Background: The feasibility and acceptability of telepsychiatry for low-income Hispanic patients with major depression were assessed. Subjects and Methods: In total, 167 adult Hispanic patients with major depression recruited from a community health center (CHC) were randomly assigned to receive psychiatry services through a video Webcam (WEB) (n=80) or to treatment as usual (TAU) (n=87). The WEB condition consisted of monthly telepsychiatry sessions at the CHC for 6 months provided by one of two Hispanic psychiatrists using an online virtual meeting program. TAU patients received their care from their providers. Acceptability was assessed by comparing appointment keeping for primary care versus telepsychiatry, patients' perceived working alliance with their provider, visit satisfaction, and antidepressant use. Feasibility was assessed using depression outcomes, functional days (unproductive or days lost), and whether WEB and TAU patients differed in their appointment keeping. Results: WEB patients did not differ in the proportion of completed primary care versus telepsychiatry appointments and rated their working alliance with the psychiatrist and their visit satisfaction significantly higher than the TAU patients with their provider. Significantly more WEB than TAU patients used antidepressants. Although depression severity decreased faster among WEB than TAU patients, no differences were found in the overall depression score. WEB and TAU patients did not differ in the number of days that were lost or unproductive due to depression. Although WEB and TAU patients reported being willing to pay for mental health services provided by the CHC, almost proportionately twice as many WEB patients were willing to pay for telepsychiatry. Conclusions: Results show that for low-income depressed Hispanic patients, telepsychiatry service for depression is acceptable, although its feasibility is questionable. The benefits of telemedicine were discussed in terms of improving patient care in ways other than directly providing services to the patients.

Barriers to risk factor control may differ by race/ethnicity. The goal of this study was to identify barriers to stroke awareness and risk factor management unique to Hispanics as compared to non-Hispanic whites (NHWs). We performed a prospective study of stroke patients from an academic Stroke Center in Arizona and surveyed members of the general community. Questionnaires included: the Duke Social Support Index (DSSI), the Multidimensional Health Locus of Control (MHLC) Scale, a stroke barriers questionnaire, and a Stroke Awareness Test. Of 145 stroke patients surveyed (72 Hispanic; 73 NHW), Hispanics scored lower on the Stroke Awareness Test compared to NHWs (72.5% vs. 79.1%, p = 0.029). Hispanic stroke patients also reported greater barriers related to medical knowledge, medication adherence, and healthcare access (p < 0.05 for all). Hispanics scored higher on the “powerful others” sub-scale (11.3 vs. 10, p < 0.05) of the MHLC. Of 177 members of the general public surveyed, Hispanics had lower stroke awareness compared to NHWs and tended to have lower awareness than Hispanic stroke patients. These results suggest that Hispanic stroke patients perceive less control over their health, experience more healthcare barriers, and demonstrate lower rates of stroke literacy. Interventions for stroke prevention and education in Hispanics should address these racial/ethnic differences in stroke awareness and barriers to risk factor control.

Objective: The purpose of our study was to describe the quality of life of older adults with seizures or epilepsy and compare its psychosocial impact between those who were new diagnosed and those diagnosed before the age of 65. Methods: In-depth face to face interviews with open ended questions were conducted with two participant groups: Incident group: 42 older adults (>65 years) with new onset or newly diagnosed after age of 65; and Prevalent group: 15 older adults (>65 years) diagnosed before age of 65. Interviews were reviewed and coded using a list of themes and results were compared between the two groups. Eight topics were selected from the participants’ responses to questions about the psychosocial impact of epilepsy and seizures. The topics were then analyzed and compared between the two groups. Results: The topics analyzed were: Emotional and physical impact, significant life changes, co-morbidities, information gathering, stigma, AED side effects, changes in relationships and attitude toward diagnosis. Conclusion: We concluded that the age at onset and duration does seem to have a negative correlation with health related quality of life. However, the perceived health status of older adults with chronic epilepsy was significantly better and reflected in their more positive approach to the diagnosis of seizures or epilepsy probably because they have had a longer opportunity to learn to cope with their diagnosis.