Sage Journals: Discover world-class research

Abstract

Purpose:

To assess differences in mental health screening based on patient’s preferred language.

Methods:

For this retrospective cohort study, data for 85 725 unique patients from 10 primary care clinics in West Michigan were analyzed if patients received at least 1 mental health screening with the Patient Health Questionnaire 4 (PHQ-4) within a 12-month period (10/15/2021-10/14/2022). A general linear regression model was used to assess the adjusted odds ratios (aOR) of being screened.

Results:

Patients having a preferred language other than English (n = 2755) had an 87.0% chance of receiving the recommended mental health screening, compared to 76.7% of English-speaking patients (P < .001). A multivariable model revealed decreased screening odds for Kinyarwanda (aOR 0.29, 95% CI 0.19-0.45) and Persian/Dari/Pashto (aOR 0.46, 95% CI 0.23-0.91) speaking patients and higher screening odds for Spanish (aOR 1.45, 95% CI 1.19-1.77), Bosnian (aOR 2.13, 95% CI 1.11-4.11), and Vietnamese (aOR 2.25 95% CI 1.64-3.08) speaking patients compared to English speaking patients.

Conclusions:

Results highlight the inequities between the language groups that are probably the result of the challenges to access multilingual depression and anxiety screening instruments. Furthermore, providers may be prone to bias about who they think “needs” a mental health screening. We suggest that measures are implemented to ensure consistency in mental health screening regardless of a patients’ preferred language.

Keywords

migrant language barrier refugee

Introduction

Depression and anxiety are serious health conditions that are associated with increased mortality, worsening of chronic medical conditions, functional disability, increased healthcare utilization,¹ and impaired quality of life. Many people who speak a language other than English and are settling in the United States are migrants, refugees, and displaced persons. They are considered to be particularly affected by depression,² post-traumatic stress disorder, and other mental health problems.^3
-5 Migrants may be exposed to adverse or even traumatizing events during or after their migration.^6
-8

In 2016, the United States Preventative Task Force (USPSTF) released a recommendation to provide consistent depression screening in primary care settings for all adult patients.⁹ Recently, the USPSTF expanded its recommendations to screen for suicidal ideation and anxiety symptoms.¹⁰ The Center for Disease Control and Prevention (CDC) has highlighted the role of primary care providers in providing basic mental health care to resettled populations and has underlined the importance of consistent screening as mental health symptoms can occur months or years after resettlement.¹¹ Despite the recommended domestic medical examination within 90 days of arrival in the United States, only a minority of eligible subjects received mental health screening.¹² This highlights the key role of primary care providers in consistently screening for mental health problems among newly arrived people. Research has shown that screening, detection, and subsequent early treatment of depression decrease clinical morbidity,⁹ improve quality of life, and decrease healthcare costs.^13,14 Racial and ethnic minorities as well as refugees benefit from consistent screening likewise.^15
-18

Other studies have shown varied mental health screening rates between 59%¹⁹ and 88.8%.²⁰ While some authors have found racial disparities in mental health screening^21,22 and lower rates among patients with a preferred language other than English or Spanish,²⁰ little is known about mental health screening practice by language groups. This study aimed to assess mental health screening disparities among patients’ preferred language in a primary care setting.

Methods

In this retrospective cohort study, data from patients in 10 urban primary care clinics in West Michigan were analyzed. The study was deemed non-human subjects research by the decision of the Corewell Health institutional review board (#2022-342). Study results were reported in accordance with the The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.²³

Setting

The Michigan based Corewell Health system comprises 22 hospitals and over 300 outpatient facilities in a large non-profit managed healthcare organization. This study was conducted in the Grand Rapids-Kentwood-Muskegon-Combined Statistical Area which is home to 1.4 million people. While important characteristics like household income are similar to the overall United States ($69 643 vs $69 717) the proportion of the foreign-born population is lower than that of the overall population (5.7%vs 13.6%). Despite this difference, West Michigan is home to many refugee communities, especially from sub-Saharan Africa (Rwanda, Democratic Republic of Congo) and East Asia (Myanmar).

Sample

This sample consists of all unique patients aged 16 and older who established care at one of the respective clinics and had at least 1 office visit between 10/15/2021 and 10/14/2022. A few patients who had only urgent care and pure clinical resource visits (eg, appointments for immunization) were excluded (Figure 1). No other inclusion or exclusion criteria were applied. Corewell Health’s honest broker performed data extraction from Electronic Medical Records (EMR, Epic HYPERSPACE, Epic Systems Corporation, Verona WI, USA) and provided de-identified datasets to the researchers.

Figure 1.

Flow chart of patient inclusion.

The clinics were selected to match with different refugee and migrant communities in the region. The maximum number of clinics to include was suggested by Corewell Health’s Sensitive Data Sharing Workgroup to ensure that data extraction did not impede operability of the EMR system. The primary care clinics were primarily large clinics with a mean of 8581 (SD 6227, min 1251, max 22 059) served patients during the 12-month study period. These clinics comprise a total of 103.8 provider full time equivalent positions.

Primary Outcome

The primary outcome was defined as unique individuals receiving at least 1 mental health screening during the 12-month study period. Corewell Health introduced regular mental health screening in their primary care clinics using the Patient Health Questionnaire (PHQ-4)²⁴ in June 2017. This policy highlights screening “every patient age 18 or older at every visit.” Repeat screening were not deemed necessary if a patient was screened within the last 2 weeks. The PHQ-4 comprises 4 questions each targeting the main diagnostic criteria for depressive disorder and generalized anxiety disorder in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5-TR).²⁵ The PHQ-4 is widely used in both research and patient care and has been validated among various populations and languages,²⁶ and has proven its usability among refugee and migrant patients.²⁷

Covariates

The requested dataset contained additional information on patients’ sociodemographics, including age (at first encounter), sex, preferred language for encounter (assessed by office staff, typically indicate need for interpreter service), and health insurance type (private insurance, no insurance, Medicare, Medicaid). Preferred languages other than English were grouped into the 10 most common languages or regions where they are predominantly spoken. While the groups “Kinyarwanda,” “Vietnamese,” “Nepali,” and “Spanish” only entail people with the respective preferred language, the “Persian/Dari/Pashto” group also comprises a small group speaking Urdu and thus reflect languages spoken mainly in Iran and Afghanistan. Likewise, the “Burmese” group comprises Chin Hakha, Karen Languages, Tamil, Rohingya, Kayah, Tedim, and Falam and therefore reflects languages and sub-dialects that are spoken in Myanmar. Also, we assigned Serbian language to the “Bosnian” group and Sudanese Arabic to “Arabic.” The “other European languages” group comprises French, Albanian, Portuguese, German, Greek, Polish, Italian, Dutch, Hungarian, Romanian, and Latvian, but not Bosnian, English, or Spanish speakers.

The following chronic conditions that are associated with higher mental health burdens were also included in analyses when they occurred during or before the study period: diabetes mellitus,²⁸ chronic ischemic heart disease,²⁹ chronic rheumatic/inflammatory condition,³⁰ malignancy and cancer,³¹ and mental health diagnoses except tobacco use. We also recorded if patients had a preventive appointment for example, well child visits for 16 to 21 year-olds, annual physical or Medicare Annual Wellness Visits³² during the study period as screening for mental health problems would be expected at these appointments.

Statistical Analyses

First, descriptive statistics (absolute and relative frequencies, mean, standard deviation [SD]) were used to characterize our sample stratified after preferred language of encounter (English and non-English). To test the independence between language groups and other categorical or continuous variables, the Chi-Square or Mann-Whitney-U test was used, where applicable. In all tables, missing values are reported.

Second, unadjusted mental health screening prevalence with corresponding 95% confidence intervals (95% CI) is reported for sociodemographic and disease-related factors as well as preferred language. Forest plots were built using GraphPadPrism 9.5 (GraphPad Software, San Diego, CA, USA).

Third, a multivariable analysis was conducted. We used a general linear model with logit link function to assess the association between preferred language on mental health screening while adjusting for sociodemographic factors (age, sex, health insurance), frequency of encounters, preventive encounters, chronic conditions (diabetes mellitus, chronic ischemic heart disease, cancer diagnosis, mental health diagnosis) and the respective clinic. The binary outcome was defined as receiving at least 1 mental health screening within the 12-month study period. Results for different languages are reported as adjusted odds ratios (aOR) with corresponding 95% with English speaking patients as reference. A table reporting aORs for all non-language covariates can be found in the Supplemental Appendix.

All statistical analyses were carried out using SPSS 28 (IBM, Armonk, NY, USA) and P values <.05 were considered significant.

Results

After applying exclusion criteria, n = 85 725 patients with a total of 184 503 encounters during the study period were analyzed (Figure 1).

Patients in our sample were between 16 and 104 years old (mean 51.0 years, SD 18.9) and 58.4% were females. In total, 3.2% (n = 2755) patients had a preferred language other than English. These patients preferred 1 of 62 different languages, with Spanish (40.3%), Vietnamese (27.3%), Bosnian (5.8%), Kinyarwanda (4.0%), Nepali (3.2%), and Burmese (2.8%) being the most prevalent.

While sex and mean age did not differ significantly between English-speaking and patients with a language other than English, the proportion of 36 to 55-year-olds was somewhat higher among the latter group. Patients with a language preferred other than English also had more encounters with primary care providers during the study period (mean 2.4vs 2.1 among English-speaking patients, P < .001) and were less often insured through Medicare (18.1%vs 29.1% among English speaking patients, P < .001). While diabetes mellitus was more prevalent among patients with a preferred language other than English, (22.5%vs 13.5%, P < .001), other chronic conditions like chronic ischemic heart disease, chronic inflammatory/rheumatic condition, malignancy/cancer, mental health problems were less common (all P < .001, see Table 1).

Table 1.

Characteristics of Enrolled Subjects.

	English speaking (N = 82 970)	Language preferred other than English (N = 2755)	All (N = 85 725)	P *
	n (%)	n (%)	n (%)	P *
Sex^#
Male	34 452 (41.5)	1181 (42.9)	35 633 (41.6)	.159
Female	48 516 (58.5)	15.74 (57.1)	50 090 (58.4)	.159
Age
Mean (SD)	51.0 (19.0)	51.6 (16.3)	51.0 (18.9)	.126
16-35	21 656 (26.1)	479 (17.4)	22 135 (25.8)	<.001
36-55	24 277 (29.3)	1118 (40.6)	25 395 (29.6)
56-75	28 846 (34.8)	957 (34.7)	29 803 (34.8)
75+	8191 (9.9)	201 (7.3)	8392 (9.8)
Race^§
Other	3520 (4.3)	934 (38.5)	4454 (5.3)	<.001
American Indian or Alaska Native	280 (0.3)	4 (0.2)	284 (0.3)
Asian	1325 (1.6)	1018 (42)	2343 (2.8)
Black or African American	5195 (6.4)	179 (7.4)	5374 (6.4)
White or Caucasian	70 704 (87.3)	291 (12)	70 995 (85.1)
Hispanic^†	4410 (5.4)	1086 (40.4)	5496 (6.6)	<.001
Encounters
Mean (SD)	2.1 (1.5)	2.4 (1.7)	2.1 (1.5)	<.001
1-2	60 438 (72.8)	1826 (66.3)	62 264 (72.6)	<.001
3-4	16 762 (20.2)	625 (22.7)	17 387 (20.3)
5-9	5495 (6.6)	290 (10.5)	5785 (6.7)
10+	275 (0.3)	14 (0.5)	289 (0.3)
Annual physical/Well Child Visit	56 543 (68.1)	1940 (70.4)	58 483 (68.2)	.012
Insurance
No insurance	850 (1)	60 (2.2)	910 (1.1)	<.001
Medicare	24 160 (29.1)	499 (18.1)	24 659 (28.8)
Medicaid	7708 (9.3)	601 (21.8)	8309 (9.7)
Other private insurance	50 252 (60.6)	1595 (57.9)	51 847 (60.5)
Diabetes mellitus	11 196 (13.5)	619 (22.5)	11 815 (13.8)	<.001
Chronic ischemic heart disease	5173 (6.2)	91 (3.3)	5264 (6.1)	<.001
Chronic inflammatory/rheumatic diagnosis	3612 (4.4)	36 (1.3)	3648 (4.3)	<.001
Malignancy/cancer diagnosis	16 536 (19.9)	302 (11.0)	16 838 (19.6)	<.001
Mental health diagnosis	40 629 (49.0)	566 (20.5)	41 195 (48.1)	<.001
None of the above	28 326 (34.1)	1531 (55.6)	29 857 (34.8)	<.001

English versus language other than English, Chi-square test/Mann-Whitney U test, where applicable, missing language n = 89.

Missing sex n = 2.

“Other” includes Native Hawaiian or Other Pacific Islander, missing race n = 2286.

†

Missing ethnicity n = 1907.

For each encounter, English-speaking patients had a 63.2% likelihood (95% CI 63.0-63.5) of completing the screening, while those with a preferred language other than English had a likelihood of 72.6% (95% CI 71.5-73.7). Within a year, 76.7% of English-speaking patients received a screening (95% CI 76.3-76.9), and 87.0% of patients with a preferred language other than English (95% CI 85.7-88.2) received a screening. However, there were considerable differences between the preferred languages, with screening prevalence rates from 60.6% (Kinyarwanda) to 94.0% (Vietnamese). Also, differences in screening rates were observed among different ethnic and racial groups, type of insurance, number of encounters, and if a patient had a pre-existing conditions (Figure 2).

Figure 2.

Unadjusted PHQ-4 screening prevalence rates (with 95% confidence intervals).

Finally, we performed a binary logistic regression analysis with logit link function (n = 85 723 subjects) with the dependent variable “receiving at least one PHQ-4 screening within the 12 months study period” (Table 2). The analyses revealed significant lower odds to receive a screening for patients with a preference of Kinyarwanda and Persian/Dari/Pashto language, and higher odds for patients with a preference of Spanish, Bosnian/Serbian, and Vietnamese language compared to English-speaking patients. Adjusted odd’s ratios of all covariates are shown in the Supplemental Appendix.

Table 2.

Adjusted Odds Ratio’s Among Preferred Languages.

Parameter	N	aOR (95% CI)	P
Kinyarwanda	109	0.29 (0.19-0.45)	<.001
Persian/Dari/Pashto	47	0.46 (0.23-0.91)	.026
Other	244	0.77 (0.55-1.06)	.107
Burmese	138	0.79 (0.51-1.21)	.271
Nepali	88	0.98 (0.57-1.70)	.951
English	82 970	Ref
Arabic	39	1.14 (0.43-2.97)	.796
Spanish	1110	1.45 (1.19-1.77)	<.001
Other European language	63	2.04 (0.80-5.20)	.138
Bosnian	164	2.13 (1.11-4.11)	.024
Vietnamese	753	2.25 (1.64-3.08)	<.001

Discussion

In this retrospective cohort study, we found that patients having a preferred language other than English had higher chances of receiving the recommended mental health screening compared to English-speaking patients. The difference between both groups of receiving a mental health screening within the 12-month study period was 10.3% (76.7% English vs 87.0% non-English). This conclusion changes when stratified for different languages: a multivariable model revealed considerably lower screening odds for Kinyarwanda and Persian/Dari/Pashto speaking patients and confirmed higher screening odds for Spanish, Bosnian, and Vietnamese speaking patients compared to English speaking patients.

A cohort study involving 52 944 patients from 6 primary care facilities in San Francisco, California, conducted before the Coronavirus disease 2019 (COVID-19) pandemic, reported similarly higher screening odds for Spanish-speaking patients but lower odds for Chinese-speaking patients and patients with other non-English language preferences. However, these differences were not consistent after the introduction of a general screening policy.²⁰

Availability of Validated Mental Health Screening Instruments

A key prerequisite to conducting a mental health screening in non-English speaking patients is access to validated and culturally adapted screening instruments for the respective language.³³ The official repository for the widely used PHQ-4 or the more comprehensive Generalized Anxiety Disorder 7 questionnaire (GAD-7)³⁴ and Patient Health Questionnaire (PHQ-9)³⁵ is the website “PHQ screeners”³⁶ by the pharmaceutical company Pfizer. While GAD-7 and PHQ-9 screeners are provided in more than 50 languages, the PHQ-4 is mostly unavailable in any other languages than English. For example, of the language groups in our sample, the PHQ-9/GAD-7 was only available for Spanish, Arabic and some other European languages at this website.

Furthermore, providers would need to compile their own PHQ-4 out of the available GAD-7 and PHQ-9 screeners, however these “self-made” instruments are not validated. Eventually, clinics may be unprepared to screen patients using the PHQ-4 because of the added effort that must go into creating translated copies. Other options for providers to gain access to validated screening instruments are through a research of PubMed or other databases. While many surveys are not validated for the particular purpose another major obstacle is that many instruments are either not included in the manuscript^37,38 or are published under a non-open access license.^39,40 Lastly, for some languages (including Kinyarwanda, Pashto) there have not been attempts to translate and validate instruments such as the GAD-7 or the PHQ-9. This is probably the main reason why Kinyarwanda and Pashto speaking patients are the least likely to receive a mental health screening. This is all the more concerning as the vast majority of these patients have fled from areas of armed conflict and have a correspondingly high risk for unrecognized mental health problems.^41,42 Conversely, for those language where translated and validated screenings instrument were available, higher screening rates were apparent.

Another option for conducting mental health screening among patients where no screening instrument is available is to instantly interpret the English version of the instrument by an interpreter. While this pragmatic approach is neither quality assured nor recommended, it allowed some of the Kinyarwanda speaking patients in our cohort to receive a mental health screening. Furthermore, this requires consistent access to well-trained culturally competent interpreting services that are familiar with mental health, which are often unavailable in primary care settings.⁴³

Reluctancy to Screen and Provider’s Implicit Bias

Besides barriers in accessing screening instruments, providers may be reluctant to screen for various reasons. Although primary care providers can identify approximately half of their depressive patients when no psychometric instrument is used,⁴⁴ many providers still decide on who receives screening on a case-by-case basis⁴⁵ or the perception of “knowing a patient personally.”⁴⁶ Other barriers include lack of comfort in treating patients with mental health problems.⁴⁷

Furthermore, providers may face limited capacities to refer non-English speaking patients to culturally and linguistically competent mental health treatment. Given the widespread shortage of mental health providers, there may also be a barrier for non-English speaking patients to receive the necessary care.^48,49 The CDC recommends that providers that regularly provide care to refugee patients should foster a good working relationship with refugee resettlement agencies and their mental health support structures.¹¹

Despite this, mental health assessment is necessary for primary care providers to evaluate if somatic symptoms and ailments are originating from a mental health concern.¹¹ As cultural variations in the clinical presentation of psychological distress may occur, providers who do not screen for mental health may misinterpret cultural idioms of distress which may lead to unnecessary tests or inappropriate treatment.^50,51

Patients with the preferred languages Spanish, Bosnian, or Vietnamese in our studies had an increased likelihood to receive a screening compared to non-English speakers. Refugee intake and migration from the region where these languages are spoken occurred decades ago, for example, through the “Indochina Migration and Refugee Assistance Act”⁵² from 1975 or the acceptance of Burmese and Bhutanese refugees in 2018.⁵³ Conversely, those with rather low screening rates are rather new to the US: For example, refugees from the Democratic Republic of Congo were by far the largest refugee group admitted to the US in 2019.⁵³ It is conceivable that clinics providing care to those patients developed workarounds over time and that decades of ongoing patient-provider relationships diminished hesitancy in bringing up mental health as a topic. As there is a high and growing number of Spanish speakers in the U.S. (approximately 41.8 million people), it is similarly likely that clinics are prepared to provide mental health screening to this group.⁵⁴ While both would explain screening odds that are comparable to English speaking patients, it remains unclear why screening rates for Bosnian and Vietnamese speaking patients are twice as high compared to English speaking patients. This may reflect that providers acknowledge the increased risk for mental health problems among these populations or may be the result of increased diversity equity and inclusion initiatives to address mental health challenges. Researchers have also discussed providers’ implicit bias as a factor in diagnosing mental health conditions in minority populations.⁵⁵

Strengths and Limitations

Our study relies on EMR-data and thus on the documentation accuracy. It is possible, that clinic staff may have performed a mental health screening but not documented it or falsely indicated preferred patients’ language as “English.” However, this might only has happened in some few cases and would not have changed the results considerably.

Other limitations include that we could not adjust for the length a patient stayed in the US or the migration status (eg, refugee, resettled migrant, migrant with a non-permanent or permanent resident visa, naturalized US citizen, born US citizen) as this information was lacking. Furthermore, the clinics and patients included in the research are not representative of the entire U.S. population. For example, the proportion of White or Caucasian people was higher in our sample than in the overall U.S. population. However, a strength of this study is the large and complete sample of patients that were included from 10 primary care clinics. As those clinics encompass over 100 primary care providers, a considerable provider bias is unlikely.

Our study could not account certain patient-associated reasons for not receiving a mental health screening, such as illiteracy, or decline to complete screening. Due to the nature of retrospective study, we could also not assess if patients received translated screening instruments or if English instruments were instantly interpreted on site. Prospective observational studies can provide a deeper understanding of the actual mental health screening practice and might further inform strategies to enhance screening uptake.

Conclusions

Screening for mental health in primary care settings is a vital component of a routine health maintenance exam and should be performed for all patients, no matter the language they speak. Providers and clinics on the local level should be aware that populations newer to the area might be less likely to be screened for mental health disorders, despite their high risk. This awareness hopefully might translate into higher screening rates. On organizational level, an open access repository on publicly available, translated, and validated mental health screening instruments, multilingual digital tools that streamline the mental health screening process,^56
-58 and efforts to culturally and linguistically diversify the healthcare workforce^59,60 might further contribute to consistent mental health screening.

Supplemental Material

sj-docx-1-jpc-10.1177_21501319231200304 – Supplemental material for Mental Health Screening Differences in Non-English Speaking Patients: Results From a Retrospective Cohort Study

Supplemental material, sj-docx-1-jpc-10.1177_21501319231200304 for Mental Health Screening Differences in Non-English Speaking Patients: Results From a Retrospective Cohort Study by Frank Müller, Alyssa M. Abdelnour, Diana N. Rutaremara, Judith E. Arnetz, Eric D. Achtyes, Omayma Alshaarawy and Harland T. Holman in Journal of Primary Care & Community Health

Footnotes

Acknowledgements

The authors want to thank the Corewell Health Office of Research and Education and the Corewell Health Honest Broker for their support. We acknowledge support by the Open Access Publication Funds of the Göttingen University.

Author’s Note

Prior presentation(s): This work has not been presented at any conference.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: FM received funding as Peter C. and Pat Cook endowed clinical research fellow. OA is funded by the United States National Center for Complementary and Integrative Health [R00AT009156] and Michigan State University. The funding organizations had no role, in designing the study; collecting, analyzing, or interpreting data; or writing or submitting the manuscript.

ORCID iDs

Frank Müller

Eric D. Achtyes

Supplemental Material

Supplemental material for this article is available online.

References

Egede

Zheng

Simpson

Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002;25(3): 464-470. doi:10.2337/diacare.25.3.464

Bedaso

Duko

Epidemiology of depression among displaced people: a systematic review and meta-analysis. Psychiatry Res. 2022;311:114493. doi:10.1016/j.psychres.2022.114493

Mesa-Vieira

Haas

Buitrago-Garcia

, et al. Mental health of migrants with pre-migration exposure to armed conflict: a systematic review and meta-analysis. Lancet Public Health. 2022;7(5):e469-e481. doi:10.1016/S2468-2667(22)00061-5

Kouvonen

Bosqui

Patel

O’Reilly

Donnelly

The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Global Health. 2016;12(1):47. doi:10.1186/s12992-016-0187-3

Abubakar

Aldridge

Devakumar

, et al. The UCL–Lancet Commission on Migration and Health: the health of a world on the move. Lancet. 2018;392(10164):2606-2654. doi:10.1016/S0140-6736(18)32114-7

Steel

Chey

Silove

Marnane

Bryant

van Ommeren

Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537-549. doi:10.1001/jama.2009.1132

Beiser

Hou

Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study. Soc Sci Med. 2001;53(10):1321-1334. doi:10.1016/s0277-9536(00)00412-3

Schweitzer

Melville

Steel

Lacherez

Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Aust N Z J Psychiatr. 2006;40(2):179-187. doi:10.1080/j.1440-1614.2006.01766.x

O’Connor

Rossom

Henninger

, et al. Screening for Depression in Adults: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality; 2016. Accessed March 21, 2023. http://www.ncbi.nlm.nih.gov/books/NBK349027/

10.

O’Connor

Henninger

Perdue

Coppola

Thomas

Gaynes

BN.

Screening for Depression, Anxiety, and Suicide Risk in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality; 2022.

11.

National Center for Emerging and Zoonotic Infectious Diseases, Division of Global Migration and Quarantine. Guidelines for Mental Health Screening During the Domestic Medical Examination for Newly Arrived Refugees . U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2015. Accessed May 14, 2023. https://www.cdc.gov/immigrantrefugeehealth/pdf/mental-health-screening-guidelines.pdf

12.

Pezzi

Lee

Kumar

, et al. Health screenings administered during the domestic medical examination of refugees and other eligible immigrants in nine US states, 2014–2016: a cross-sectional analysis. PLoS Med. 2020;17(3):e1003065. doi:10.1371/journal.pmed.1003065

13.

Birk

Kronish

Moise

Falzon

Yoon

Davidson

KW.

Depression and multimorbidity: considering temporal characteristics of the associations between depression and multiple chronic diseases. Psychol Health. 2019;38(9):802-811. doi:10.1037/hea0000737

14.

Mulvaney-Day

Marshall

Downey Piscopo

, et al. Screening for behavioral health conditions in primary care settings: a systematic review of the literature. J Gen Intern Med. 2018;33(3):335-346. doi:10.1007/s11606-017-4181-0

15.

Meyers

Groh

Binienda

Depression screening and treatment in uninsured urban patients. J Am Board Fam Med. 2014;27(4):520-529. doi:10.3122/jabfm.2014.04.130254

16.

Savin

Seymour

Littleford

Bettridge

Giese

Findings from mental health screening of newly arrived refugees in Colorado. Public Health Rep. 2005;120(3):224-229. doi:10.1177/003335490512000303

17.

Barnes

DM.

Mental health screening in a refugee population: a program report. J Immigr Health. 2001;3(3):141-149. doi:10.1023/A:1011337121751

18.

Randle

Spurlock

Kelley

Depression screening among African American adults in the primary care setting. J Psychosoc Nurs Ment Health Serv. 2019;57(10):18-23. doi:10.3928/02793695-20190610-01

19.

Pfoh

Janmey

Anand

Martinez

Katzan

Rothberg

MB.

The impact of systematic depression screening in primary care on depression identification and treatment in a large health care system: a cohort study. J Gen Intern Med. 2020;35(11):3141-3147. doi:10.1007/s11606-020-05856-5

20.

Garcia

Hinton

Neuhaus

Feldman

Livaudais-Toman

Karliner

LS.

Equitability of depression screening after implementation of general adult screening in primary care. JAMA Netw Open. 2022;5(8):e2227658. doi:10.1001/jamanetworkopen.2022.27658

21.

Kato

Borsky

Zuvekas

Soni

Ngo-Metzger

Missed opportunities for depression screening and treatment in the United States. J Am Board Fam Med. 2018;31(3):389-397. doi:10.3122/jabfm.2018.03.170406

22.

Akincigil

Matthews

EB.

National rates and patterns of depression screening in primary care: results from 2012 and 2013. Psychiatr Serv. 2017;68(7):660-666. doi:10.1176/appi.ps.201600096

23.

von Elm

Altman

Egger

Pocock

Gøtzsche

Vandenbroucke

JP.

The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-349. doi:10.1016/j.jclinepi.2007.11.008

24.

Kerper

Spies

Tillinger

, et al. Screening for depression, anxiety, and general psychological distress in pre-operative surgical patients: a psychometric analysis of the Patient Health Questionnaire 4 (Phq-4). Clin Health Promot. 2014;4(1):5-14. doi:10.29102/clinhp.14002

25.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR, 5th ed. American Psychiatric Association Publishing; 2022.

26.

Wicke

Krakau

Löwe

Beutel

Brähler

Update of the standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2022;312:310-314. doi:10.1016/j.jad.2022.06.054

27.

Poole

Liao

Larson

, et al. Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees. Ann Gen Psychiatry. 2020;19(1):5. doi:10.1186/s12991-020-0259-x

28.

Wang

Lopez

Bolge

Zhu

Stang

PE.

Depression among people with type 2 diabetes mellitus, US National Health and Nutrition Examination Survey (NHANES), 2005-2012. BMC Psychiatry. 2016;16:88. doi:10.1186/s12888-016-0800-2

29.

Karami

Kazeminia

Karami

Salimi

Ziapour

Janjani

Global prevalence of depression, anxiety, and stress in cardiac patients: a systematic review and meta-analysis. J Affect Disord. 2023;324:175-189. doi:10.1016/j.jad.2022.12.055

30.

Fiest

Hitchon

Bernstein

, et al. Systematic review and meta-analysis of interventions for depression and anxiety in persons with rheumatoid arthritis. J Clin Rheumatol. 2017;23(8):425-434. doi:10.1097/RHU.0000000000000489

31.

Riedl

Schuessler

Prevalence of depression and cancer – a systematic review. Z Psychosom Med Psychother. 2022;68(1):74-86. doi:10.13109/zptm.2021.67.oa11

32.

Moore

Koenig

Shakiba

Heidbrink

Guinn

Increasing Medicare annual wellness visits in accountable care organizations. Am J Accountable Care. 2021;9(3):13-18. doi:10.37765/ajac.2021.88749

33.

Magwood

Kassam

Mavedatnia

, et al. Mental health screening approaches for resettling refugees and asylum seekers: a scoping review. Int J Environ Res Public Health. 2022;19(6):3549. doi:10.3390/ijerph19063549

34.

Spitzer

Kroenke

Williams

JBW

Löwe

A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092. doi:10.1001/archinte.166.10.1092

35.

Kroenke

Spitzer

Williams

JB.

The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x

36.

Pfizer Inc. Patient Health Questionnaire (PHQ) screeners. 2014. Accessed May 16, 2023. https://www.phqscreeners.com/select-screener/

37.

Sebera

Vissoci

JRN

Umwiringirwa

Teuwen

Boon

Dedeken

Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda. PLoS One. 2020;15(6):e0234095. doi:10.1371/journal.pone.0234095

38.

Kasujja

Bangirana

Chiumento

, et al. Translating, contextually adapting, and pilot testing of psychosocial and mental health assessment instruments for Congolese refugees in Rwanda and Uganda. Confl Health. 2022;16(1):17. doi:10.1186/s13031-022-00447-z

39.

Naveed

Waqas

Memon

Jabeen

Sheikh

MH.

Cross-cultural validation of the Urdu translation of the Patient Health Questionnaire for adolescents among children and adolescents at a Pakistani school. Public Health. 2019;168:59-66. doi:10.1016/j.puhe.2018.11.022

40.

Nallusamy

Afgarshe

Shlosser

Reliability and validity of Somali version of the PHQ-9 in primary care practice. Int J Psychiatr Med. 2016;51(6):508-520. doi:10.1177/0091217417696732

41.

Tonui

. The cultural perceptions on mental health and post-resettlement challenges among Rwandan refugees in the U.S. Psychiatry Res. 2022;313:114642. doi:10.1016/j.psychres.2022.114642

42.

Alemi

James

Cruz

Zepeda

Racadio

Psychological distress in Afghan refugees: a mixed-method systematic review. J Immigr Minor Health. 2014;16(6):1247-1261. doi:10.1007/s10903-013-9861-1

43.

Tribe

Thompson

Working with interpreters when working with forced migrants in mental health. Int Rev Psychiatry. 2022;34(6):613-621. doi:10.1080/09540261.2022.2073202

44.

Mitchell

Vaze

Rao

Clinical diagnosis of depression in primary care: a meta-analysis. Lancet. 2009;374(9690): 609-619. doi:10.1016/S0140-6736(09)60879-5

45.

Pilipenko

Vivar-Ramon

Depression screening perceptions and practices in a primary care clinic: a mixed-methods study. Psychol Serv. 2023. Published online February 23, 2023. doi:10.1037/ser0000753

46.

Hill

Cantrell

Edwards

Dalton

Factors influencing mental health screening and treatment among women in a rural South Central Appalachian Primary Care Clinic: mental health screening in rural primary care. J Rural Health. 2016; 32(1):82-91. doi:10.1111/jrh.12134

47.

Stilwell

Pelkey

Platt

, et al. Survey of primary care provider comfort in treating psychiatric patients in 2 community clinics: a pilot study. Prim Care Companion CNS Disord. 2022;24: 21m03020. doi:10.4088/PCC.21m03020

48.

Tadmon

Bearman

PS.

Differential spatial-social accessibility to mental health care and suicide. Proc Natl Acad Sci USA. 2023;120(19):e2301304120. doi:10.1073/pnas.2301304120

49.

Substance Abuse and Mental Health Services Administration . Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2021. https://www.samhsa.gov/data/

50.

Kirmayer

LJ.

Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry. 2001;62(Suppl 13):22-28. discussion 29-30.

51.

Bagayogo

Interian

Escobar

. Transcultural aspects of somatic symptoms in the context of depressive disorders. In: Alarcón

(ed.) Advances in Psychosomatic Medicine, Vol. 33. S. Karger AG; 2013;64-74.

52.

Congress.gov. Indochina Migration and Refugee Assistance Act. 1975. Accessed May 17, 2023. http://www.congress.gov/

53.

Krogstad

. Key facts about refugees to the U.S. Pew Research Center. Published October 7, 2019. Accessed May 17, 2023. https://www.pewresearch.org/short-reads/2019/10/07/key-facts-about-refugees-to-the-u-s/

54.

United States Census Bureau. S1601: language spoken at home 2019—Census Bureau table. Published online 2019. Accessed May 17, 2023. https://data.census.gov/table?q=Language+Spoken+at+Home&tid=ACSST1Y2019.S1601

55.

Olbert

Nagendra

Buck

. Meta-analysis of black vs. White racial disparity in schizophrenia diagnosis in the United States: do structured assessments attenuate racial disparities? J Abnorm Psychol. 2018;127(1):104-115. doi:10.1037/abn0000309

56.

Noack

Schäning

Müller

A multilingual app for providing information to SARS-CoV-2 vaccination candidates with limited language proficiency: development and pilot. Vaccines. 2022;10(3):360. doi:10.3390/vaccines10030360

57.

Müller

Schröder

Noack

EM.

Overcoming language barriers in paramedic care with an app designed to improve communication with foreign-language patients: nonrandomized controlled pilot study. JMIR Form Res. 2023;7:e43255. doi:10.2196/43255

58.

Müller

Chandra

Furaijat

, et al. A digital communication assistance tool (DCAT) to obtain medical history from foreign-language patients: development and pilot testing in a primary health care center for refugees. Int J Environ Res Public Health. 2020;17(4):1368. doi:10.3390/ijerph17041368

59.

LaVeist

Pierre

Integrating the 3Ds–social determinants, health disparities, and health-care workforce diversity. Public Health Rep. 2014;129(Suppl 2):9-14. doi:10.1177/00333549141291S204

60.

Müller

Holman

Hummers

Schröder

Noack

EM.

Multilingual competencies among ambulatory care providers in three German Federal States. BMC Prim Care. 2022;23(1):315. doi:10.1186/s12875-022-01926-1

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB