Community Partnered Approach to Implement Depression Screening in Black Churches

社区合作方法在黑人教堂实施抑郁症筛查

• 批准号: 10663468
• 负责人: SIDNEY H HANKERSON
• 金额: $ 76.72万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10663468
• 关键词: Address; Adult; African American; American; Area; Behavior; Black race; Cardiovascular Diseases; Caring; Chronic Disease; Church; Clergy; Client; Clinical; Cognitive; Communities; Community Health Aides; Consolidated Framework for Implementation Research; Counseling; Data; Depression screen; Detection; Disabled Persons; Disease; Economically Deprived Population; Ethnic group; Evidence based intervention; Evidence based program; Funding; Health; Health Personnel; Health Services Research; Hispanic; Hybrids; Influentials; Infrastructure; Institution; Intervention; Intervention Studies; Knowledge; Link; Malignant Neoplasms; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; National Institute of Mental Health; Neurology; Outcome; Pamphlets; Patients; Persons; Pharmaceutical Preparations; Population Heterogeneity; Provider; Public Health; Questionnaires; Randomized; Randomized Controlled Trials; Reporting; Research; Site; Testing; Time; Training; Training Programs; Trust; Underserved Population; United States National Institutes of Health; Universities; Visit; Work; acute stroke; arm; base; brief intervention; care seeking; community engagement; compare effectiveness; contextual factors; cost; depression education; depression model; depressive symptoms; disability; disadvantaged population; effectiveness implementation design; evidence base; experience; health literacy; health related quality of life; help-seeking behavior; member; motivational enhancement therapy; novel; patient-level barriers; primary care setting; primary outcome; process evaluation; racial and ethnic; racial disparity; research study; screening; screening and brief intervention; screening, brief intervention, referral, and treatment; secondary outcome; social capital; social stigma; socioeconomics; treatment arm; treatment comparison; treatment site; uptake; usual care arm

PROJECT SUMMARY / ABSTRACT African American adults (AAs), compared to White adults, are half as likely to be screened for depression in primary care settings. Disparities in depression screening contribute to poor clinical outcomes, as AAs with depression are more disabled, sicker longer, and less likely to seek treatment compared to Whites. Black churches are trusted settings that provide “de facto” mental health services for depression. Indeed, in the first study of its kind, the study team found that 20% of adults in Black churches screened positive for depression using the Patient Health Questionnaire-9 (PHQ-9). However, no subjects with a positive screen (PHQ-9 ≥10) accepted a treatment referral when offered by research coordinators onsite for each screening. Community Health Workers (CHWs), who are trusted para-professionals from the target community, may bridge the gap between depression screening and treatment. We have trained and certified 102 CHWs from 42 Black churches in Harlem to deliver an evidence-based intervention called Screening, Brief Intervention, and Referral to Treatment (SBIRT), which is centered on culturally tailored Motivational Interviewing (MI). Thus, the scientific premise of this study is that employing CHWs to implement depression screening in Black churches will bridge the gap between church-based depression-screening and engagement with clinical providers. Using a Hybrid Type 1 Effectiveness- Implementation design, we propose a 2-arm, mixed-methods Cluster-Randomized Controlled Trial within 30 Black churches our CHWs currently attend. Based on our pilot data, we expect 20% of adults (n=600) to have a positive depression screen. Adults will be randomized based on church study site to either SBIRT (n=15 churches) or Referral As Usual (RAU, n=15 churches). We will then compare the effectiveness of SBIRT (Intervention arm) to RAU (Usual Care arm) on treatment engagement (primary outcome), defined as attending a depression-related clinical visit for which the subject reported receiving information, referral, counseling, or medication for depression (Aim 1). We will then compare changes in Mental Health Related Quality of Life and depressive symptoms (secondary outcomes) at 3- and 6-months post-screening (Aim 2). Finally, we will conduct a concurrent, mixed-methods (qualitative-quantitative) process evaluation to assess contextual facilitators and barriers of screening and referral (Aim 3). This study has potential for large-scale public health impact as 20 to 22 million Americans attend the 65,000 to 70,000 Black churches in the U.S.

项目总结/摘要 与白色成年人相比，非洲裔美国成年人（AAs）接受抑郁症筛查的可能性是白人的一半。 初级保健机构。抑郁症筛查的差异导致临床结局不佳，因为患有 与白人相比，抑郁症患者残疾程度更高，患病时间更长，寻求治疗的可能性更小。黑色 教会是值得信赖的环境，为抑郁症提供“事实上”的心理健康服务。的确，在第一次 在一项同类研究中，研究小组发现，黑人教堂中20%的成年人抑郁症筛查呈阳性 使用患者健康问卷-9（PHQ-9）。但是，没有受试者的筛查结果为阳性（PHQ-9 ≥10） 每次筛选时接受研究协调员现场提供的治疗转诊。社区卫生 工作人员（CHW）是来自目标社区的受信任的准专业人员，可能会弥合抑郁症之间的差距。 筛查和治疗。我们已经培训和认证了来自哈莱姆42个黑人教堂的102名CHW， 基于证据的干预措施，称为筛查、简短干预和转诊治疗（SBIRT）， 关于文化定制的动机面试（MI）。因此，本研究的科学前提是， CHW在黑人教堂实施抑郁症筛查将弥合教会之间的差距 抑郁症筛查和与临床提供者的接触。使用混合1型有效性- 实施设计，我们提出了一个2臂，混合方法的随机对照试验，在30个黑人 我们的CHW目前参加的教会。根据我们的试点数据，我们预计20%的成年人（n=600）有阳性反应。 抑郁症屏幕成人将根据教会研究中心随机分配至SBIRT（n=15个教会）或转诊A Raval（RAU，n=15 churches）.然后，我们将比较SBIRT（干预组）和RAU（家庭护理组）的有效性 治疗参与（主要结局），定义为参加抑郁相关临床访视， 受试者报告接受信息、转诊、咨询或抑郁症药物治疗（目标1）。我们将比较 3个月和6个月时心理健康相关生活质量和抑郁症状（次要结局）的变化 筛选后（目标2）。最后，我们将进行并行的混合方法（定性-定量）流程 评估筛查和转诊的背景促进者和障碍（目标3）。这项研究有可能 2000万到2200万美国人参加了美国65,000到70,000个黑人教堂的大规模公共卫生影响。