The Impact of Community Engagement on Health, Social, and Utilization Outcomes in Depressed, Impoverished Populations: Secondary Findings from a Randomized Trial

Christine A Lam; Cathy Sherbourne; Lingqi Tang; Thomas R Belin; Pluscedia Williams; Angela Young-Brinn; Jeanne Miranda; Kenneth B Wells

doi:10.3122/jabfm.2016.03.150306

The Impact of Community Engagement on Health, Social, and Utilization Outcomes in Depressed, Impoverished Populations: Secondary Findings from a Randomized Trial

J Am Board Fam Med. 2016 May-Jun;29(3):325-38. doi: 10.3122/jabfm.2016.03.150306.

Authors

Christine A Lam¹, Cathy Sherbourne², Lingqi Tang², Thomas R Belin², Pluscedia Williams², Angela Young-Brinn², Jeanne Miranda², Kenneth B Wells²

Affiliations

¹ From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B) christinealam@mednet.ucla.edu.
² From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B).

Abstract

Background: Disparities in depression care exist among the poor. Community Partners in Care (CPIC) compared a community coalition model with technical assistance to improve depression services in under-resourced communities. We examine effects on health, social, and utilization outcomes among the poor and, non-poor depressed, and poor subgroups.

Methods: This study analyzed clients living above (n = 268) and below (n = 750) the federal-poverty level and, among the poor, 3 nonoverlapping subgroups: justice-involved (n = 158), homeless and not justice-involved (n = 298), and other poor (n = 294). Matched programs (n = 93) from health and community sectors were randomly assigned to community engagement and planning (CEP) or resources for services (RS). Primary outcomes were poor mental health-related quality of life and 8-item Patient Health Questionnaire scores, whereas community-prioritized and utilization outcomes were secondary. Effects were scrutinized using false discovery rate-adjusted P values to account for multiple comparisons.

Results: In the impoverished group, CEP and RS clients of participating study programs did not differ in primary outcomes, but CEP more than RS improved mental wellness among the depressed poor (unadjusted P = .004) while providing suggestive evidence for other secondary outcomes. Within the poor subgroups, evidence favoring CEP was only suggestive but was strongest among justice-involved clients.

Conclusions: A coalition approach to improving outcomes for low-income clients with depression, particularly those involved in the justice system, may offer additional benefits over standard technical assistance programs.

Keywords: Depression; Health Care Disparities; Homelessness; Populations; Social Determinants of Health; Underserved.

Publication types

Comparative Study
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adult
Community Mental Health Services*
Community-Based Participatory Research
Criminals / psychology
Criminals / statistics & numerical data
Depressive Disorder / therapy*
Female
Health Care Coalitions*
Health Planning Technical Assistance
Healthcare Disparities*
Hospitalization / statistics & numerical data
Humans
Ill-Housed Persons / psychology
Ill-Housed Persons / statistics & numerical data
Male
Middle Aged
Patient Acceptance of Health Care / statistics & numerical data
Poverty
Quality of Life
Surveys and Questionnaires
Vulnerable Populations / psychology*
Vulnerable Populations / statistics & numerical data

Abstract

Publication types

MeSH terms

Grants and funding