Non–English-Speaking Patients Have High Rates of Depression

Peter M. Yellowlees, MBBS, MD


April 19, 2018

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Patients with limited English proficiency (LEP) have high rates of depression, yet face challenges accessing effective care in outpatient settings. Now a team of investigators[1] from UCSF California have undertaken a systematic review to investigate the effectiveness of the collaborative care model for depression for LEP patients in primary care. Fifteen studies were included, involving 4859 participants of whom 2679 (55%) reported being LEP, the majority Spanish (93%).

The researchers concluded that although limited by the number and variability of studies, the available research suggests that collaborative care for depression delivered by bilingual providers may be more effective than usual care among patients with LEP. They recommended that implementation studies of collaborative care, particularly among Asian and non–Spanish-speakers, are needed.

So what is the significance of this study, and how can we help depressed patients with LEP? There is a substantial literature demonstrating the overall effectiveness of collaborative care models in primary care, but only a small literature dealing with patients with LEP, where the traditional gold standard of care is for providers to work with professional interpreters who are unfortunately not always easily accessible. The alternative is to employ bilingual providers to deliver care, as this review suggests—but again, shortages of such providers exist.

Alternative approaches for the future may include the use of automated machine learning interpretation systems, but as of today these are not yet accurate enough for clinical use. At a practical level, this is an important problem that we have not yet solved but which we must not ignore.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.


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