Perceived stress, self-esteem, and experiences of discrimination: Examining predictors of depression within integrated behavioral health

Background: Depression is pervasive and influences health. Individuals with depression frequently present to primary care providers, and integrated care models have emerged to better address depression within primary care settings. Though there has been increased understanding regarding methods of addressing depression in primary care through integrated care models, there is a lack of understanding regarding the nuanced way racial discrimination influences depression within these settings. Method: Our study evaluated the nuanced presentation of depression within an integrated care setting examining the role of racial discrimination and the experience of depression. Stratified random sampling was used, yielding 383 participants (228 White and 155 Black). Participants completed a survey designed to assess levels of anxiety, depression, perceived stress, self-esteem, experiences with discrimination, and demographic information. A series of t-tests were run to analyze differences between racial groups regarding depression, anxiety, stress, self-esteem, and discrimination. Then a hierarchical regression model was utilized to assess which factors predicted variance in depression. Result: Our findings indicated that anxiety, perceived stress, and experiences with discrimination were strong predictors of depression (F (4, 221) = 91.75, p < 0.001) and accounted for 63% of the variance in depression. Conclusion: Integrated care models innovate primary care settings by expanding medical teams to address mental health needs. Our paper identifies additional patient concerns within these settings including stress, discrimination and self esteem while identifying methods integrated care models can screen for and address these concerns as a routine component of care.