HEALTH SERVICE RESEARCH POSTER PRESENTATION ABSTRACTS
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Salons 10-12.
THURSDAY, 5:30-6:15 PM
Patel, SR, Schmidt AB, Lewis-Fernández R.
Prevalence and predictors of natural remedy and spiritual
consultation use in primary care Hispanic patients.
Columbia University and The New York State Psychiatric
Institute sp2309@columbia.edu
OBJECTIVE: Several studies have examined complementary
and alternative medicine (CAM) use among individuals seeking conventional
medical and mental health care. To date, there has been relatively little
research on CAM use among ethnic minority individuals with mental health
disorders. This study presents data on the prevalence and predictors
of two types of CAM: natural remedy and spiritual consultation use among
primary care Hispanic outpatients with depressive and anxiety disorders
in the context of a primary care intervention to enhance conventional
mental health care services.
METHODS: We designed an intervention targeting
seven Spanish-speaking, community primary care physician offices (PCP's)
in Upper Manhattan. The intervention consisted of on-site weekly training
and consultation to enhance PCP ability to diagnose, treat, and refer
Hispanic outpatients with psychiatric disorders. Data were collected
from Hispanic outpatients who screened positive for depressive and anxiety
disorders according to the Patient's Health Questionnaire (PHQ). Patients
(n=181) were interviewed after the PCP index visit and 3 months later.
Data was collected on sociodemographic variables, perceived need, stigma,
cultural interpretations of illness, treatment preferences, self-perceived
health, disability, and utilization. Using logistic regression, we analyzed
predictors of natural remedy and spiritual consultation use, adjusting
for covariates.
RESULTS: The sample consisted of 181 patients,
predominantly middle-aged (mean=53 years), Spanish-speaking (86%), females
(87%) with a low education level and an annual average income of $10,000.
By 3-month follow-up, natural remedies (47%) and spiritual consultation
(35%) had been used more frequently than conventional mental health
services such as medication (25%) or psychiatric referral (15%). Preference
for spiritual help over medication predicted natural remedy use (p=.
01). Belief that, nervios (a culture-bound syndrome) is a serious illness
predicted spiritual consultation use (p=. 01).
CONCLUSIONS: Despite efforts to improve conventional
mental health services, the prevalence of natural remedy and spiritual
consultation use was greater than mental health service use. Patient
level-factors such as perception of illness and treatment preferences
were strongest predictors of utilization. Future efforts should investigate
the influence of acculturation and perceived efficacy on utilization
as well as the potential importance of discussing CAM when negotiating
mental health treatment in primary care.
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