Recognition of Psychiatric Distress in Low Income Asian and Latino Primary Care Patients

Recognition of Psychiatric Distress in Low Income Asian and Latino Primary Care Patients

Henry Chung, M. D. ,Jeanne Teresi, EdD,Ph.D., Peter Guarnaccia, Ph.D.~ Barnett S. Meyers, M..D._, Traci Goldstein, MA, Joseph P. Eimicke, Emesto Perran, Jr, M.D.

(presented by Dr. Chung at the 1998 CAMS Annual Scientific Meeting)

Objective: Few studies of recognition of depressive symptoms have been conducted on ethnic minorities, particularly non English speaking. In this pilot study, we examined primary care physician recognition psychiatric distress in an ethnically diverse primary care sample composed primarily of Asians and Hispanics. In addition, the relationship of patient and physician sociodemographic factors and diagnostic congruence were investigated.

Method: The study sample is comprised of 252 consecutive patients in the general medicine clinics in a large ambulatory medical facility who agreed to participate and completed the following measures prior to their medical visit: Center for Epidemiologic Studies Depression (CES-D) scale, a demographic questionnaire, and an acculturation scale. Immediately after the visit, physicians completed a mental health treatment summary. Sixteen primary care providers agreed to participate in the study; 90% were attending physicians, and 30% have moderate to complete fluency in either Spanish or Chinese (Cantonese or Mandarin). To make meaningful differential comparisons between ethnic groups, only Asian and Latino patients were included in the statistical analyses (n=224). Hierarchical logistic regression analyses were perform-ed examining provider recognition of psychiatric distress and CES-D/ provider congruence in relation to demographic characteristics and acculturation.

Results: 45% of the sample were psychiatri-cally distressed as measured by the CES-D whereas 35.6% were judged by physicians to be distressed (X- 28.4, df=1, p<.01). Physicians were more likely to diagnose distress in Hispanics (Wald statistic =6.5, p<.0I) and for those with higher accul-turation status (Wald statistic =4.5, p <.05). Higher patient acculturation status was the only factor that improved diagnos-tic congruence (Wald statistic -4.5, p < 05).

Conclusions: Primary care physicians (PCP) in this study Adiagnosed@ psy-chiatric distress more frequently in Latino patients and in those who have higher acculturation status. Higher acculturation status improved diagnostic congruence (agreement between a positive CES-D and provider stating the patient had distress and a negative CES-D and the provider stating that the patient had no distress), but language match did not. We speculate that PCP are more likely to respond to the communication style of patients in recognizing psychiatric distress; particularly among patients who are more likely to express their distress in a psychological or emotional context. Further research will be required to understand how low in-come and racially diverse primary care patients express their psychiatric distress in the clinical encounter and how physicians identify those patients for intervention. #

Dr. Chung is Medical Director, New York Chinatown Health Clinic.