Resilience Against Depression Disparities (RADD)
Depression is the leading cause of adult disability and common among lesbian, gay, bisexual (LGB) adults. Primary care depression quality improvement (QI) programs can improve outcomes for minorities more significantly than for non-minorities, but they are seldom available in safety-net systems. We build on findings from Community Partners in Care (CPIC) and Building Resiliency and Increasing Community Hope (B-RICH). CPIC compared depression QI approaches across healthcare and social /community services in communities of color. CPIC included healthcare and “community-trusted” programs (e.g., homeless, faith-based) to work as a network to address depression, compared to individual-program technical assistance. In CPIC, both conditions improved mental wellness, mental health quality of life, and depression over 12 months. B-RICH, a randomized study, evaluated lay delivery of a seven-session, CBT-informed resiliency education class versus case management on patients’ depressive symptoms over three months, in unpublished but completed analyses. The proposed demonstration supplements the resiliency class with a mobile/interactive voice response case management tool to reinforce class content and depression care reminders (B-RICH+).
Specific Aims are (1) to engage New Orleans (NO) and Los Angeles (LA) partners in a demonstration to improve depression outcomes for predominantly LGB adults; (2) to evaluate B-RICH+ in improving adult patients’ depressive symptoms over and above depression QI resources and training to healthcare and community programs serving minority LGB patients; (3) to disseminate the proposed demonstration’s findings and tools with PCORnet and Community Partnered Participatory Research Network partners.
Methods: Three clusters of four to five LGB-focused programs: two clusters in LA (Hollywood and South LA) and one cluster in NO. Clusters are comprised of one primary care, one mental health, and two to three community agencies (e.g., faith-based, social services/support, advocacy). All programs will receive depression QI training. Enrolled adult depressed patients will be randomized individually to B-RICH+ or depression QI alone. Primary outcomes are depressive symptoms (8-item patient health questionnaire); mental health quality of life (12-item mental composite score ≤ 40), mental wellness, and physical health quality of life (12-item physical composite score) are secondary. Participants are depressed adults from LGB-focused programs, recruited from in-person screening at programs (1743), for 320 enrolled and offered 6-month (n=242) and 12-month (n=224) follow-up. Inclusion criteria: Age≥18 years, PHQ-8≥10 (depressed), providing contact information; Exclusions: Not speaking English or Spanish or too impaired to complete screening. We use an intent-to-treat analysis to test the added value of individual level, B-RICH+ over and above program-level depression QI on patient outcomes. Pre-specified subgroups: African American vs. Latino; male vs. female. Study findings will inform patients, practices, and policy makers on how to reduce depression disparities.