The Impact of Community Engagement on Health, Social, and Utilization Outcomes in Depressed, Impoverished Populations

Secondary Findings from a Randomized Trial

Published in: Journal of American Board of Family Medicine, v. 29, no. 3, May-June 2016, p. 325-338

Posted on RAND.org on May 26, 2016

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

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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.

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