# Assessing the Prevalence of Depression Among English- and Spanish-Speaking Patients at a Free Medical Clinic

## TL;DR

This study found that English-speaking patients at a free clinic were more likely to screen positive for depression than Spanish-speaking patients, possibly due to language and access barriers.

## Contribution

The study provides empirical evidence of language-based disparities in depression screening outcomes at a free medical clinic.

## Key findings

- 18.02% of 111 patients screened positive for depression.
- English-speaking patients had a significantly higher positive screening rate than Spanish-speaking patients.
- Patients who did not need an interpreter were more likely to screen positive for depression.

## Abstract

Objective: The goal of this study was to assess the rate of positive depression screens in a randomly selected group of 111 patients at St. Luke’s Free Medical Clinic in Spartanburg, South Carolina, while also looking for differences in positive depression screeners between English- and Spanish-speaking patients. Our hypothesis is that at the free clinic, there is an overall low positive screening rate for depression in Spanish-speaking patients due to stigma, lack of interpreters, and the English language Patient-Health Questionnaire-2 (PHQ-2).

Methods: All patients seen at St. Luke’s fill out a PHQ-2, which screens for depression. Patients self-report this information. To conduct the research study, a random number generator was used to pick five dates from 2023 when patients were seen at the clinic. Patients were given a numerical code as deidentifiers, and the data were recorded in a password-protected computer. The deidentified data recorded included patient year of birth, biological sex, race, preferred language, need for an interpreter, depression screen date, depression screening result, and follow-up plan if positive for depression screening. Given the categorical nature of the outcomes, tests of association will be conducted with chi-square tests using a type I error rate of 0.05. All statistics and significance tests were performed using Statistical Analysis System 9.4 (SAS Inc., Cary, NC).

Results: Of the 111 patients, 20 individuals screened positive for depression (18.02%), while 90 screened negative (81.98%). Of the 20 individuals who screened positive, 10 (50.00%) had a documented follow-up plan. Using chi-square tests of association, those who screened positive for depression had a statistically significant association with English as their preferred language (13.03% positive given preferred language is English, 6.97% positive given preferred language is Spanish, p = 0.0175). Additionally, there was a statistically significant association between a positive depression screening and not needing an interpreter (13.761% positive given an interpreter was not needed, 6.2385% given an interpreter was needed, p = 0.0236).

Conclusion: Through our data collection and analyses, we observed a statistically significant difference in rates of positive depression screenings between English- and Spanish-speaking patients. This supports our hypothesis in theorizing that language barriers create inequities in access to healthcare and resources.