Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

Assessing the Prevalence of Depression Among English versus Spanish Speaking Patients at a Free Medical Clinic Kushali Patel, B.S. 1 , Anushka Parekh, B.S. 1 , Grace Ralston, B.S. 1 , Amanda Donald, B.S. 2 , Emma Beier, B.S. 1 , David Redden, PhD 4 , Lisa Carroll, MD 3

1. VCOM Carolinas, OMS III., Spartanburg, SC. 2. VCOM Carolinas, OMS II, Spartanburg, SC.

3. VCOM Carolinas, Department Chair for Clinical Sciences, Spartanburg, SC. 4. VCOM Carolinas, Biomedical Affairs and Research, Spartanburg, SC

Discussion

Introduction

Methods • Access to quality healthcare is a critical determinant of health outcomes, yet language barriers remain a significant obstacle, particularly for patients who do not speak English. In the free clinic settings, this challenge is further exacerbated by limited resources, including limited availability and use of interpreters (Whitaker et al 2021). • Depression is a highly prevalent mental health condition but is often underdiagnosed and undertreated in populations facing language barriers. This is possibly due to factors such as cultural stigma, inadequate communication, and lack of follow-up care. • This study aims to examine the incidence of depression among English-speaking and Spanish-speaking patients at St. Luke’s Free Medical Clinic in Spartanburg, South Carolina. • By comparing depression screening outcomes between these groups, we seek to identify disparities in mental health screening and follow-up care, ultimately providing data to guide strategies for improving patient-centered and culturally appropriate healthcare. Study Design : Patients at St. Luke’s Free Medical Clinic fill out the Patient Health Questionnaire-2 (PHQ-2) to screen for depression. Study Population : The population includes patients that visited St. Luke’s Free Medical Clinic in Spartanburg, SC during 2023. The patients for the study spoke either Spanish or English as their primary language. Intervention : Every patient seen at St. Luke’s Free Medical Clinic fills out the PHQ-2 questionnaire to screen for depression based off their self-report. For the research study, a random number generator picked 5 dates that patients were seen at the clinic in 2023. The patients were given a numerical code to de-identify the data. The data that was recorded included the patient’s birth year, biological sex, race, preferred language, interpreter use, depression screen date and result, and if a positive depression screening included a follow up plan.

• The data demonstrates that a positive depression screen was associated with preferred language, as significantly more patients who screened positive were English speakers compared to Spanish speakers. Also found was that needing an interpreter was associated with a positive depression screen. • Although not statistically significant, it was found that positive screening for depression varied based on race, with Hispanics being the lowest to report positive depression with a p value of 0.0874. • Latino immigrants experience higher rates of depression compared to non-Hispanic whites and are more likely to seek care at primary healthcare clinics instead of mental health facilities (Timmins, 2021). • This study has limitations due to the small sample size, making it difficult to extrapolate this data to other geographical areas. In addition, studying patients from a free clinic limits the generalizability of the data to all income levels and socioeconomic statuses. • Following the results of this study, we are working with St. Luke's Free Medical Clinic to implement a verified Spanish version of the PHQ-2. With this change, we hope that it is a first step towards closing the gap in language barriers and providing care to all patients. Conclusions • This study demonstrated a statistically significant difference in the rates of positive depression screenings between English and Spanish-speaking patient populations. • These findings highlight the potential impact of language barriers on healthcare outcomes and access to resources, aligning with the hypothesis for this study. • Future research efforts: Does accessibility to mental health services improve between English and Spanish-speaking populations if the depression screenings are performed with the provider versus the patients completing the screening forms individually?

Figure 1. Verified PHQ-2.

Results

Figure 2. Screening positive for depression was associated with whether an interpreter was needed (24.00% positive given an interpreter was not needed, 5.88% given an interpreter was needed).

Figure 3. Though not statistically significant at the 0.05 level, the proportion of positive screening varied by self-reported race (21.43% positive given race is African American, 26.83% positive given race is Caucasian, and 7.69% positive given race is Hispanic) generating a p value = 0.0874. There were a total of 111 charts reviewed. Of the 111, 41 individuals reported race as Caucasian, 28 reported race as African American, 39 reported race as Hispanic/ Latino , and 3 reported race as other. Of the 111, 71 reported their preferred language as English, 38 reported their preferred language as Spanish, and 2 individuals had missing data. Of the 111, 34 required an interpreter, 75 did not require an interpreter, and 2 individuals had missing data. Of the 111, 20 individuals screened position for depression (18.02%) while 90 screened negative (81.98%). Of the 20 individuals who screened positive, 10 have a documented follow-up plan.

References

Figure 4. Screening positive for depression was associated with preferred language (25.35% positive with English, 5.26% positive with Spanish)

• Limon, F. J., Lamson, A. L., Hodgson, J., Bowler, M., & Saeed, S. (2016). Screening for Depression in Latino Immigrants: A Systematic Review of Depression Screening Instruments Translated into Spanish. Journal of Immigrant and Minority Health , 18 (4), 787 – 798. https://doi.org/10.1007/s10903-015-0321-y • Noe-Bustamante, M. M. and L. (2023, August 16). Facts on Latinos in the U.S. Pew Research Center . https://www.pewresearch.org/race-and-ethnicity/fact-sheet/latinos-in-the-us-fact-sheet/ • Timmins, C. L. (2002). The impact of language barriers on the health care of Latinos in the United States: A review of the literature and guidelines for practice. Journal of Midwifery & Women’s Health , 47 (2), 80 – 96. https://doi.org/10.1016/S1526-9523(02)00218-0 • Whitaker, K. L., Krystallidou, D., Williams, E. D., Black, G., Vindrola-Padros, C., Braun, S., & Gill, P. (2021). Addressing language as a barrier to healthcare access and quality. The British Journal of General Practice , 72 (714), 4 – 5. https://doi.org/10.3399/bjgp22X718013

• Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of Language Barriers for Healthcare: A Systematic Review. Oman Medical Journal , 35 (2), e122. https://doi.org/10.5001/omj.2020.40 • Bohm, P., & Cupertino, A. P. (2014). Accommodating Limited English Proficient Spanish Speakers in Rural Hospitals. J Immigrant Minority Health . • Costantini, L., Pasquarella, C., Odone, A., Colucci, M. E., Costanza, A., Serafini, G., Aguglia, A., Belvederi Murri, M., Brakoulias, V., Amore, M., Ghaemi, S. N., & Amerio, A. (2021). Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. Journal of Affective Disorders , 279 , 473 – 483. https://doi.org/10.1016/j.jad.2020.09.131 • Kroenke K, Spitzer RL, Williams JB . The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92. (n.d.). • Lépine, J.-P., & Briley, M. (2011). The increasing burden of depression. Neuropsychiatric Disease and Treatment , 7 (sup1), 3 – 7. https://doi.org/10.2147/NDT.S19617

Assessment : The data was assessed through Chi-Square using a Type 1 error rate of 0.05. The analysis was performed using SAS 9.4.

2025 Research Recognition Day

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