Major
Communication Studies
Research Abstract
Introduction: In the United States, depression is the second leading disease/illness. Although depression and mental health crises’ have been an exponentially growing, ongoing issue, many ethnic minority groups do not have access to the care that they need. Moreover, cultural stigmas and structural barriers including language concordance often discourage Chinese and Latinx communities from entering mental health facilities as well. The goal of this study was to understand how people in the Chinese and Latinx patients who screen positively for anxiety/depression discuss or do not discuss mental health in primary care clinician visits.
Methods: Data for this study came from a larger study of primary-care visits with Chinese and Latinx patients, language concordance, and use of medical/lay interpreters. For this paper, we examined a subset of 17 Latinx patient, and 19 Chinese patient audio-recorded conversations with their primary care clinician who either had a diagnosis of anxiety/depression or screened positively for anxiety/depression using the PHQ-2. Conversations occurred in English, Spanish, Cantonese, Mandarin or Toishan and were transcribed and translated by bilingual/bicultural research assistants. Data were analyzed using both an inductive and deductive thematic and discourse analysis. All transcripts were analyzed by at least two researchers. After comparing and contrasting important themes that emerged from the dataset, we met regularly as a team to reconcile differences.
Results: Our initial analysis focuses on four important types of conversational moves within these visits. First, there were open conversations between clinicians and patients about current and ongoing mental health diagnoses, assessment, and treatment. Second, we examined conversations where there were missed opportunities when either the clinician or patient initiated a possible entry into mental health talk that the other did not reciprocate. Finally, we examine the conversations where patients recognize the mental concerns and actively work to negotiate alternative treatments including complementary therapies, taking supplements, exercise and social outings. Notably, many of these same conversations included patient disclosures about worries about the cost of mental health medication and concerns about language concordance and/or cultural relevance of suggested therapy.
Discussion: Primary care visits are important touch-points for clinicians to check in with patients about mental health even when it is not the most pressing health concern. As such, it is important for clinicians to be aware of the various ways that patients may raise mental health concerns in subtle ways as part of the discussion of other health concerns. Further research should examine how to make mental health care more accessible for ethnic minority groups who may be concerned with issues such as cost of treatment and cultural resonance of mental health treatment.
Faculty Mentor/Advisor
Evelyn Ho
PowerPoint presentation
Mood Talk to Mental Health Treatment: Conversations with Chinese and Latinx Patients in Primary Care Recorded Visits
Introduction: In the United States, depression is the second leading disease/illness. Although depression and mental health crises’ have been an exponentially growing, ongoing issue, many ethnic minority groups do not have access to the care that they need. Moreover, cultural stigmas and structural barriers including language concordance often discourage Chinese and Latinx communities from entering mental health facilities as well. The goal of this study was to understand how people in the Chinese and Latinx patients who screen positively for anxiety/depression discuss or do not discuss mental health in primary care clinician visits.
Methods: Data for this study came from a larger study of primary-care visits with Chinese and Latinx patients, language concordance, and use of medical/lay interpreters. For this paper, we examined a subset of 17 Latinx patient, and 19 Chinese patient audio-recorded conversations with their primary care clinician who either had a diagnosis of anxiety/depression or screened positively for anxiety/depression using the PHQ-2. Conversations occurred in English, Spanish, Cantonese, Mandarin or Toishan and were transcribed and translated by bilingual/bicultural research assistants. Data were analyzed using both an inductive and deductive thematic and discourse analysis. All transcripts were analyzed by at least two researchers. After comparing and contrasting important themes that emerged from the dataset, we met regularly as a team to reconcile differences.
Results: Our initial analysis focuses on four important types of conversational moves within these visits. First, there were open conversations between clinicians and patients about current and ongoing mental health diagnoses, assessment, and treatment. Second, we examined conversations where there were missed opportunities when either the clinician or patient initiated a possible entry into mental health talk that the other did not reciprocate. Finally, we examine the conversations where patients recognize the mental concerns and actively work to negotiate alternative treatments including complementary therapies, taking supplements, exercise and social outings. Notably, many of these same conversations included patient disclosures about worries about the cost of mental health medication and concerns about language concordance and/or cultural relevance of suggested therapy.
Discussion: Primary care visits are important touch-points for clinicians to check in with patients about mental health even when it is not the most pressing health concern. As such, it is important for clinicians to be aware of the various ways that patients may raise mental health concerns in subtle ways as part of the discussion of other health concerns. Further research should examine how to make mental health care more accessible for ethnic minority groups who may be concerned with issues such as cost of treatment and cultural resonance of mental health treatment.
