(Press-News.org) Improving care for depression in low-income communities -- places where such help is frequently unavailable or hard to find -- provides greater benefits to those in need when community groups such as churches and even barber shops help lead the planning process, according to a new study.
When compared to efforts that provided only technical support to improve depression care, a planning effort co-led by community members from diverse services programs further improved clients' mental health, increased physical activity, lowered their risk of becoming homeless and decreased hospitalizations for behavioral problems.
The study was conducted in two large under-resourced areas of Los Angeles and the findings are reported in papers published online by the Journal of General Internal Medicine. The study team included researchers from the RAND Corporation and UCLA, and community partners from Healthy African American Families, QueensCare Health and Faith Partnership, and Behavioral Health Services.
"People who received help as a part of the community-led effort to improve depression care were able to do a better job navigating through the daily challenges of life," said psychiatrist Kenneth Wells, the project's lead RAND investigator. "People became more stable in their lives and were at lower risk of facing a personal crisis, such as experiencing poor quality of life or becoming homeless."
Researchers say the findings demonstrate that incorporating an array of community groups in planning efforts to treat depression, and then providing trainings to address depression jointly across health care and community agencies, can provide a more-complete support system and help depressed people make broader improvements in health and social outcomes.
Depression is one of the world's leading causes of impairment and affects 15 percent to 20 percent of people from all cultural groups at some point in their lives. Wells said one participant in the study characterized depression as a "silent monster" in the low-income neighborhoods studied. Evidence-based treatments for depression, such as antidepressants or therapy, often are not available in these neighborhoods because of poor access to services and other obstacles such as stigma or cost.
The study team, including researchers and community leaders, worked together for a decade to determine how to address depression in communities with few resources. The latest project compared two models.
One approach involved providing technical support and culturally-sensitive outreach to individual programs, including health, mental health, substance abuse and an array of other community programs. The second was a community engagement approach. In this effort, programs across the same broad array of health, mental health, substance abuse and other community programs worked together with shared authority to make decisions and collaborate as a network in providing depression services.
The study took place in South Los Angeles and Hollywood-Metropolitan Los Angeles, and involved nearly 100 programs across the range of primary care, mental health, substance abuse and social services providers. Participating programs included those who provide homeless services, prisoner re-entry help, family preservation programs, and faith-based and other community-based programs like senior centers, barber shops and exercise clubs. All programs were randomly assigned to one of the two approaches (technical assistance or community engagement), but only in the community engagement approach did agencies work together to decide how best to provide training for providers and collaborate to deliver depression services.
"Community members helped us think about where in their neighborhoods people with depression go for help and to think about how support could be provided for depression in all those places," Wells said.
"We worked together as a community to create a system that would provide clear and consistent messages for anyone with depression, regardless of gender, ethnicity, medical conditions, age or income level," said Loretta Jones, one of the project's lead community investigators and CEO of Healthy African American Families.
Agencies in the community engagement approach created programs to aid depressed persons by combining the study resources with their own expertise. One substance abuse program operates a reading club based on the book, "Beating Depression: The Journey to Hope," which is based on a prior RAND study. A group of churches developed classes that teach people resiliency skills to better cope with life's challenges. And two park and senior centers linked outreach and social services to exercise classes to encourage depressed elderly people to increase their physical activity.
People enrolled in the study were primarily African American and Latino, most had earnings below the federal poverty level, and nearly half were both uninsured and at high risk for becoming homeless. The majority also had multiple chronic medical conditions, while many had multiple psychiatric conditions and substance abuse problems.
Once the two improvement efforts were in place, survey staff hired from the community screened about 4,400 clients from participating agencies, following about 1,200 who showed signs of depression. Symptoms and functioning were assessed at the beginning of the project and six months after the project began. The work was done during 2010 and 2011.
The study team found that the chance of having depression at six months was similar for the two groups, as well as the chance of having antidepressant medication or formal health care counseling for depression. But those participants involved in the community-partnered planning had better mental health-related quality of life and reported being more physically active.
In addition, clients from programs in the community-planning group had a lower risk of either being currently homelessness or having multiple risk factors for future homelessness, including having prior homeless nights, food insecurity, eviction or a financial crisis. They also had a lower rate of hospitalization for behavioral problems and shifted their outpatient services from specialty medication visits toward primary care, faith-based and park-based depression services.
"The pattern of findings suggests that the community engagement approach increased support for depressed clients in nontraditional settings, with gains in quality of life and social outcomes like homelessness risk factors," Wells said. "This is in contrast to traditional depression improvement programs affecting use of depression treatments and symptoms."
Researchers also noted that there are few studies showing that community engagement and planning can improve health more than traditional training approaches. This is one of the largest and most rigorous studies of that issue in the field of mental health.
###
Support for the study was provided by the National Institute of Mental Health, the Robert Wood Johnson Foundation and the California Community Foundation. The project was led by Wells at RAND with UCLA psychologist Jeanne Miranda, and three lead community investigators, including Jones for South Los Angeles, Elizabeth Dixon for Hollywood-Metropolitan Los Angeles, and James Gilmore across areas.
The study team included researchers from RAND, the Semel Institute for Neuroscience and Human Behavior at UCLA, the Geffen School of Medicine at UCLA, the Fielding School of Public Health at UCLA, the Greater Los Angeles Veterans Affairs Health System, Healthy African American Families, QueensCare Health and Faith Partnership, Behavioral Health Services, and more than two dozen community-based agencies on the project's steering council.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.
Involving community group in depression care improves coping among low-income patients, study finds
2013-06-25
ELSE PRESS RELEASES FROM THIS DATE:
Effects of diluted bitumen on crude oil transmission pipelines
2013-06-25
WASHINGTON -- Diluted bitumen has no greater likelihood of accidental pipeline release than other crude oils, says a new report from the National Research Council. The committee that wrote the report found that diluted bitumen has physical and chemical properties within the range of other crude oils and that no aspect of its transportation by pipeline would make it more likely than other crude oils to cause an accidental release. The committee was not asked to address whether the consequences of a diluted bitumen release differ from those of other crude oils.
Bitumen ...
Bumpy beast was a desert dweller
2013-06-25
DEERFIELD, IL—During the Permian era, the Earth was dominated by a single supercontinent called Pangea – "All-Earth". Animal and plant life dispersed broadly across this land, as documented by identical fossil species found on multiple modern continents. But a new study published in the Journal of Vertebrate Paleontology supports the idea that there was an isolated desert in the middle of Pangea with a fauna all its own.
Roaming this desert in what is now northern Niger was a very distinctive creature known as a pareiasaur. Pareiasaurs were large, herbivorous reptiles ...
Annals of Internal Medicine tip sheet for June 25, 2013
2013-06-25
Task Force Recommendation: Screen All Baby Boomers and High-risk Patients for Hep C
The United States Preventive Services Task Force (USPSTF) recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection and one-time screening for all adults born between 1945 and 1965. Up to 3.9 million people in the United States are infected with HCV, a virus that can cause inflammation, permanent liver damage, and cancer. The most significant risk factor for HCV infection is past or current injection drug use. Receiving a blood transfusion before ...
Rotation-resistant rootworms owe their success to gut microbes
2013-06-25
CHAMPAIGN, Ill. — Researchers say they now know what allows some Western corn rootworms to survive crop rotation, a farming practice that once effectively managed the rootworm pests. The answer to the decades-long mystery of rotation-resistant rootworms lies – in large part – in the rootworm gut, the team reports.
The findings appear in the Proceedings of the National Academy of Sciences.
Differences in the relative abundance of certain bacterial species in the rootworm gut help the adult rootworm beetles feed on soybean leaves and tolerate the plant's defenses a little ...
Giving children non-verbal clues about words boosts vocabularies
2013-06-25
The clues that parents give toddlers about words can make a big difference in how deep their vocabularies are when they enter school, new research at the University of Chicago shows.
By using words to reference objects in the visual environment, parents can help young children learn new words, according to the research. It also explores the difficult-to-measure quality of non-verbal clues to word meaning during interactions between parents and children learning to speak. For example, saying, "There goes the zebra" while visiting the zoo helps a child learn the word "zebra" ...
Genes involved in birth defects may also lead to mental illness
2013-06-25
Gene mutations that cause cell signaling networks to go awry during embryonic development and lead to major birth defects may also cause subtle disruptions in the brain that contribute to psychiatric disorders such as schizophrenia, autism, and bipolar disorder, according to new research by UC San Francisco scientists.
Over the past several years, researchers in the laboratory of psychiatrist Benjamin Cheyette, MD, PhD, have shown that mice with mutations in a gene called Dact1 are born with a range of severe malformations, including some reminiscent of spina bifida in ...
700 women with urinary cancers missing out on prompt diagnosis every year
2013-06-25
This may be because family doctors tend to attribute women's - rather than men's - initial symptoms to harmless causes, such as bacterial infections, and some women therefore have to visit their GP several times before they get referred to a specialist, say the researchers.
Currently, survival rates for kidney and bladder cancer in England show that fewer women than men live for five years after diagnosis.
The researchers looked at the numbers of patients diagnosed with kidney and bladder cancers in England between 2009 and 2010. They used data from the National Audit ...
Breastfeeding boosts ability to climb social ladder
2013-06-25
The findings are based on changes in the social class of two groups of individuals born in 1958 (17,419 people) and in 1970 (16,771 people).
The researchers asked each of the children's mums, when their child was five or seven years old, whether they had breastfed him/her.
They then compared people's social class as children - based on the social class of their father when they were 10 or 11 - with their social class as adults, measured when they were 33 or 34.
Social class was categorised on a four-point scale ranging from unskilled/semi-skilled manual to professional/managerial. ...
Study sets guidelines for stem cell transplants in older patients with myelodysplastic syndromes
2013-06-25
BOSTON -- A new study by an international team led by Dana-Farber Cancer Institute scientists provides the first statistically-based guidelines for determining whether a stem cell transplant is appropriate for older patients with myelodysplastic syndromes (MDS) – the most common blood disorders in people over 60 years of age, and frequently a precursor for leukemia.
Using mathematical models to analyze hundreds of MDS cases from around the world, the researchers found reduced intensity transplants of donor stem cells are advisable for patients aged 60-70 who have higher-risk ...
NMR advance brings proteins into the open
2013-06-25
PROVIDENCE, R.I. [Brown University] —When working a cold case, smart investigators try something new. By taking a novel approach to nuclear magnetic resonance spectroscopy – a blending of four techniques – scientists have been able to resolve a key interaction between two proteins that could never be observed before. They report on their findings the week of June 24, 2013 in Proceedings of the National Academy of Sciences (PNAS).
The interaction the team became the first to describe is nearly universal across all of life. A protein machines called a chaperone takes hold ...