Professional Abstract
Objective
To compare the long-term effectiveness of two collaborative care interventions for adults with depression in underresourced communities
Study Design
Design Elements |
Description |
Design |
Randomized controlled trial |
Population |
980 people with depression from 89 mental health service programs in Los Angeles County |
Interventions/
Comparators |
- Community Engagement and Planning
- Resources for Services
|
Outcomes |
Primary: depression and mental health-related quality of life
Secondary: physical health-related quality of life, behavioral health-related hospitalization nights
|
Timeframe |
3-year follow-up for primary outcomes |
This extension study of a randomized controlled trial examined the long-term outcomes of two interventions to enhance collaborative care for adults with depression in healthcare and other community service settings. The study included community sites such as primary care clinics, agencies specializing in mental health and substance use disorder, social services agencies, faith-based groups, and community centers in the South Los Angeles and Hollywood-Metro Los Angeles communities.
In the previous study, the research team randomly assigned healthcare and community programs to one of two interventions and recruited adults with depression who received services from these programs. The two interventions were
- Community Engagement and Planning, or coalition approach. Programs formed local coalitions, co-chaired by study and community leaders. Each coalition invited program administrators to two-hour meetings bimonthly for four months to plan how to disseminate intervention resources across the diverse programs in this intervention. Adapting resources to local culture, the coalition provided trainings to program staff through online and written resources, conferences, webinars, and site visits.
- Resources for Services, or technical assistance approach. An expert, interdisciplinary team provided technical assistance to individual programs through webinars, site visits, and online and written resources. This team offered programs 12 webinars using a train-the-trainer model, with site visits for primary care providers. Topics included team building, case management, and clinical assessment and treatments.
The previous study found that the coalition approach was more effective than the technical assistance approach in improving mental health-related quality of life and reducing behavioral health hospitalizations at 6 and 12 months.
In this extension study, the research team compared the study outcomes for people in the two interventions at baseline and three years. The study included 980 clients with baseline surveys and 600 with three-year surveys. All clients were receiving services from 89 programs. Of these clients, 46% were African American, 41% were Latino, and 9% were white. The average age of participants at baseline was 45, and 58% were female. In addition, 74% of participants had incomes below the poverty line, and 54% were homeless or had two or more risk factors for chronic homelessness.
People who have depression and other community members worked with researchers to design and conduct the study and prioritize outcomes for future research.
Results
At three years, compared with people in programs assigned to the technical assistance approach, those in programs assigned to the coalition approach did not differ in depression or mental health quality of life. However, people in the coalition approach had improved physical health-related quality of life (difference in scores=1.2; 95% confidence interval [CI]: 0.2, 2.2) and fewer behavioral health-related hospitalization nights (incidence rate ratio=0.2; 95% CI: 0.1, 0.8) (both p<0.05).
Limitations
The study took place in two underresourced, mostly African American and Latino communities in Los Angeles County. Results may be different in other areas or with different populations. Many people in the study were homeless. As a result, the research team had difficulty contacting them for follow-up surveys, which limited response rates.
Conclusions and Relevance
Collaborative care approaches for depression show promise in improving the quality of health care in underresourced communities. In this extension study, the two collaborative care approaches did not differ in primary mental health outcomes at three years, but the coalition approach was more effective in improving physical health-related quality of life and reducing behavioral health-related hospitalization nights.
Future Research Needs
Future research could explore efforts to maintain long-term effects of collaborative care approaches on mental health outcomes and other outcomes important to adults with depression, such as physical health-related quality of life.