychiatric disorders in patients with and without Type 2 diabetes.

INTRODUCTION: Type 2 diabetes is often comorbid with internalizing mental health disorders and associated with greater psychiatric treatment resistance. Integrating psychotherapy into primary care can help treat internalizing disorders generally. We explored whether such treatment had comparable effectiveness in patients with and without Type 2 diabetes. METHOD: Participants were 468 consecutive adults (23% male; 62% Hispanic, Mage = 41.46 years) referred by medical staff for psychotherapy appointments to address internalizing symptoms (e.g., depression). After each visit, patients completed a self-report measure and clinicians assessed patient symptom severity. These data and demographics extracted from electronic medical records were analyzed using descriptive and multilevel modeling analyses. RESULTS: Patients with and without diabetes were similar in types of internalizing disorders experienced and baseline clinician- and self-reported symptomology. Multilevel modeling suggested improvements in self-reported symptomology was comparable across patient groups; however, only patients without diabetes significantly improved according to clinician reports. DISCUSSION: Although findings suggested integrated psychotherapy resulted in comparable patient-reported reductions of internalizing symptoms, these effects were not evident in clinician reports of diabetic patients. Possible reasons for this discrepancy (e.g., reporting biases) are discussed. Integrated psychotherapy for internalizing disorders may be effective for Type 2 diabetic patients, though caution is warranted. (PsycINFO Database Record

The Effects of Interpreter Use on Agreement Between Clinician- and Self-Ratings of Functioning in Hispanic Integrated Care Patients.

This study explored whether concordance between self- and clinician- assessment of functioning differs when an interpreter is used in therapy versus when there is language congruence between the clinician and the patient, and whether concordance is affected by patient distress. Participants were 418 Spanish-speaking patients seen at one of three primary care clinics. Patients were primarily Hispanic (94 %), uninsured (65 %), and female (84 %), and ranged in age from 18 to 73 years (M = 41.70, SD = 10.70). Pearson's correlation coefficients assessed the association between self- and clinician- reports of patient functioning with and without use of an interpreter. Fisher's z transformations assessed the significance of the difference between the correlation coefficients. Although interpreter use did not significantly disrupt communication of functioning when the patient was highly distressed, there was significant discordance in clinician and patient reports in patients experiencing milder levels of distress communicating by means of an interpreter.

Effects of language concordance and interpreter use on therapeutic alliance in Spanish-speaking integrated behavioral health care patients.

The discrepancy between the growing number of Spanish speakers in the U.S. and the availability of bilingual providers creates a barrier to accessing quality mental health care. Use of interpreters provides one strategy for overcoming this linguistic barrier; however, concerns about whether sessions with interpreters, versus bilingual providers, impede therapeutic alliance remain. The current study explored associations between the use of interpreters and therapeutic alliance in a sample of 458 Spanish-speaking patients seen for integrated behavioral health visits at primary care clinics. Patients completed a brief (4 item) therapeutic alliance scale at their behavioral health appointment. In addition, to supplement the quantitative study data, a pilot study of 30 qualitative interviews was conducted with a new sample of 10 Spanish-speaking patients, 10 behavioral health consultants (BHCs), and 10 trained interpreters. Quantitative results showed that interpreter use did not relate to therapeutic alliance, even when controlling for relevant demographic variables. However, qualitative interviews suggested major themes regarding the relative benefits and challenges of using interpreters for patients, interpreters, and BHCs. In interviews, patients expressed a strong preference for bilingual providers. Benefits included greater privacy, sense of trust, and accuracy of communication. However, in their absence, interpreters were seen as increasing access to services and facilitating communication with providers, thereby addressing the behavioral health needs of patients with limited English proficiency. BHCs and interpreters emphasized the importance of interpreter training and a good collaborative relationship with interpreters to minimize negative effects on the quality of care.

Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings.

Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen's d values > .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos.

A multi-study analysis of conceptual and measurement issues related to health research on acculturation in Latinos.

PURPOSE: The aims of the study were to evaluate the orthogonality of acculturation for Latinos. DESIGN: Regression analyses were used to examine acculturation in two Latino samples (N = 77; N = 40). In a third study (N = 673), confirmatory factor analyses compared unidimensional and bidimensional models. METHOD: Acculturation was assessed with the ARSMA-II (Studies 1 and 2), and language proficiency items from the Children of Immigrants Longitudinal Study (Study 3). RESULTS: In Studies 1 and 2, the bidimensional model accounted for slightly more variance (R (2)Study 1 = .11; R (2)Study 2 = .21) than the unidimensional model (R (2)Study 1 = .10; R (2)Study 2 = .19). In Study 3, the bidimensional model evidenced better fit (Akaike information criterion = 167.36) than the unidimensional model (Akaike information criterion = 1204.92). DISCUSSION: Acculturation is multidimensional. IMPLICATIONS: Care providers should examine acculturation as a bidimensional construct.