Skip to main content
Log in

Depressive Symptoms and Psychiatric Distress in Low Income Asian and Latino Primary Care Patients: Prevalence and Recognition

  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

The aims of the study were to: (a) assess the degree to which primary care physicians recognize psychiatric distress among an ethnically diverse primary care sample composed primarily of Asians and Hispanics; and (b) to investigate the relationship between patient and physician sociodemographic factors and overall diagnostic recognition of psychiatric distress. The study sample is comprised of 252 consecutively-selected patients and eleven primary care general internists from general medicine clinics in a large public ambulatory medical center. The measures used were the Center for Epidemiologic Studies-Depression (CES-D) scale, a demographic questionnaire, and an acculturation scale; these measures were completed during interviews conducted by trained bilingual research assistants. Physicians completed a mental health treatment summary immediately after the patient's visit. Hierarchical logistic regression analyses were performed in order to examine: (1) the degree to which providers identified psychiatric distress and (2) overall diagnostic recognition among this sample in relation to demographic characteristics and degree of acculturation. As measured by the CES-D, almost one half (47.3%) of the Latino and 41.6% of the Asian patients had depressive symptoms indicative of psychiatric distress. In contrast, physicians identified 43.8% of Latino patients and only 23.6% of Asian patients as being psychiatrically distressed (p < .01). Physicians were more likely to classify Latinos and those with higher acculturation status as distressed (p < .01 and p < .05, respectively). Higher patient acculturation status was the only factor significantly associated with overall diagnostic recognition (p < .05), as measured by physician agreement with the CES-D. Being Asian and/or having low acculturation levels may put the patient at risk for non-detection of psychiatric distress. The high prevalence of distress lends support to initiating improved methods for screening and detection of depression among low income and racially diverse primary care patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Broadhead, W. E., Blazer, D. G., George, L. K., & Tse, C. K. (1990). Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA, 264, 2524-2528.

    Google Scholar 

  • Buchwald, D., Manson, S. M., Dinges, N. G., Keane, E. M., & Kinzie, J. D. (1993). Prevalence of depressive symptoms among established Vietnamese refugees in the United States: Detection in a primary care setting. J Gen Intern Med, 8, 76-81.

    Google Scholar 

  • Cheung, F. K., Young, K., Takeuchi, D., & Lin, K. M. (1996). Psychiatric symptoms among Chinese American patients in a primary health care setting. Paper Presentation at Tenth Annual NIMH Research Conference on Mental Disorders in the General Health Care Sector. Bethesda, Maryland.

  • Fears, T. R., Benichou, J., & Gail, M. H. (1996). A reminder of the fallibility of the Wald Statistic (50, pp. 226-227).

    Google Scholar 

  • Fechner-Bates, S., Coyne, J. C., & Schwenk, T. L. (1994). The relationship of self-reported distress to depressive disorders and other psychopathology. Jour Consult Clin Psychol, 62, 550-559.

    Google Scholar 

  • Huack, W. W., & Donner, A. (1977). Wald's Test as applied to hypotheses in Logit Analysis. Journal of the American Statistical Association, 72, 851-853.

    Google Scholar 

  • Kahn, R., Goldfarb, A., Pollack, M., & Peck, A. (1960). Brief objective measures of mental status in the aged. Amer Jour Psychiatry, 117, 326-328.

    Google Scholar 

  • Katon, W., Von Korff, M., Lin, E.,Bush, T.,& Ormel, J. (1992). Adequacy and duration of antidepressant treatment in primary care. Med Care, 30, 67-76.

    Google Scholar 

  • Lin, K. M., Inui, T. S., Kleinman, A. M., & Womack, W. M. (1982). Sociocultural determinants of the help-seeking behaviors of patients with mental illness. J Nerv Ment Dis, 170, 78-85.

    Google Scholar 

  • Lin, T. Y., Tardiff, K., Donetz, G., & Goresky, W. (1978). Ethnicity and patterns of help-seeking. Cult Med Psychiatry, 2, 3-13.

    Google Scholar 

  • Marin, G., Sabogal, F., Marin, B. V., & Otero-Sabogal, R. (1987). Development of a short acculturation scale for Hispanics. Hisp Jour Behavioral Sciences, 9, 183-205.

    Google Scholar 

  • McCusker, J., Karp, E., Yaffe, M. J., Cole, M., & Bellavance, F. (1996).Determining detection of depression in the elderly by primary care physicians: Chart review or questionnaire? Prim Care Psychiatry, 2, 217-221.

    Google Scholar 

  • Meyers, B., Principal Investigator. Funding for this study was provided by the National Institute of Mental Health (NIMH) grant #R24MH53816 to Cornell University Medical College Department of Psychiatry, Division of Geriatrics, Research Transition Grant Program (RTGP).

  • Perez-Stable, E., Miranda, J., Muñ oz, R., & Ying, Y. (1990). Depression in medical outpatients: Underrecognition and misdiagnosis. Arch Internal Medicine, 150, 1083-1088.

    Google Scholar 

  • Radloff, L. S. (1997). The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas, 1, 385-401.

    Google Scholar 

  • Roberts, R. E., & Vernon, S. W. (1983). The Center for Epidemiologic Studies Depression Scale: Its use in a community sample.Am J Psychiatry, 140, 41-46.

    Google Scholar 

  • Roberts, R. E., Vernon, S. W., & Rhoades, H. M. (1989). Effects of language and ethnic status on reliability and validity of the Center for Epidemiologic Studies-Depression Scale with psychiatric patients. Jour Nervous Mental Disease, 177, 581-592.

    Google Scholar 

  • Rogler, L. H., & Cortes, D. E. (1993). Help seeking pathways: A unifying concept in mental health care. Am J Psychiatry, 150, 554-561.

    Google Scholar 

  • Rost, K., Smith, G. R., Matthews, D. B., & Guise, B. (1994). The deliberate misdiagnosis of major depression in primary care. Arch Fam Med, 3, 333-337.

    Google Scholar 

  • Schulberg, H. C., Magruder, K. M., & deGruy, F. (1996). Major depression in primary medical care practice: Research trends and future priorities. Gen Hosp Psychiatry, 18, 395-406.

    Google Scholar 

  • Simon, G. E., Von Korff, M., Wagner, E., & Barlow, W. (1993). Patterns of antidepressant use in community practice. Gen Hosp Psychiatry, 15, 399-408.

    Google Scholar 

  • Spitzer, R. L., Kroenke, K., Linzer, M., Hahn, S. R., Williams, J. B., deGruy, F. V., Brody, D., & Davies, M. (1995). Health-related quality of life in primary care patients with mental disorders. JAMA,274, 1511-1517.

    Google Scholar 

  • Spitzer, R. L., Williams, J., & Kroenke, K. (1994). The PRIME-MD 1,000 study: Utility of a new procedure for diagnosing mental disorders in primary care. JAMA, 272, 1749-1756.

    Google Scholar 

  • Sue, S., & Morishima, J. (1982). The Mental Health of Asian Americans. San Francisco: Jossey-Bass.

    Google Scholar 

  • Suinn, R. M., Richard-Figueroa, K., Lew, S., & Vigil, P. (1987). The Suinn-Lew Asian Self-Identity Acculturation Scale: An initial report. Educ Psych Measurement, 47, 401-407.

    Google Scholar 

  • Ustun, B., & Sartorius, N. (Eds.). (1995). Mental Illness in General Health Care. An International Study. Chichester: John Wiley.

    Google Scholar 

  • Von Korff, M., Wagner, E. H., & Saunders, K. (1992). A Chronic Disease Score from automated pharmacy data. J Clin Epidemiol, 45, 197-203.

    Google Scholar 

  • Wallen, J. (1992). Providing culturally appropriate mental health services for minorities. Jour Mental Health Admin, 19, 288-295.

    Google Scholar 

  • Wells, K. B., Stewart, A., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M., Berry, S., Greenfield, S., & Ware, J. (1989). The functioning and well-being of depressed patients: Results from the Medical Outcomes Study. JAMA, 262,914-919.

    Google Scholar 

  • Williams, J. W., Kerber, C. A., Mulrow, C.D., Medina, A.,&Aguilar, C. (1995). Depressive disorders in primary care: Prevalence, functional disability, and identification. J Gen Internal Medicine,10, 7-12.

    Google Scholar 

  • Ying, Y. W. (1988). Depressive symptomatology among Chinese-Americans as measured by the CES-D. Jour Clin Psych, 44, 739-746.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chung, H., Teresi, J., Guarnaccia, P. et al. Depressive Symptoms and Psychiatric Distress in Low Income Asian and Latino Primary Care Patients: Prevalence and Recognition. Community Ment Health J 39, 33–46 (2003). https://doi.org/10.1023/A:1021221806912

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1021221806912

Navigation