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.
- 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