Activity 1: Cultural Nuances and Challenges in Diagnosing and Treating Depression

Program Overview

The recognition and treatment of depression remains a significant challenge for primary care physicians. In ethnic minorities, culture, belief systems and language barriers contribute to the current rates of under-recognition, misdiagnosis and lack of treatment. Many cultures discourage discussing or seeking medical attention for mental disorders. In addition, as depression is not a recognized medical entity in some cultures, patients may present with somatic complaints rather than more distinguishing symptoms such as sadness or adhedonia.

In Cultural Nuances and Challenges in Diagnosing and Treating Depression, family physicians discuss how culture and belief systems can impact diagnosis and management of depression in the family medicine setting. At the heart of this discussion are two video patient vignettes that reveal the patients’ perspective on how their culture influenced their acceptance of the diagnosis and treatment of depression.

Intended Audience

This continuing medical education program is intended for family practitioners and other healthcare professionals who manage depression.

Learning Objectives

After completing this activity, participants will be better able to:

• Recognize risk factors, signs and symptoms of depression and the impact that a patient’s ethnic identity/socio-cultural background may have on presentation
• Craft an effective treatment plan, taking into account patient preferences (e.g., medication, psychotherapy or combination therapy)
• Address barriers/challenges that can derail effective management, including cultural/societal influences
• Establish a follow-up plan to assess progress toward patient goals, adjust treatment if needed and minimize risk of relapse

Faculty and Planning Committee

Nipa Shah, MD
Director, Predoctoral Education
Associate Professor of Clinical Family Medicine
University of Illinois College of Medicine at Chicago

Josie Tenore, MD
Assistant Professor, Department of Family Medicine
Feinberg School of Medicine

Penny Tenzer, MD
Vice Chair, Director of the Residency Program
University of Miami, Miller School of Medicine
Chief of Service for Family Medicine
University of Miami Hospital

CME Accreditation

This activity has been reviewed and is acceptable for up to 1.0 Prescribed credit by the American Academy of Family Physicians. AAFP accreditation begins January 4, 2010. Term of approval is for 2 years from this date with the option of yearly renewal. This Prescribed credit conforms to the AAFP criteria for evidence-based CME clinical content. It is not necessary to label credit as evidence-based CME for reporting purposes.

The EB CME credit awarded for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since some clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Family Physicians designates this education activity for a maximum of 1 AMA PRA Category 1 credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Agenda

Introduction and opening remarks
Module 1: Unmasking Depression: The Impact of Culture
                   Case 1 – Asian American Man
Module 2: Patient-centered Approach to Depression Care
                   Case 2 – Latina Woman
Module 3: Getting to Remission: Targeting Treatment Goals to the Individual

Disclosures:

It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interests and, if identified, they are resolved prior to confirmation of participation. Only these participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in this CME activity.

The AAFP and MedEd Architects staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity. Drs. Shah, Tenore and Tenzer have returned a disclosure form indicating that she/he have no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material.

Please note that faculty is required to disclose all relevant relationships prior to the beginning of the activity.