Depression can affect anyone, but it hits ethnic groups more heavily because the poor often have less access to quality health care. To offset this imbalance, researchers from the RAND Corporation and UCLA, and community partners from more than two dozen community agencies, compared whether evidence-based quality improvement programs, which include psychotherapies such as cognitive behavioral therapy and antidepressant medications, are better implemented through involvement of the entire community or through clinic-based programs. The findings, which show the former to be the case, are reported in two papers published online by the Journal of General Internal Medicine. Project officer and Associate Director of Dissemination and Implementation Research at the National Institute of Mental Health David Chambers, Ph.D., discusses the significance of these findings.
>> Chambers: There have been a lot of efforts to try and improve depression care within the context of clinical trials. But often if you have effective interventions, there's not as much success in figuring out how do we implement those more broadly so that they reach the populations as well as they possibly can. This particular study was trying to take the next step of saying how can we take an effective model for depression care--collaborative care for depression--and scale it up within community settings, particularly for those who don't typically benefit from care or who don't receive any care. This was an innovative model that was looking at a community engagement approach toward trying to implement collaborative care and thinking about community agencies as a logical focus as opposed to assuming that a clinic-based model, which has been the more traditional approach, would be preferred by communities who may not have kind of infrastructure. This took place within south and east Los Angeles. The communities were primarily those with high levels of poverty, particularly high levels of comorbidity, and high levels of community stress--primarily African American and Latino populations. It's not just that it's testing a particular model, but the actual approach to the research was seen as a partnership between researchers and community agencies. The lead investigators were Ken Wells from UCLA-RAND as well as Loretta Jones from a nonprofit Healthy African American Families. Together with a council, they really ran the research. We have efforts to think about community-based participatory research just as a research approach. What was novel here is that they were thinking about those partnership principles both in terms of the intervention to try and implement effective care and the way in which they conducted the research itself.