Isabella Morton1, Brian Hurley2, Enrico G Castillo1,3,4, Lingqi Tang1,5, James Gilmore6, Felica Jones7, Katherine Watkins8, Bowen Chung1,4,5,7,8, Kenneth Wells1,5,8,9,10. 1. Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 2. Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 3. Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA. 4. Los Angeles County Department of Mental Health, Los Angeles, CA, USA. 5. Center for Health Services and Society, UCLA, Los Angeles, CA, USA. 6. Behavioral Health Services, Los Angeles, CA, USA. 7. Healthy African American Families II, Los Angeles, CA, USA. 8. The RAND Corporation, Santa Monica, CA, USA. 9. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA. 10. Greater Los Angeles Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA.
Abstract
Background: Comorbid depression and substance use disorders (SUDs) are associated with poor health and social outcomes disproportionately affecting under-resourced communities. Objectives: To test the hypothesis that a coalition approach to collaborative care (CC) for depression would improve outcomes of hazardous drinking and behavioral health hospitalizations, relative to technical assistance, for individuals with comorbid substance use problems. Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months. Methods: Two depression CC implementation approaches were compared: Resources for Services (RS) provided expert technical support for CC toolkits to individual programs. Community engagement and planning (CEP) supported multi-sector coalitions in collaborating in planning, adapting, implementing and monitoring CC toolkits. One thousand eighteen individuals with depression (PHQ-8 ≥10) enrolled. Regression analyses estimated intervention effects in participants with comorbid substance use problems (n = 588, 281 females, 307 males). Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months. Results: There were no significant baseline differences by intervention status among participants with depression and substance use problems. Intervention effects on primary outcomes including depression were not significant at 6 months. Compared to RS, CEP significantly reduced alcohol consumption (CEP = 1.6, RS = 2.1, p = .038), probability of behavioral health hospitalizations (OR = 0.50, p = .036), and use of specialty mental health visits (IRR = 0.52, p = .027), while increasing use of faith-based depression services (IRR = 3.4, p = .001).Conclusions: Given feasibility and possible benefits, CEP should be considered a promising approach to implementing depression CC with potential benefits to adults with comorbid substance use problems.
Background: Comorbid depression and substance use disorders (SUDs) are associated with poor health and social outcomes disproportionately affecting under-resourced communities. Objectives: To test the hypothesis that a coalition approach to collaborative care (CC) for depression would improve outcomes of hazardous drinking and behavioral health hospitalizations, relative to technical assistance, for individuals with comorbid substance use problems. Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months. Methods: Two depression CC implementation approaches were compared: Resources for Services (RS) provided expert technical support for CC toolkits to individual programs. Community engagement and planning (CEP) supported multi-sector coalitions in collaborating in planning, adapting, implementing and monitoring CC toolkits. One thousand eighteen individuals with depression (PHQ-8 ≥10) enrolled. Regression analyses estimated intervention effects in participants with comorbid substance use problems (n = 588, 281 females, 307 males). Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months. Results: There were no significant baseline differences by intervention status among participants with depression and substance use problems. Intervention effects on primary outcomes including depression were not significant at 6 months. Compared to RS, CEP significantly reduced alcohol consumption (CEP = 1.6, RS = 2.1, p = .038), probability of behavioral health hospitalizations (OR = 0.50, p = .036), and use of specialty mental health visits (IRR = 0.52, p = .027), while increasing use of faith-based depression services (IRR = 3.4, p = .001).Conclusions: Given feasibility and possible benefits, CEP should be considered a promising approach to implementing depression CC with potential benefits to adults with comorbid substance use problems.
Authors: Nicholas Ialongo; Beth K McCreary; Jane L Pearson; Amy L Koenig; Norman B Schmidt; Jeanne Poduska; Sheppard G Kellam Journal: J Affect Disord Date: 2004-04 Impact factor: 4.839
Authors: Stephen G West; Naihua Duan; Willo Pequegnat; Paul Gaist; Don C Des Jarlais; David Holtgrave; José Szapocznik; Martin Fishbein; Bruce Rapkin; Michael Clatts; Patricia Dolan Mullen Journal: Am J Public Health Date: 2008-06-12 Impact factor: 9.308
Authors: D V Sheehan; Y Lecrubier; K H Sheehan; P Amorim; J Janavs; E Weiller; T Hergueta; R Baker; G C Dunbar Journal: J Clin Psychiatry Date: 1998 Impact factor: 4.384