January 2018—As PCORI-funded studies produce results of interest to patients and those who care for them, we are updating the stories of those projects. You can read the original story here.
As a girl, Pluscedia Williams regularly rode the train with her mother from their home in Compton, California, to see a psychiatrist in Los Angeles. She never knew her diagnosis, but she took prescription medicines for years, including Valium.
Williams didn’t learn until she was an adult that she had depression. More recently, by becoming a community partner on a PCORI-funded study of ways to improve depression care quality in underserved communities, she has helped others avoid undergoing care like her childhood experience, in which doctors failed to communicate with her and her family.
The three-year project followed the progress of clients with depression as they received care at health- and community-based organizations, such as recreation centers and exercise clubs. The goal was to determine which of two approaches worked better for improving depression care, specifically for people with low incomes from minority groups. People with this background tend to have more difficulty accessing evidence-based care and less success with treatment.
Kenneth Wells, MD, MPH, and Bowen Chung, MD, MSHS, both of the University of California, Los Angeles, and their team of academic, community, and patient partners recently reported results in Psychiatric Services. A coalition-based approach to care, in which clinicians with expertise in depression care and community members work together to train staff who provide depression care, had more-positive long-term effects for patients than a program providing staff training by experts in depression care.
Wells says that after three years of follow-up, compared with the expert-training approach, the coalition-based approach improved clients’ physical-health-related quality of life and reduced the number of nights clients stayed in the hospital for behavioral-health reasons.
Expanding on a Network of Services
Community partners like Williams told the research team that people with depression often don’t recognize what they are experiencing. They may seek help in healthcare and nonhealthcare settings, including churches.
The project examined the effects of the two interventions, Resources for Services and Community Engagement and Planning, on 93 healthcare and community organizations in Los Angeles. The research team assigned each of the organizations to one of these interventions. (See original story, Fighting Depression with the Power of Community.)
In Resources for Services, experts in collaborative depression care, such as psychiatrists and nurses, provided each organization with trainings and webinars on topics such as depression assessment, medication management, and cognitive behavioral therapy. Instead of solely providing expert guidance, the Community Engagement and Planning intervention brought together program administrators from different sectors of the community, such as churches, depression-care centers, and healthcare clinics, to collaborate to build trainings for improving depression care. The coalition helped organizations develop plans tailored to their communities.
The researchers found that Community Engagement and Planning improved physical health and reduced behavioral health hospitalizations more than Resources for Services did. In another article in Psychiatric Services, the team reported that the interventions had different effects on people with depression depending on where they received their diagnosis through routine screening: a community organization or a healthcare program.
For example, researchers found that in comparison with Resources for Services, the Community Engagement and Planning intervention increased primary care visits and antidepressant use among clients screened by community-based programs. Yet, clients in the same intervention, but screened at healthcare programs, increased their use of community-program visits.
This pattern suggests to Wells that the relationships that Community Engagement and Planning built across agencies may have offered people with depression more care options than they originally had. Clients learned to trust these care options and use them even three years after the study began, Wells says.
However, the two interventions did not differ in effect on clients’ mental health after three years. Both interventions supported high-quality depression care, Wells explains.
The community had also prioritized physical-health-related quality of life and reducing hospitalization, both of which the Community Engagement and Planning intervention improved. Fewer overnight hospitalizations, Wells says, may mean that clients have avoided crises by receiving care or community support.
The Future of Depression Care
The research team has adapted and implemented its interventions beyond their study. For instance, after Baton Rouge’s catastrophic floods in 2016, researchers partnered with health-service providers, researchers, and community partners in Louisiana to implement interventions from the study to help community members with behavioral health conditions. The program is called Resilient Baton Rouge.
The hope is that implementing these programs widely should create more high-quality, trustworthy depression-care services for patients, Wells says. Patients receiving such care may experience fewer behavioral health crises requiring hospitalizations, for example. For patients, this could mean more autonomy, and for providers, less use of expensive hospital services, he says.
As for Williams, helping others with depression has been life-affirming.
“When Ken asked me to share my story and to get involved in this study, it changed my life,” she says. “I didn’t think I was valuable or that my voice counted. Now, I know it does. I know I’m somebody.”
At a Glance
Long-Term Outcomes of Community Engagement to Address Depression Outcomes Disparities
Principal Investigator: Kenneth B. Wells, MD, MPH
Goal: To reduce disparities in depression-treatment outcomes by providing information and improving services in inner-city minority communities.
By Melissa Schenkman, Writer and Editor
Posted: January 26, 2018
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