Community-partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles

Published in: Journal of General Internal Medicine, v. 28, no. 10, Oct. 2013, p. 1279-1287

Posted on RAND.org on January 01, 2013

by Jeanne Miranda, Michael Ong, Loretta Jones, Bowen Chung, Elizabeth L. Dixon, Lingqi Tang, James Gilmore, Cathy D. Sherbourne, Victoria K. Ngo, Susan Stockdale, Esmeralda Ramos, Thomas R. Belin, Kenneth B. Wells

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Research Questions

  1. What is the need for depression care in under-resourced Los Angeles communities?
  2. Where are patients receiving care?

BACKGROUND: As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. OBJECTIVE: To understand the distribution of need and current burden of services for depression in under-resourced, diverse communities in Los Angeles. DESIGN: Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. PARTICIPANTS: Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. MAIN MEASURES: Comparisons by setting in 6-month retrospective recall of depression services use. KEY RESULTS: Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. CONCLUSIONS: Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.

Key Findings

  • There is substantial need for depression care among safety-net populations in Los Angeles.
  • Many types of agencies provide care.
  • Most depression services for this population occur outside of primary care settings, emphasizing the need for care coordination.

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