African Americans underutilize specialty mental health services (i.e., psychiatrists, psychologists, counselors, etc). Racial differences in specialty mental health care exist regardless of patients’ socioeconomic and health insurance status. However, African Americans with depression are just as likely as whites to receive care in primary care settings. Recent work suggests that African American patients are less likely to be recognized as depressed and offered antidepressants by health professionals, less likely to follow through with recommended antidepressant medication, mental health referrals, or complete an adequate number of counseling visits. Additionally, African American patients express stronger preferences for counseling over antidepressant medication. African Americans are also more likely to see depression and its treatment through a spiritual framework. The data from studies strongly supports the conclusion that African Americans with depression are undertreated.

Interventions focusing on patient-centeredness (i.e., care that is congruent with and responsive to patients’ values, needs, and preferences) have documented benefits on patient adherence, patient satisfaction, and health outcomes. Therefore, quality improvement interventions that enhance this dimension of care are promising strategies to improve treatment and outcomes of depression among African Americans.

Research Question:
Does a patient-centered, culturally targeted intervention that focuses on the concerns and preferences of African American patients with depression and their primary care clinicians improve the processes and outcomes of care for African Americans to a greater degree than a standard depression intervention?

• Our study included patient and clinician interventions that were tailored to address the individual needs of African American patients with depression and their primary care physicians.
• The patient-centered patient intervention elicited patient preferences, encouraged participatory decision-making, and incorporated cultural beliefs and values. It addresses common cultural misconceptions about mental illness and its treatment and encouraged patients to use active and effective coping strategies (spirituality, strong family and social networks, creative expression, verbal communication skills) that have been salient in African-American culture.
• The patient-centered clinician intervention incorporated a self-administered, computerized, participatory communication skills training program delivered via interactive CD-ROM to model specific strategies for engaging and retaining depressed African American patients in care.