October 2013, Volume 28, Issue 10, pp 1268-1278,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 07 May 2013
Community-Partnered Cluster-Randomized Comparative Effectiveness Trial of Community Engagement and Planning or Resources for Services to Address Depression Disparities
Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors.
To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients’ mental health-related quality of life (HRQL) and services use.
Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles.
From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up.
Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use.
CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p < 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p > 0.05).
Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.
An erratum to this article can be found at http://dx.doi.org/10.1007/s11606-013-2501-6.
Williams DR, Gonzalez HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, et al. Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Arch Gen Psychiatry. 2007;64(3):305–15.PubMedCrossRef
U.S. Department of Health and Human Services. New freedom commission on mental health: achieving the promise: transforming mental health in America. Final report. Rockville, MD: USDHHS; 2003. Report No.: SMA-03—3832.
Marmot MG, Wilkinson RG. Social determinants of health. USA: Oxford University Press; 2006.
Smedley BD, Syme SL. Promoting health: intervention strategies from social and behavioral research. Washington, D.C.: National Academies Press; 2000.
Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376(9758):18–31.CrossRef
Bluthenthal R, Jones L, Fackler-Lowrie N, Ellison M, Booker T, Jones F, et al. Witness for Wellness: preliminary findings from a community-academic participatory research mental health initiative. Ethn Dis. 2006;16(Suppl):S18–34.PubMed
Jones L, Wells K, Norris K, Meade B, Koegel P. The vision, valley, and victory of community engagement. Ethn Dis. 2009;19(4 Suppl 6):S6.
Wennerstrom A, Vannoy SD, Allen C. Community-based participatory development of a community health worker mental health outreach role to extend collaborative care in post-Katrina New Orleans. Ethn Dis. 2011;21(Suppl 1):S1–45.
Hepner KA, Miranda JM, Woo SM, Watkins KE, Lagomasino IT, Wiseman SH, et al. Building recovery by improving goals, habits, and thoughts (BRIGHT): A group cognitive behavioral therapy for depression in clients with co-occurring alcohol and drug use problems-Group Leader’s Manual. Santa Monica, Calif: RAND Corporation; 2011.
Rubenstein LV. Improving Depression Outcomes in Primary Care: A User’s Guide to Implementing the Partners in Care Approach. Santa Monica, CA: RAND Corporation; 2000.
Corbie-Smith G, Thomas SB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med. 2001;14(9):537–46.CrossRef
Rubenstein LV, Jackson-Triche M, Unutzer J, Miranda J, Minnium K, Pearson ML, et al. Evidence-based care for depression in managed primary care practices. Health Aff. 1999;18(5):89–105.CrossRef
U.S. Department of Health and Human Services. Mental health: culture, race, and ethnicity—a supplement to mental health: a report of the Surgeon General. Rockville, MD: USDHHS; 2001.
UCLA-NPI/RAND Research Center on Managed Care for Psychiatric Disorders. Community Update. Los Angeles, CA: UCLA/RAND, 2000–04.
Khodyakov D, Shariff M, Dixon E, Mendel P, Chung B, Linski B, et al. An implementation evaluation of the community engagement and planning intervention in the CPIC depression care improvement trial. Community Ment Health J. In press.
Los Angeles County Department of Health Services. LA County Department of Health Services Key Health Indicators. Los Angeles, CA, 2009.
Murray DM. Design and analysis of group-randomized trials. USA: Oxford University Press; 1998.
Belin TR, Stockdale S, Tang L, Jones F, Jones A, Wright A, et al., eds. Developing a randomization protocol in a community-partnered participatory research project to reduce the burden of depression. Proceedings of the American Statistical Association Health Policy Statistics Section, Alexandria Virginia. 2010;5165–5171.
Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, New Jersey: Lawrence Erlbaum; 1988.
Kish L. Survey sampling. New York: Wiley; 1965.
Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):509–15.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;473–83.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–33.PubMed
Apicello J. A paradigm shift in housing and homeless services: applying the population and high-risk framework to preventing homelessness. Open Health Serv Policy J. 2010;3:41–52.CrossRef
Gundersen C, Weinreb L, Wehler C, Hosmer D. Homelessness and food insecurity. J Hous Econ. 2003;12(3):250–72.CrossRef
Little RJA. Missing-data adjustments in large surveys. J Bus Econ Stat. 1988;287–96.
Rubin D. Multiple imputation for nonresponse in surveys. Hoboken, NJ: Wiley; 1987.CrossRef
Binder DA. On the variances of asymptotically normal estimators from complex surveys. Int Stat Rev. 1983;279–92.
Graubard BI, Korn EL. Predictive margins with survey data. Biometrics. 2004;55(2):652–9.CrossRef
Dunn OJ. Multiple comparisons among means. J Am Stat Assoc. 1961;56(293):52–64.CrossRef
- Community-Partnered Cluster-Randomized Comparative Effectiveness Trial of Community Engagement and Planning or Resources for Services to Address Depression Disparities
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of General Internal Medicine
Volume 28, Issue 10 , pp 1268-1278
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- community partnered participatory research
- community-based participatory research
- Industry Sectors
- Kenneth B. Wells MD, MPH (1) (2) (3) (4)
- Loretta Jones MA (5) (6)
- Bowen Chung MD (1) (2) (7)
- Elizabeth L. Dixon RN, PhD (8)
- Lingqi Tang PhD (2) (4)
- Jim Gilmore MBA (9)
- Cathy Sherbourne PhD (1)
- Victoria K. Ngo PhD (1)
- Michael K. Ong MD (10)
- Susan Stockdale PhD (12) (2)
- Esmeralda Ramos BA (2)
- Thomas R. Belin PhD (11) (2)
- Jeanne Miranda PhD (2) (4)
- Author Affiliations
- 1. RAND Corporation, Santa Monica, CA, USA
- 2. David Geffen School of Medicine, Departments of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
- 3. Department of Healthy Policy and Management, UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
- 4. Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- 5. Healthy African American Families II, Los Angeles, CA, USA
- 6. Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- 7. Harbor-UCLA Medical Center, Torrance, CA, USA
- 8. QueensCare Health and Faith Partnership, Los Angeles, CA, USA
- 9. Behavioral Health Services, Gardena, CA, USA
- 10. Department of Medicine, David Geffen School of Medicine, UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, CA, USA
- 12. Greater Los Angeles Veteran’s Affairs, Los Angeles, CA, USA
- 11. UCLA Johnathan and Karin Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA, USA