Finding the Sore Spot Using Medical Records: How Big Data and Community Awareness Can Help Prevent Anxiety and Depression

Background: The Latinx community has long been underserved for mental health services. Underrepresentation in service providers, cultural barriers, and language barriers contribute to difficulties in healthcare access, diagnosis and treatment for this population. Using secondary analyses of medical records data, we investigated how internalizing outcomes are associated with characteristics of the Hispanic community. Data: El Futuro, a Durham, NC based mental health provider, has provided services to nearly 7,000 Latinx patients for over 10 years. 2,547 patients completed the Depression Anxiety Stress Scale (DASS) or the Pediatric Symptom Checklist (PSC), in English or Spanish, depending on their English-speaking ability. Assessments were completed at intake, 3 months, 6 months, and 12 months later. Since 2005, El Futuro has recorded 4,589 assessments. Residence location is available for nearly all clients. Methods: Growth mixture modeling with time-varying covariates modelled and tested change in symptoms over time. Patient data are nested by clinician. To adjust for community effects, patients census blocks are recorded and U.S. Census data provide median household income, poverty, and population density. Other location-specific data will be explored as appropriate. Results: The sample is 59% female and 41% male. Patient mean age was 11.1 years for the PSC and 32.1 for the DAS. Patients taking the Spanish DAS were an average of 5 years older than patients who took the English DAS (no corresponding difference occurred for the PSC). Nearly 60% of patients completed the English DAS while 10% took the Spanish DAS. A quarter of the sample (26%) took the English language PSC, while 5% of the sample took the Spanish language PSC. Initial trajectory analyses demonstrate significant improvement in patients’ depression and anxiety. Non-English-speaking adults experienced greater reductions in depression and anxiety compared to English-speaking adults. Planned analyses will test the roles of neighborhood characteristics and social determinants of health. Conclusions: Access to healthcare has a large role in treating existing conditions in adults and mitigating the effect of traumatic events in children, particularly for an underserved community. Results demonstrated that Latinx patients with internalizing diagnoses benefit from mental health services that are designed specifically for the Hispanic community. Moreover, greater benefit was associated with less proficiency with English. These results and the planned analyses will inform future offerings of mental health services that are likely to benefit the Hispanic community within El Futuro’s catchment area. Secondary analysis of medical records will be critical for informing this program planning.