• Jacquelyn Stephenson, Brian Distelberg, Kelly R Morton, Larry Ortiz, and Susanne B Montgomery.
• From Inland Empire Health Plan, Rancho Cucamonga, CA (JS); Behavioral Medicine Center, Loma Linda University, Redlands, CA (BD); School of Behavioral Health, Department of Counseling and Family Sciences, Loma Linda University, Loma Linda, CA (BD); School of Behavioral Health Loma Linda University, Loma Linda, CA (KRM); School of Behavioral Health, Department of Psychology, Loma Linda University, Loma Linda, CA (KRM); School of Medicine, Department of Family Medicine, Loma Linda University, Loma Linda, CA (KRM); Loma Linda University School of Behavioral Health, Social Work and Social Ecology, Loma Linda, CA (LO); School of Behavioral Health, Social Work and Social Ecology, Loma Linda University, Loma Linda, CA (SBM); Behavioral Health Institute, Redlands, CA (SBM). jstephenson@llu.edu.
• J Am Board Fam Med. 2019 Nov 1; 32 (6): 904-912.

IntroductionNational guidelines recommend primary care providers (PCPs) screen patients for depression with a standardized tool and address positive screenings. However, depression prevalence is lower in Latinos (8% to 15%, with Spanish speakers at 8%) than non-Latino whites (22%). As a result of these prevalence differences, PCPs may use ethnicity and language of the patient to determine depression screening behaviors. This study examined standard of care (SoC) depression treatment recommendations by ethnicity and language for patients who screened positive for major depression during a medical visit.Methods275 patients scored ≥10 on the Patient Health Questionnaire-9 screening; a chart review assessed treatment referrals, followed by semistructured interviews with 18 patients and 7 PCPs regarding depression treatment behaviors.Results138 patients (50%) received SoC treatment recommendations. After controlling for age, gender, and race, a binary logistic regression was performed to determine language and ethnicity effects on SoC depression treatment recommendations (psychotherapy/pharmacotherapy vs other). Spanish-speaking Latinos were 72% less likely to receive SoC recommendations than English speakers (odds ratio [OR] = 0.39). Interviews with Spanish-speaking patients confirmed that negative perceptions about medications, patient noncompliance, and a shortage of bilingual behavioral health providers within the clinic impacted SoC recommendations and uptake.ConclusionsSpanish-speaking Latinos did not receive or follow through with SoC recommendations as often as English speakers regardless of ethnicity. Future studies should explore reasons why language is a barrier to SoC recommendations for Latinos and explore culturally and linguistically sensitive methods to effectively treat Spanish speakers for depression during a medical visit.© Copyright 2019 by the American Board of Family Medicine.

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