The Role of Social Networks in Treatment Engagement for Minorities

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DESCRIPTION (provided by applicant): This application is in response to NOT-MH-10-021 's request for competitive revision applications for targeted research on mental health disparities. We request a revision to the UCLA/RAND NIMH Partnered Research Center for Quality Care. We plan secondary analysis of a unique data base to understand the roles that social networks play in supporting the engagement in treatment and medication use of persons who are at risk of or in need of treatment for depression, in particular those who are underserved minorities. The objective of this analysis is to inform the development of future community-based interventions that include a focus on the social networks of intervention recipients as a mechanism for improving outcomes. The data base includes a large sample of underserved minorities and a matched sample of whites which allows for the analyses of the potential of social network members to support engagement for minorities as well as whites. It will also allow for exploration of the effect of a Quality Improvement intervention on the activation level of networks related to treatment seeking and adherence to treatments as well as comparisons by ethnic group. The project will build on network analysis theory and methods to investigate how personal networks are used in coping with symptoms, life events, help-seeking and use of treatments by those who have experienced depression. Our specific aim is: To analyze secondary data from Partners in Care minority and matched white respondents to determine how their social interactions differ and the types of proactive coping strategies used to deal with depressive symptoms and stressful events. A grounded theory approach will be used to identify themes in the qualitative data, examine network visualizations derived from the social network interviews, and identify the roles social networks play in enhancing treatment engagement and outcome. We propose to use a mixed-methods analytic approach to develop theory, based on empirical analysis of data from Partners in Care, a group-level randomized controlled trial of practice-initiated Quality Improvement programs for depression for which funding ended March 2009. Data include a series of 780 in-depth qualitative interviews with all minorities and a sub-sample of whites in which respondents provided detailed information about specific events involving stress, depression, and treatment and how they coped with those situations. It also includes data from a social network interview in which respondents provided detailed information about their personal networks, the positive and negative influence of network members on the respondent's stress, depression and treatment and the structure of relationships among these network members. These data will be linked to 9 years of longitudinal survey data. The findings from our analyses will add to the evidence base for future effective mental health interventions for diverse groups, including ethnic minorities. We will use a community work group to review the data and help generate hypotheses and explanations as well as provide cultural competence in the analysis.