Effectiveness and Implementation of a Mindfulness Intervention for Depressive Symptoms Among Low-income, Racial/Ethnic Minority Adults in a Federally Qualified Health Center

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The objective of this R01 (PA-16-160) application is to examine the clinical effectiveness of a mindfulness intervention on reducing depressive symptoms among socio-economically disadvantaged, racial/ethnic minority adults and explore factors related to implementation in a Federally Qualified Health Center (FQHC). This research will be used to develop a generalizable model for delivery of streamlined mental health interventions in community based settings that will be broadly disseminated and scalable to other populations. Black and Hispanic adults are more likely than those who are White to receive depression treatment in primary care, where antidepressants are the most commonly offered treatment. However, Black and Hispanic adults are less likely than Whites to find antidepressants acceptable. A mindfulness depression intervention provided within primary care may be more accessible and acceptable for low-income, racial/ethnic minority individuals, a severely underserved population. Accumulating research suggests that mindfulness interventions reduce the inflammatory response that can be triggered by stress and improves psychological outcomes. We propose to conduct a randomized controlled trial to test the clinical effectiveness of a mindfulness intervention (M-Body) on reducing depressive symptoms, compared to usual care, among low-income racial/ethnic minority adults in a FQHC. In preliminary studies, women ages 18-65 with depressive symptoms were recruited from a FQHC to participate in the 8-week, 90 minute per session M-Body intervention. The M-Body intervention is based on Mindfulness Based Stress Reduction (MBSR) and has been tailored for the FQHC setting and patient population. Data from four pilot groups led by the PI (N=31) and FQHC health educator (N=41) provide evidence of acceptability, feasibility and improved depressive symptom and stress outcomes over time. Adults (N=330) with depressive symptoms will be recruited from a FQHC in the Chicago, IL area that serves majority racial/ethnic minority individuals (90%) living at or below the poverty line (74%). Half of the patients will be randomized to the M-Body intervention arm where they will receive 8-weeks of mindfulness training led by FQHC staff and the other half will be randomized to usual care. Information on factors relevant to implementation of the intervention in the FQHC will be obtained by convening a series of workgroups and individual interviews with FQHC staff, executive leadership and community stakeholders. Specific Aims: 1) Determine the effectiveness of a mindfulness intervention (M-Body) on reducing depressive symptoms compared to enhanced usual care for racial/ethnic minority adults in a Federally Qualified Health Center (FQHC); 2) Explore potential mediators (stress related biomarkers, mindfulness) and moderators (age, personal, social, environmental stressors) of the intervention's effect; 3) Conduct a broad assessment of organizational and individual agency factors related to preparation and implementation of the M-Body intervention in a FQHC using a mixed methods approach.