At PCORI, one of our National Priorities for Research is Addressing Disparities (see box). This effort includes addressing racial and ethnic disparities in both physical and mental health care and outcomes. We have heard from our stakeholders that racial and ethnic disparities in mental health are a concern, and so PCORI has awarded 23 clinical comparative effectiveness research studies that focus primarily on reducing such disparities. In observance of National Minority Health Month, we highlight several of these promising projects below and provide further information in a downloadable fact sheet.
PCORI funds a broad collection of research to reduce and eliminate disparities in health and health care, including studies on heart disease, cancer, and nutritional and metabolic disorders. To date, we have awarded $238 million to fund 78 comparative effectiveness research studies related to addressing disparities.
For instance, PCORI has dedicated $23 million to funding eight studies of ways to decrease rates of uncontrolled asthma among minority populations, who are disproportionately affected by the disease. For more information, see our fact sheet and a list of our Addressing Disparities projects.
Peer Support to Help Those with Serious Mental Illness Get Health Care
People with serious mental illnesses, such as schizophrenia and bipolar disorder, die on average 10 to 20 years earlier than others, according to multiple studies. A primary reason for this disparity is preventable medical conditions, such as those linked with obesity and smoking. People with serious mental illnesses are more at risk for such conditions and often don’t receive the basic care they need to address them. Now, two PCORI-funded studies have shown that peer support can help Latinos with serious mental illness get the health care they need.
In one study in Southern California involving low-income, largely Hispanic/Latino participants with serious mental illness, half the participants received health navigation services—coaching to learn how to manage their health. The navigators were peers, people who had managed their own serious mental illness or had a family member who had serious mental illness. After six months, compared with people who received usual care, those who received peer support used primary care services more and emergency departments less, and they felt more confident in their ability to manage their health. Their doctors also diagnosed more chronic diseases in these people, an important step in a group that tends to have undetected health conditions, the research team reports in Schizophrenia Research.
The other study took place in Chicago and was similar in its approach and findings. In this case, peer navigators took a hands-on approach, including accompanying participants to their appointments. After a year, the research team reports in Psychiatric Services, compared with people who received usual care, those aided by peer navigation reported having a better quality of life and more appointments with clinicians. The navigators “helped Latinos overcome cultural and language barriers to services,” the research team writes.
Improving Mental Health Care for Older People
Two other studies aim to improve care for depression and anxiety among older adults in minority communities. Mental health concerns late in life can cause serious consequences and often go untreated. Older Latinos are the focus of one study. Evidence suggests that, compared with older non-Hispanic whites, older Latinos have higher rates of depression-related disability, longer periods of depression, and less likelihood of receiving appropriate depression care.
The study, which is ongoing, is testing whether providing care while teaching people about mental illness and problem-solving skills is better than usual care, which includes regular doctor visits and handouts about depression treatment. Both interventions are delivered in Spanish for participants who don’t speak English. After the program, the study tests whether participants feel less depressed and whether their depression affects their lives less. If successful, the program could help older Latino adults dealing with depression or other mental health issues late in life.
The other study is the first to our knowledge of late-life anxiety interventions in low-income minority adults. It tests two programs for older people who have clinically significant worry, a problem often unrecognized by clinicians in older adults. Older African Americans are at high risk for inadequate care for this condition. The study is taking place in low-income, predominantly African-American communities in Houston with little access to mental healthcare services. One approach being assessed is culturally tailored cognitive behavioral treatment that teaches skills for handling anxiety, while the other provides information and referrals to counseling. The study is looking at which program works better to reduce worry, anxiety, and depression, and to improve sleep and the ability to perform daily activities.
Reaching Children through School Programs
At the other end of the age range, children in minority groups also tend to have a greater risk of mental health problems and less access to care than non-Hispanic whites. A research team is conducting a study in low-income schools in the Washington, D.C. area. About half of the children in the study are Latino or African American. The team is testing two school-based interventions for children with autism spectrum disorders or attention deficit hyperactivity disorder. One intervention teaches children to use specific scripts to help them deal with daily activities and stresses, while the other emphasizes positive rewards for behavioral changes. The study is comparing changes in children’s behavior, problem-solving abilities, self-control, use of medical care, and overall executive function, which enables people to regulate their emotions, behaviors, and thinking.
Providing appropriate and effective mental health care is a challenge in any population. People in minority groups often face unique barriers, including a lack of research to find effective treatments and culturally appropriate methods of healthcare delivery. We hope that filling these evidence gaps will improve quality of life for patients and their families.