Pilot study of INSIGHT therapy in African American women

Technology-Assisted, Group-Based CBT for Rural Adults' Depression: Open Pilot Trial Results

Purpose

This pilot study assesses the association of Raising Our Spirits Together (ROST), a technology-assisted, group-based cognitive behavioral therapy for depression, with rural adults' depressive symptoms and anxiety.

Method

Nine adults from rural Michigan participated in an open pilot of ROST. Clergy facilitated pilot groups. The pilot began in February 2020 in-person. Due to COVID-19, the pilot was completed virtually.

Results

Mean depressive symptom scores, based on the PHQ-9, significantly decreased from pre-treatment (M = 14.4) to post-treatment (M = 6.33; t (8) = 6.79; P < .001). Symptom reduction was maintained at 3-month follow-up (M = 8.00), with a significant pattern of difference in depressive symptoms over time (F(2) = 17.7; P < .001; eta-squared = .689). Similar patterns occurred for anxiety based on the GAD-7. Participants attended an average of 7.33 of 8 sessions. Fidelity ratings were excellent.

Discussion

ROST is a potentially feasible intervention for rural adults' depressive symptoms. ROST offers a promising model for increasing treatment access and building capacity in rural areas.

Evidence for interventions to promote mental health and reduce stigma in Black faith communities: systematic review

PURPOSE

There are significant documented inequalities for the Black community in the UK in relation to mental health care. Research has also indicated that cultural difference exists in pathways into, and engagement with, mental health services. To reduce inequalities and improve engagement with mental health services, it is important that professionals utilise culturally appropriate community networks to increase mental health awareness and reduce stigma. This systematic review considers research in Black faith settings, with two linked aims to review the evidence for the effectiveness of (i) mental health interventions, and (ii) other health stigma interventions as the latter have been implemented in Black faith settings. The review identified 'active ingredients' of interventions for this population that can be applied in future work. The authors seek to draw from the mental health and wider health stigma literature to inform the design of the ON TRAC project, a collaborative partnership between King's College London, South London and Maudsley NHS Foundation Trust and Black faith community groups in Southwark and Lambeth, London, in this currently under-researched area.

METHODS

A systematic search of ten major medical and social sciences databases was conducted in 2019, for studies on mental health or other health stigma interventions in Black faith settings. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review.

RESULTS

The review identified sixteen studies for inclusion. Ten were quantitative studies, four qualitative studies and two systematic reviews. Active ingredients of interventions included utilisation of 'bottom up' development of approaches and mental health champions. Multiple factors were found to influence effective implementation. Co-production and partnership working are key to ensure that an acceptable and accessible intervention is agreed.

CONCLUSION

Evidence for the effectiveness of interventions focused on mental health awareness and stigma reduction in the Black faith community is limited due to the low quality of studies. This review sheds light on the lessons learnt and necessary key requirements for interventions that can guide future projects.

STUDY REGISTRATION

PROSPERO registration number: CRD42018110068.

Reducing loneliness among migrant and ethnic minority people: a participatory evidence synthesis

Background

To date, there has been little research into the causes of, and solutions to, loneliness among migrant and ethnic minority people.

Objectives

The objectives were to synthesise available evidence and produce new insights relating to initiatives that aim to address loneliness among these populations, plus the logic, functioning and effects of such initiatives.

Data sources

Electronic database searches (MEDLINE, Applied Social Sciences Index and Abstracts and Social Science Citation Index via Web of Science – no date restrictions were applied), grey literature searches, and citation and reference searching were conducted. Data were generated via nine workshops with three consultation panels involving 34 public contributors, and one practitioner workshop involving 50 participants.

Review methods

Guided by ‘systems thinking’, a theory-driven synthesis was combined with an effectiveness review to integrate evidence on the nature and causes of loneliness, interventional types and programme theory, and intervention implementation and effectiveness.

Results

The theory review indicated that common conceptualisations of ‘loneliness’ can be usefully extended to recognise four proximate determinants when focusing on migrant and ethnic minority populations: positive social ties and interactions, negative social ties and interactions, self-worth, and appraisal of existing ties. A total of 170 interventions were included. A typology of eight interventions was developed. Detailed logic models were developed for three common types of intervention: befriending, shared-identity social support groups and intercultural encounters. The models for the first two types were generally well supported by empirical data; the third was more tentative. Evaluation of intervention processes and outcomes was limited by study content and quality. Evidence from 19 qualitative and six quantitative studies suggested that social support groups have a positive impact on dimensions of loneliness for participants. Evidence from nine qualitative and three quantitative studies suggested that befriending can have positive impacts on loneliness. However, inconsistent achievements of the befriending model meant that some initiatives were ineffective. Few studies on intercultural encounters reported relevant outcomes, although four provided some qualitative evidence and three provided quantitative evidence of improvement. Looking across intervention types, evidence suggests that initiatives targeting the proximate determinants – particularly boosting self-worth – are more effective than those that do not. No evidence was available on the long-term effects of any initiatives. UK intervention (n = 41) and non-intervention (n = 65) studies, together with consultation panel workshop data, contributed to a narrative synthesis of system processes. Interlocking factors operating at individual, family, community, organisational and wider societal levels increase risk of loneliness, and undermine access to, and the impact of, interventions. Racism operates in various ways throughout the system to increase risk of loneliness.

Limitations

There was a lack of high-quality quantitative studies, and there were no studies with longer-term follow-up. UK evidence was very limited. Studies addressing upstream determinants operating at the community and societal levels did not link through to individual outcome measures. Some elements of the search approach may mean that relevant literature was overlooked.

Conclusions

Theory regarding the causes of loneliness, and functioning of interventions, among migrant and ethnic minority populations was usefully developed. Evidence of positive impact on loneliness was strongest for shared-identity social support groups. Quantitative evidence was inadequate. The UK evidence base was extremely limited.

Future work

UK research in this area is desperately needed. Co-production of interventional approaches with migrant and ethnic minority people and evaluation of existing community-based initiatives are priorities.

Study registration

This study is registered as PROSPERO CRD42017077378.

Funding

This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 10. See the NIHR Journals Library website for further project information.

Faith-based organizations and the Affordable Care Act: Reducing Latino mental health care disparities

The Patient Protection and Affordable Care Act (ACA; 2010) is expected to increase access to mental health care through provisions aimed at increasing health coverage among the nation's uninsured, including 10.2 million eligible Latino adults. The ACA will increase health coverage by expanding Medicaid eligibility to individuals living below 138% of the federal poverty level, subsidizing the purchase of private insurance among individuals not eligible for Medicaid, and requiring employers with 50 or more employees to offer health insurance. An anticipated result of this landmark legislation is improvement in the screening, diagnosis, and treatment of mental disorders in racial/ethnic minorities, particularly for Latinos, who traditionally have had less access to these services. However, these efforts alone may not sufficiently ameliorate mental health care disparities for Latinos. Faith-based organizations (FBOs) could play an integral role in the mental health care of Latinos by increasing help seeking, providing religion-based mental health services, and delivering supportive services that address common access barriers among Latinos. Thus, in determining ways to eliminate Latino mental health care disparities under the ACA, examining pathways into care through the faith-based sector offers unique opportunities to address some of the cultural barriers confronted by this population. We examine how partnerships between FBOs and primary care patient-centered health homes may help reduce the gap of unmet mental health needs among Latinos in this era of health reform. We also describe the challenges FBOs and primary care providers need to overcome to be partners in integrated care efforts.

Screening for Depression in African-American Churches

INTRODUCTION

Substantial racial/ethnic disparities exist in the identification and management of major depression. Faith-Based Health Promotion interventions reduce disparities in health screenings for numerous medical conditions. However, the feasibility of systematically screening for depression in faith-based settings has not been investigated. The purpose of this study was to assess the feasibility of using a validated instrument to screen for depression in African-American churches.

METHODS

Participants were recruited between October and November 2012 at three predominantly African-American churches in New York City. A participatory research approach was used to determine screening days. The Patient Health Questionnaire-9 (PHQ-9) was administered to 122 participants. Positive depression screen was defined as a PHQ-9 score ≥10. Descriptive statistics were used to report sample characteristics, prevalence of participants who screened positive, and history of help seeking. Logistic regression analyses were conducted to determine the association of positive depression screen and sociodemographic characteristics. Initial analyses were conducted in 2013, with additional analyses in 2014.

RESULTS

The prevalence estimate for positive depression screen was 19.7%. More men (22.5%) screened positive than women (17.7%). Total household income was inversely related to positive depression screen. A similar percentage of respondents had previously sought help from primary care providers as from clergy.

CONCLUSIONS

It was feasible to screen for depression with the PHQ-9 in African-American churches. The prevalence of positive depression screen was high, especially among black men. Churches may be an important setting in which to identify depressive symptoms in this underserved population.

As I see it: a study of African American pastors' views on health and health education in the black church

The Black Church is the only institution that has consistently served the interest of African Americans, and there is no other institution in the African American community that rivals its influence (Camara, 2004). The spiritual well-fare, social support, health, and well-being of its people have been one of its main goals. With health disparities of African Americans still at an alarming rate, the Black Church has used informal education as a means to impart knowledge on health, as well as other non-religious and religious topics. One of the avenues least researched within the Black Church is the pastor's perception of its educational role in health and wellness and its efforts to reduce health discrimination and health disparities between African American and European Americans in the U.S. Since social justice appears as a theme and concern in the traditions of many churches, it is only appropriate that, among other things, the Black Church should address the issue of health education and interventions. The purpose of this study was to explore African American pastors' perceptions of the role of the Black Church in providing health care, health education, and wellness opportunities to African Americans. Many pastors reported their church provided some form of health education and/or health screenings. Their perceptions about the important issues facing their congregants versus African Americans in general were quite similar.

Implementing a mental health ministry committee in faith-based organizations: the promoting emotional wellness and spirituality program

Social workers have successfully collaborated with African-American faith-based organizations to improve health outcomes for numerous medical conditions. However, the literature on Faith-Based Health Promotion for major depression is sparse. Thus, the authors describe a program used to implement a Mental Health Ministry Committee in African-American churches. Program goals are to educate clergy, reduce stigma, and promote treatment seeking for depression. Key lessons learned are to initially form partnerships with church staff if there is not a preexisting relationship with the lead pastor, to utilize a community-based participatory approach, and to have flexibility in program implementation.

Ministers' perceptions of church-based programs to provide depression care for African Americans

African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers' perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n = 21) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants' confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.

Church-based health programs for mental disorders among African Americans: a review

OBJECTIVE

African Americans underutilize traditional mental health services, compared with white Americans. The authors conducted a systematic review of studies involving church-based health promotion programs for mental disorders among African Americans to assess the feasibility of utilizing such programs to address racial disparities in mental health care.

METHODS

A literature review of MEDLINE, PsycINFO, CINAHL, and ATLA Religion databases was conducted to identify articles published between January 1, 1980, and December 31, 2009. Inclusion criteria were as follows: studies were conducted in a church; the primary objective involved assessment, perceptions and attitudes, education, prevention, group support, or treatment for DSM-IV mental disorders or their correlates; number of participants was reported; qualitative or quantitative data were reported; and African Americans were the target population.

RESULTS

Of 1,451 studies identified, only eight met inclusion criteria. Five studies focused on substance-related disorders, six were designed to assess the effects of a specific intervention, and six targeted adults. One study focused on depression and was limited by a small sample size of seven participants.

CONCLUSIONS

Although church-based health promotion programs have been successful in addressing racial disparities for several chronic medical conditions, the literature on such programs for mental disorders is extremely limited. More intensive research is needed to establish the feasibility and acceptability of utilizing church-based health promotion programs as a possible resource for screening and treatment to improve disparities in mental health care for African Americans.

A meta-analysis of interventions to reduce loneliness

Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.

Outcomes of a Program to Reduce Depression

Depression is increasing among Korean college students. Moreover, it is common for depressed individuals to consider attempting suicide. The purpose of this study therefore was to develop and examine the effectiveness of an intervention to reduce suicidal ideation and depression among female college students. Study participants were assigned to either an intervention ( n = 27) or control ( n = 31) group. The intervention group received a depression-reducing program in eight 1-hr weekly sessions. Measures of suicidal ideation and depression were administered. The program has effects on suicidal ideation and depression among female college students. The findings suggest that the study program may be useful in reducing suicidal ideation and depression among female college students.