Depression manifests differently in Latinos when compared to other racial-ethnic groups, but little is known regarding linguistic differences among Latinos. This mixed methods study explored the depression screening processes among patients and medical providers at a Federally Qualified Health Center (FQHC) through an ethnic-linguistic lens. Binary logistic regressions were performed to determine the effects of ethnicity and language on PHQ-2 screening rates for 10,285 adult patients seen during a primary care medical visit from 2014 to 2015; of these 4,745 (46%) patients were screened for depression. Spanish-speakers were screened for depression more often than non-Latinos and Latinos who were English-speakers. Spanish-speakers screened positive for depression 31% less often than English speaking Latinos. Additionally, a chart review was conducted on 692 patients who screened positive on the PHQ-2; 275 of these who scored ≥10 (major depression) on the PHQ-9 were included in further analysis. Controlling for demographics, we found that despite increased screening, Spanish-speakers were less likely to receive standard of care recommendations (combined psychotherapy and pharmacotherapy) than English-speaking patients.

To explore these issues contextually, key informant interviews were conducted with 6 English-speaking Latinos, 6 Spanish-speaking Latinos, 6 English-speaking non-Latinos and 7 provider participants. Semi-structured, member-checking focus groups were conducted with the four groups to validate interview themes. Participants confirmed that negative perceptions about medications, patient non-compliance, and a shortage of bilingual behavioral health specialists within the clinic impacted standard of care treatment recommendations and uptake for the Spanish-speaking Latinos. However, strength of relationships with providers and family, handoff to integrated behavioral health specialists, and motivating factors (i.e. diet and exercise) helped patients to overcome depression. Manifestation of depressive symptoms were associated with ethnic-linguistic differences. Understanding ethnic-linguistic differences further could improve screening accuracy and depression care for Latinos.

LLU Discipline

Social Policy and Social Research


Social Work and Social Ecology


School of Behavioral Health

First Advisor

Montgomery, Susanne

Second Advisor

Distelberg, Brian J.

Third Advisor

Morton, Kelly R.

Fourth Advisor

Ortiz, Larry

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Depression; Hispanic Americans; Language; Depression - Diagnosis

Subject - Local

Federally Qualified Health Center; Linguistic influences on health screening



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives