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

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 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

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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