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Metts AV, Roy-Byrne P, Stein MB, Sherbourne CD, Bystritsky A, Craske MG. Reciprocal and Indirect Effects Among Intervention, Perceived Social Support, and Anxiety Sensitivity Within a Randomized Controlled Trial for Anxiety Disorders. Behav Ther 2024; 55:80-92. [PMID: 38216239 DOI: 10.1016/j.beth.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Social support may facilitate adaptive reappraisal of stressors, including somatic symptoms. Anxiety sensitivity refers to negative beliefs about somatic symptoms of anxiety, which may influence one's perception of social support. Evidence-based treatment may impact these associations. The current longitudinal study evaluated reciprocal relationships between perceived social support and anxiety sensitivity, and explored indirect intervention effects, in a randomized controlled trial for anxiety disorders that compared cognitive behavioral therapy with or without medications (CALM) to usual care. Data collected over 18 months from 940 primary care patients were examined in random intercept cross-lagged panel models. There were significant reciprocal associations between perceived social support increases and anxiety sensitivity decreases over time. There were significant indirect effects from intervention to perceived social support increases through anxiety sensitivity decreases and from intervention to anxiety sensitivity decreases through perceived social support increases. These data suggest that, relative to usual care, CALM predicted changes in one construct, which predicted subsequent changes in the other. Secondary analyses revealed an influence of anxiety and depressive symptoms on reciprocal associations and indirect effects. Findings suggest that future treatments could specifically address perceived social support to enhance reappraisal of somatic symptoms, and vice versa.
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Escovar EL, Bocanegra ES, Craske MG, Bystritsky A, Roy-Byrne P, Sherbourne CD, Stein MB, Chavira DA. Mediators of Ethnic Differences in Dropout Rates From a Randomized Controlled Treatment Trial Among Latinx and Non-Latinx White Primary Care Patients With Anxiety Disorders. J Nerv Ment Dis 2023; 211:427-439. [PMID: 37252881 PMCID: PMC10234492 DOI: 10.1097/nmd.0000000000001533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
ABSTRACT Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1-10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.
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Affiliation(s)
| | | | | | - Alexander Bystritsky
- Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Peter Roy-Byrne
- Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations, University of Washington at Harborview Medical Center, Seattle, Washington
| | | | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Pubic Health, University of California, San Diego, La Jolla, California
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3
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Tieu L, Walton QL, Sherbourne CD, Miranda JM, Wells KB, Tang L, Williams P, Anderson GL, Booker-Vaughns J, Pulido E, Carr T, Heller SM, Bromley E. Life Events, Barriers to Care, and Outcomes Among Minority Women Experiencing Depression: A Longitudinal, Mixed-Method Examination. J Nerv Ment Dis 2022; 210:596-606. [PMID: 35184128 PMCID: PMC9338920 DOI: 10.1097/nmd.0000000000001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The long-term course of depression is not well-understood among minority women. We assessed depression trajectory, barriers to depression care, and life difficulties among minority women accessing health and social service programs as part of the Community Partners in Care study. Data include surveys ( N = 339) and interviews ( n = 58) administered at 3-year follow-up with African American and Latina women with improved versus persistent depression. The majority of the sample reported persistent depression (224/339, 66.1%), ≥1 barrier to mental health care (226/339, 72.4%), and multiple life difficulties (mean, 2.7; SD, 2.3). Many barriers to care ( i.e. , related to stigma and care experience, finances, and logistics) and life difficulties ( i.e. , related to finances, trauma, and relationships) were more common among individuals reporting persistent depression. Results suggest the importance of past experiences with depression treatment, ongoing barriers to care, and negative life events as contributors to inequities in depression outcomes experienced by minority women.
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Affiliation(s)
- Lina Tieu
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, USA
| | - Quenette L. Walton
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd Room 110HA, Houston, TX, USA
| | | | - Jeanne M. Miranda
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
| | - Kenneth B. Wells
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, USA
- RAND Corporation, 1776 Main St, Santa Monica, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
| | - Pluscedia Williams
- Department of Social and Preventive Medicine: Community Engagement, Charles R. Drew University of Medicine & Science,1731 E. 120th St, Los Angeles, CA, USA
| | - Gera L. Anderson
- Asian Americans for Community Involvement, 2400 Moorpark Ave, San Jose, CA, USA
| | - Juanita Booker-Vaughns
- Department of Social and Preventive Medicine: Community Engagement, Charles R. Drew University of Medicine & Science,1731 E. 120th St, Los Angeles, CA, USA
| | - Esmeralda Pulido
- University of Washington Medical Center, 1959 N.W. Pacific St, Seattle, WA, USA
| | - Themba Carr
- Autism Discovery Institute, Rady Children’s Hospital San Diego, 3020 Children’s Way, San Diego, CA, USA
| | - S. Megan Heller
- Department of Anthropology, University of California, Los Angeles, 375 Portola Plaza, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
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4
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Shier V, Edelen MO, McMullen TL, Ahluwalia SC, Chen EK, Dalton SE, Paddock S, Rodriguez A, Sherbourne CD, Mandl S, Mota T, Saliba D. Standardized assessment of cognitive function of post-acute care patients. J Am Geriatr Soc 2022; 70:1001-1011. [PMID: 35235208 DOI: 10.1111/jgs.17652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/03/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The assessment of cognitive function in post-acute care (PAC) settings is important for understanding an individual's condition and care needs, developing better person-directed care plans, predicting resource needs and understanding case mix. Therefore, we tested the feasibility and reliability of cognitive function assessments, including the Brief Interview for Mental Status (BIMS), Confusion Assessment Method (CAM©), Expression and Understanding, and Behavioral Signs and Symptoms for patients in PAC under the intent of the IMPACT Act of 2014. METHODS We conducted a national test of assessments of four standardized cognitive function data elements among patients in PAC. One hundred and forty-three PAC settings (57 home health agencies, 28 inpatient rehabilitation facilities, 28 long-term care hospitals, and 73 Skilled Nursing Facilities) across 14 U.S. markets from November 2017 to August 2018. At least one of four cognitive function data elements were assessed in 3026 patients. We assessed descriptive statistics, percent of missing data, time to complete, and interrater reliability between paired research nurse and facility staff assessors, and assessor feedback. RESULTS The BIMS, CAM©, Expression and Understanding, and Behavioral Signs and Symptoms demonstrated low rates of missing data (less than 2%), high percent agreement, and substantial support from assessors. The prevalence of Behavioral Signs and Symptoms was low in our sample of PAC settings. CONCLUSION Findings provide support for feasibility of implementing standardized assessment of all our cognitive function data elements for patients in PAC settings. The BIMS and CAM© were adopted into federal Quality Reporting Programs in the fiscal year/calendar year 2020 final rules. Future work could consider implementing additional cognitive items that assess areas not covered by the BIMS and CAM©.
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Affiliation(s)
- Victoria Shier
- Leonard D. Schaeffer Center for Health Policy & Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Maria O Edelen
- RAND Corporation, Boston, Massachusetts, USA.,Patient Reported Outcomes Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tara L McMullen
- Pain Management, Opioid Safety, and PDMP Program Office, Veterans Health Administration, Washington, District of Columbia, USA
| | - Sangeeta C Ahluwalia
- RAND Corporation, Santa Monica, California, USA.,UCLA Fielding School of Public Health, Los Angeles, California, USA
| | | | | | - Susan Paddock
- NORC at the University of Chicago, Chicago, Illinois, USA
| | | | | | - Stella Mandl
- Division of Health Care Financing, Department of Health and Human Services, Office of Health Policy in the Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia, USA
| | - Teresa Mota
- Abt Associates, Cambridge, Massachusetts, USA
| | - Debra Saliba
- RAND Corporation, Santa Monica, California, USA.,UCLA Borun Center, Los Angeles, California, USA.,Los Angeles VA GRECC, Los Angeles, California, USA
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Hays RD, Sherbourne CD, Spritzer KL, Hilton LG, Ryan GW, Coulter ID, Herman PM. Experiences With Chiropractic Care for Patients With Low Back or Neck Pain. J Patient Exp 2020; 7:357-364. [PMID: 32821795 PMCID: PMC7410126 DOI: 10.1177/2374373519846022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Musculoskeletal disorders are the second leading cause of disability worldwide. Objective Examine experiences of chiropractic patients in the United States with chronic low back or neck pain. Method Observational study of 1853 chronic low back pain and neck pain patients (74% female) who completed an online questionnaire at the 3-month follow-up that included Consumer Assessment of Healthcare Providers and Systems (CAHPS) items assessing their experiences with care. Results We found similar reports of communication for the chiropractic sample and patients in the 2016 CAHPS National Database, but 85% in the database versus 79% in the chiropractic sample gave the most positive response to the time spent with provider item. More patients in the CAHPS database rated their provider at the top of the scale (8 percentage points). More chiropractic patients reported always getting answers to questions the same day (16 percentage points) and always being seen within 15 minutes of their appointment time (29 percentage points). Conclusions The positive experiences of patients with chronic back and neck pain are supportive of their use of chiropractic care.
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Affiliation(s)
- Ron D Hays
- Division of General Internal Medicine & Health Services Research, UCLA Department of Medicine, Los Angeles, CA, USA
| | | | - Karen L Spritzer
- Division of General Internal Medicine & Health Services Research, UCLA Department of Medicine, Los Angeles, CA, USA
| | - Lara G Hilton
- RAND Health, Santa Monica, CA, USA.,Deloitte Consulting LLP, Los Angeles, CA, USA
| | | | - Ian D Coulter
- RAND Health, Santa Monica, CA, USA.,UCLA School of Dentistry, Los Angeles, CA, USA
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6
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Arevian AC, Jones F, Tang L, Sherbourne CD, Jones L, Miranda J. Depression Remission From Community Coalitions Versus Individual Program Support for Services: Findings From Community Partners in Care, Los Angeles, California, 2010-2016. Am J Public Health 2020; 109:S205-S213. [PMID: 31242001 DOI: 10.2105/ajph.2019.305082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To explore effects of coalitions (Community Engagement and Planning [CEP]) versus technical assistance (Resources for Services [RS]) for depression collaborative care and the effects of social determinants on long-term remission outcomes. Methods. We randomized 95 health care and community programs in Los Angeles County, California, to CEP or RS. In 2010, 1246 depressed (Patient Health Questionnaire [PHQ-8] ≥ 10) adults enrolled and were invited for baseline and 6-, 12-, and 36-month surveys. Of 598 3-year completers, 283 participated at 4 years (2016). We examined effects of CEP versus RS, social factors (e.g., family income, food insecurity) on time to and periods in clinical (PHQ-8 < 10) and community-defined (PHQ-8 < 10 or PHQ-2 < 3; mental health composite score [MCS-12] > 40, or mental wellness) remission during the course of 3 years, and at 4 years. Results. We found that CEP versus RS increased 4-year depression remission and, for women, community-defined remission outcomes during the course of 3 years. Social factors and clinical factors predicted remission. Conclusions. At 4 years, CEP was more effective than RS at increasing depression remission. Public Health Implications. Coalitions may improve 4-year depression remission, while addressing social and clinical factors associated with depression may hold potential to enhance remission.
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Affiliation(s)
- Armen C Arevian
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Felica Jones
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Lingqi Tang
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Cathy D Sherbourne
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Loretta Jones
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Jeanne Miranda
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
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- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
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7
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Vargas SM, Wennerstrom A, Alfaro N, Belin T, Griffith K, Haywood C, Jones F, Lunn MR, Meyers D, Miranda J, Obedin-Maliver J, Pollock M, Sherbourne CD, Springgate BF, Sugarman OK, Rey E, Williams C, Williams P, Chung B. Resilience Against Depression Disparities (RADD): a protocol for a randomised comparative effectiveness trial for depression among predominantly low-income, racial/ethnic, sexual and gender minorities. BMJ Open 2019; 9:e031099. [PMID: 31641001 PMCID: PMC6830623 DOI: 10.1136/bmjopen-2019-031099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Depression is the leading cause of adult disability and common among sexual and gender minority (SGM) adults. The current study builds on findings showing the effectiveness of depression quality improvement (QI) and delivery of cognitive behavioural therapy (CBT) skills provided by community health workers in reducing depression. Depression QI approaches across healthcare and social/community services in safety-net settings have shown improvements in mental wellness, mental health quality of life and depression over 12 months. Further, a randomised study showed improved depression among low-income racial/ethnic minorities enrolled in a CBT-informed resiliency class (Building Resilience and Increasing Community Hope (B-RICH)). The current protocol describes a comparativeness effectiveness study to evaluate whether predominantly low-income, SGM racial/ethnic minority adults randomised to a CBT-informed resiliency class have improvements in depressive symptoms over and above community-engaged QI resources and training only. METHODS AND ANALYSIS The study approached three clusters of four to five programs serving predominantly SGM and racial/ethnic minority communities in the USA: two clusters in Los Angeles, California, and one in New Orleans, Louisiana. Clusters are comprised of one primary care, one mental health and two to three community agencies (eg, faith-based, social services/support, advocacy). All programs received depression QI training. The current study employed a community-partnered participatory research model to adapt the CBT-informed resiliency class, B-RICH+, to SGM communities. Study participants were screened and recruited in person from participating programs, and will complete baseline, 6- and 12-month survey follow-ups. Participants were depressed adults (8-item Patient Health Questionnaire ≥10; ≥18 years of age) who provided contact information. Enrolled participants were individually randomised to B-RICH+ or depression QI alone. Primary outcomes are depressive symptoms; secondary outcomes are mental health quality of life, mental wellness and physical health quality of life. Data collection for this study is ongoing. ETHICS AND DISSEMINATION The current study was approved by the UCLA Institutional Review Board. Study findings will be disseminated through scientific publications and community conferences. TRIAL REGISTRATION NUMBER https://clinicaltrials.gov/ct2/show/NCT02986126.
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Affiliation(s)
- Sylvanna Maria Vargas
- Psychology, University of Southern California, Los Angeles, California, USA
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
- Preventive Medicine, University of Southern California, Los Angeles, California, United States
| | - Ashley Wennerstrom
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
- LSU Health Sciences Center New Orleans, Louisiana State University, New Orleans, Louisiana, United States
| | - Nancy Alfaro
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | - Thomas Belin
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Krystal Griffith
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | - Catherine Haywood
- Tulane Prevention Research Center, Tulane University, New Orleans, Louisiana, USA
- Women with a Vision, Inc, New Orleans, Louisiana, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, California, USA
| | - Mitchell R Lunn
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- The PRIDE Study, Stanford University School of Medicine, Stanford, California, United States
| | - Diana Meyers
- Saint Anna's Episcopal Church, New Orleans, Louisiana, USA
| | - Jeanne Miranda
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
- Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, California, United States
| | - Juno Obedin-Maliver
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- The PRIDE Study, Stanford University School of Medicine, Stanford, California, United States
| | - Miranda Pollock
- Section of Community and Population Medicine, Department of Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | | | - Benjamin F Springgate
- Section of Community and Population Medicine, Department of Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Olivia K Sugarman
- Section of Community and Population Medicine, Department of Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
- Center for Health Care Value and Equity, LSU Health Sciences Center, New Orleans, Louisiana, United States
- School of Public Health, LSU Health Sciences Center, New Orleans, California, United States
| | - Emily Rey
- LGBT Community Center, New Orleans, Louisiana, USA
- Let's Hatch Media, New Orleans, Louisiana, USA
| | | | - Pluscedia Williams
- Healthy African American Families II, Los Angeles, California, USA
- Department of Preventive and Social Medicine, Charles R Drew University of Medicine and Science, Los Angeles, California, USA
| | - Bowen Chung
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
- RAND Corporation, Los Angeles, California, USA
- Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, United States
- Department of Mental Health, County of Los Angeles, Los Angeles, California, United States
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Belin TR, Jones A, Tang L, Chung B, Stockdale SE, Jones F, Wright A, Sherbourne CD, Perlman J, Pulido E, Ong MK, Gilmore J, Miranda J, Dixon E, Jones L, Wells KB. Maintaining Internal Validity in Community Partnered Participatory Research: Experience from the Community Partners in Care Study. Ethn Dis 2018; 28:357-364. [PMID: 30202188 DOI: 10.18865/ed.28.s2.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective With internal validity being a central goal of designed experiments, we seek to elucidate how community partnered participatory research (CPPR) impacts the internal validity of public health comparative-effectiveness research. Methods Community Partners in Care (CPIC), a study comparing a community-coalition intervention to direct technical assistance for disseminating depression care to vulnerable populations, is used to illustrate design choices developed with attention to core CPPR principles. The study-design process is reviewed retrospectively and evaluated based on the resulting covariate balance across intervention arms and on broader peer-review assessments. Contributions of the CPIC Council and the study's design committee are highlighted. Results CPPR principles contributed to building consensus around the use of randomization, creating a sampling frame, specifying geographic boundaries delimiting the scope of the investigation, grouping similar programs into pairs or other small blocks of units, collaboratively choosing random-number-generator seeds to determine randomized intervention assignments, and addressing logistical constraints in field operations. Study protocols yielded samples that were well-balanced on background characteristics across intervention arms. CPIC has been recognized for scientific merit, has drawn attention from policymakers, and has fueled ongoing research collaborations. Conclusions Creative and collaborative fulfillment of CPPR principles reinforced the internal validity of CPIC, strengthening the study's scientific rigor by engaging complementary areas of knowledge and expertise among members of the investigative team.
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Affiliation(s)
- Thomas R Belin
- UCLA Department of Biostatistics, Center for Health Sciences, Los Angeles, CA.,UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA
| | - Andrea Jones
- Healthy African American Families II, Los Angeles, CA
| | - Lingqi Tang
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA
| | - Bowen Chung
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA.,Harbor-UCLA Medical Center, Torrance, CA
| | - Susan E Stockdale
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,Greater Los Angeles VA Medical Center, Sepulveda, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Aziza Wright
- Healthy African American Families II, Los Angeles, CA
| | | | | | | | - Michael K Ong
- Greater Los Angeles VA Medical Center, Sepulveda, CA.,UCLA Department of Medicine, Los Angeles, CA
| | | | - Jeanne Miranda
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA
| | | | - Loretta Jones
- Healthy African American Families II, Los Angeles, CA
| | - Kenneth B Wells
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA.,RAND Corporation, Santa Monica, CA.,UCLA Department of Health Policy and Management, Center for Health Sciences, Los Angeles, CA
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9
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Springgate BF, Arevian AC, Wennerstrom A, Johnson AJ, Eisenman DP, Sugarman OK, Haywood CG, Trapido EJ, Sherbourne CD, Everett A, McCreary M, Meyers D, Kataoka S, Tang L, Sato J, Wells KB. Community Resilience Learning Collaborative and Research Network (C-LEARN): Study Protocol with Participatory Planning for a Randomized, Comparative Effectiveness Trial. Int J Environ Res Public Health 2018; 15:E1683. [PMID: 30720791 PMCID: PMC6121437 DOI: 10.3390/ijerph15081683] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/04/2018] [Indexed: 11/16/2022]
Abstract
This manuscript presents the protocol and participatory planning process for implementing the Community Resilience Learning Collaborative and Research Network (C-LEARN) study. C-LEARN is designed to determine how to build a service program and individual client capacity to improve mental health-related quality of life among individuals at risk for depression, with exposure to social risk factors or concerns about environmental hazards in areas of Southern Louisiana at risk for events such as hurricanes and storms. The study uses a Community Partnered Participatory Research (CPPR) framework to incorporate community priorities into study design and implementation. The first phase of C-LEARN is assessment of community priorities, assets, and opportunities for building resilience through key informant interviews and community agency outreach. Findings from this phase will inform the implementation of a two-level (program-level and individual client level) randomized study in up to four South Louisiana communities. Within communities, health and social-community service programs will be randomized to Community Engagement and Planning (CEP) for multi-sector coalition support or Technical Assistance (TA) for individual program support to implement evidence-based and community-prioritized intervention toolkits, including an expanded version of depression collaborative care and resources (referrals, manuals) to address social risk factors such as financial or housing instability and for a community resilience approach to disaster preparedness and response. Within each arm, the study will randomize individual adult clients to one of two mobile applications that provide informational resources on services for depression, social risk factors, and disaster response or also provide psychoeducation on Cognitive Behavioral Therapy to enhance coping with stress and mood. Planned data collection includes baseline, six-month and brief monthly surveys for clients, and baseline and 12-month surveys for administrators and staff.
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Affiliation(s)
- Benjamin F Springgate
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
- LSU Health Sciences Center, New Orleans School of Public Health, New Orleans, LA 70112, USA.
| | - Armen C Arevian
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | | | - Arthur J Johnson
- Center for Sustainable Engagement and Development, New Orleans, LA 70117, USA.
| | - David P Eisenman
- David Geffen School of Medicine at UCLA and UCLA Center for Public Health and Disasters, Los Angeles, CA 90095, USA.
| | - Olivia K Sugarman
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
- LSU Health Sciences Center, New Orleans School of Public Health, New Orleans, LA 70112, USA.
| | | | - Edward J Trapido
- LSU Health Sciences Center, New Orleans School of Public Health, New Orleans, LA 70112, USA.
| | | | - Ashley Everett
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
| | - Michael McCreary
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | - Diana Meyers
- St. Anna's Episcopal Church, New Orleans, LA 70116, USA.
| | - Sheryl Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | - Lingqi Tang
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | - Jennifer Sato
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
| | - Kenneth B Wells
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
- The RAND Corporation, Santa Monica, CA 90401, USA.
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10
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Escovar EL, Craske M, Roy-Byrne P, Stein MB, Sullivan G, Sherbourne CD, Bystritsky A, Chavira DA. Cultural influences on mental health symptoms in a primary care sample of Latinx patients. J Anxiety Disord 2018; 55:39-47. [PMID: 29576380 PMCID: PMC5918638 DOI: 10.1016/j.janxdis.2018.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 03/09/2018] [Accepted: 03/10/2018] [Indexed: 12/31/2022]
Abstract
The present study examines how both between group (i.e., ethnic group membership) and within group cultural factors (i.e., nativity status, age of immigration, and perceived discrimination) may contribute to anxiety and related symptoms in Latinx with anxiety disorders. Baseline data were examined from patients who participated in one of the largest intervention studies for adults with anxiety disorders in primary care settings; 196 Latinx and 568 NLW (non-Latinx White) patients participated. Proportions of anxiety disorders were similar between Latinx and NLWs; however, Latinx, on average, had a greater number of anxiety disorders than NLWs. Levels of anxiety and depression symptom severity, anxiety sensitivity, and mental functional impairment were similar between the ethnic groups. Latinx expressed greater somatization and physical functional impairment than NLWs. Among Latinx, perceived discrimination, but not other cultural variables, was predictive of mental health symptoms while controlling for age, gender, education, and poverty. Overall, these findings suggest more similarities than differences in types and levels of anxiety and anxiety-related impairment, with some important exceptions, including greater levels of somatization and physical functional impairment among Latinx patients. Further, perceived discrimination may be an important factor to consider when examining risk for greater symptom burden among Latinx with anxiety.
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Affiliation(s)
- Emily L. Escovar
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michelle Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Peter Roy-Byrne
- Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable, Populations (CHAMMP), University of Washington at Harborview Medical Center, USA
| | - Murray B. Stein
- Department of Psychiatry and Department of Family & Preventive Medicine, University of California, San Diego, San Diego, CA, USA
| | - Greer Sullivan
- South Central VA Mental Illness Research Education and Clinical Center, North Little Rock, AK, USA; University of Arkansas for Medical Sciences, USA
| | | | - Alexander Bystritsky
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Denise A. Chavira
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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11
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Ong MK, Jones L, Aoki W, Belin TR, Bromley E, Chung B, Dixon E, Johnson MD, Jones F, Koegel P, Khodyakov D, Landry CM, Lizaola E, Mtume N, Ngo VK, Perlman J, Pulido E, Sauer V, Sherbourne CD, Tang L, Vidaurri E, Whittington Y, Williams P, Lucas-Wright A, Zhang L, Southard M, Miranda J, Wells K. A Community-Partnered, Participatory, Cluster-Randomized Study of Depression Care Quality Improvement: Three-Year Outcomes. Psychiatr Serv 2017; 68:1262-1270. [PMID: 28712349 PMCID: PMC5711579 DOI: 10.1176/appi.ps.201600488] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Community Partners in Care, a community-partnered, cluster-randomized trial with depressed clients from 93 Los Angeles health and community programs, examined the added value of a community coalition approach (Community Engagement and Planning [CEP]) versus individual program technical assistance (Resources for Services [RS]) for implementing depression quality improvement in underserved communities. CEP was more effective than RS in improving mental health-related quality of life, reducing behavioral health hospitalizations, and shifting services toward community-based programs at six months. At 12 months, continued evidence of improvement was found. This study examined three-year outcomes. METHODS Among 1,004 participants with depression who were eligible for three-year follow-up, 600 participants from 89 programs completed surveys. Multiple regression analyses estimated intervention effects on poor mental health-related quality of life and depression, physical health-related quality of life, behavioral health hospital nights, and use of services. RESULTS At three years, no differences were found in the effects of CEP versus RS on depression or mental health-related quality of life, but CEP had modest effects in improving physical health-related quality of life and reducing behavioral health hospital nights, and CEP participants had more social- and community-sector depression visits and greater use of mood stabilizers. Sensitivity analyses with longitudinal modeling reproduced these findings but found no significant differences between groups in change from baseline to three years. CONCLUSIONS At three years, CEP and RS did not have differential effects on primary mental health outcomes, but CEP participants had modest improvements in physical health and fewer behavioral health hospital nights.
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Affiliation(s)
- Michael K Ong
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Loretta Jones
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Wayne Aoki
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Thomas R Belin
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Elizabeth Bromley
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Bowen Chung
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Elizabeth Dixon
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Megan Dwight Johnson
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Felica Jones
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Paul Koegel
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Dmitry Khodyakov
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Craig M Landry
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Elizabeth Lizaola
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Norma Mtume
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Victoria K Ngo
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Judith Perlman
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Esmeralda Pulido
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Vivian Sauer
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Cathy D Sherbourne
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Lingqi Tang
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Ed Vidaurri
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Yolanda Whittington
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Pluscedia Williams
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Aziza Lucas-Wright
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Lily Zhang
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Marvin Southard
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Jeanne Miranda
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Kenneth Wells
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
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Sherbourne CD, Aoki W, Belin TR, Bromley E, Chung B, Dixon E, Gilmore JM, Johnson MD, Jones F, Koegel P, Khodyakov D, Landry CM, Lizaola E, Mtume N, Ngo VK, Ong MK, Perlman J, Pulido E, Sauer V, Tang L, Whittington Y, Vidaurri E, Williams P, Lucas-Wright A, Zhang L, Miranda J, Jones L, Wells K. Comparative Effectiveness of Two Models of Depression Services Quality Improvement in Health and Community Sectors. Psychiatr Serv 2017; 68:1315-1320. [PMID: 29089009 PMCID: PMC5872839 DOI: 10.1176/appi.ps.201700170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The effectiveness of community coalition building and program technical assistance was compared in implementation of collaborative care for depression among health care and community sector clients. METHODS In under-resourced communities, within 93 programs randomly assigned to coalition building (Community Engagement and Planning) or program technical assistance (Resources for Services) models, 1,018 clients completed surveys at baseline and at six, 12, or 36 months. Regression analysis was used to estimate intervention effects and intervention-by-sector interaction effects on depression, mental health-related quality of life, and community-prioritized outcomes and on services use. RESULTS For outcomes, there were few significant intervention-by-sector interactions, and stratified findings suggested benefits of coalition building in both sectors. For services use, at 36 months, increases were found for coalition building in primary care visits, self-help visits, and appropriate treatment for community clients and in community-based services use for health care clients. CONCLUSIONS Relative to program technical assistance, community coalition building benefited clients across sectors and shifted long-term utilization across sectors.
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Affiliation(s)
- Cathy D Sherbourne
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Wayne Aoki
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Thomas R Belin
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Elizabeth Bromley
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Bowen Chung
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Elizabeth Dixon
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - James M Gilmore
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Megan Dwight Johnson
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Felica Jones
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Paul Koegel
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Dmitry Khodyakov
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Craig M Landry
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Elizabeth Lizaola
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Norma Mtume
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Victoria K Ngo
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Michael K Ong
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Judith Perlman
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Esmeralda Pulido
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Vivian Sauer
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Lingqi Tang
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Yolanda Whittington
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Ed Vidaurri
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Pluscedia Williams
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Aziza Lucas-Wright
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Lily Zhang
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Jeanne Miranda
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Loretta Jones
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Kenneth Wells
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
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Bomyea J, Lang A, Craske MG, Chavira DA, Sherbourne CD, Rose RD, Golinelli D, Campbell-Sills L, Welch SS, Sullivan G, Bystritsky A, Roy-Byrne P, Stein MB. Course of symptom change during anxiety treatment: Reductions in anxiety and depression in patients completing the Coordinated Anxiety Learning and Management program. Psychiatry Res 2015; 229:133-42. [PMID: 26228164 PMCID: PMC4656042 DOI: 10.1016/j.psychres.2015.07.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/19/2015] [Accepted: 07/19/2015] [Indexed: 01/25/2023]
Abstract
When treating anxious patients with co-occurring depression, research demonstrates that both types of symptoms independently improve. The current analyses examined how reductions in anxiety and depression may be interrelated both during treatment, as well as over time following treatment. Participants were 503 individuals with one or more DSM-IV anxiety disorders who completed a collaborative care anxiety management program. Anxiety and depression were assessed at each treatment session (i.e., session by session data) and also at 6, 12, and 18-month post-baseline assessments (i.e., long-term outcomes data). Mediation analyses examined changes in symptoms in session by session data and long-term outcomes data. Anxiety and depression changed reciprocally in session by session data; change in anxiety mediated change in depression to a greater extent than vice versa. In the long-term outcomes data, change in anxiety mediated change in depression. However, the reverse mediation model of the long-term outcomes period revealed that accounting for changes in depression altered the effect of time on anxiety. Thus, temporal change during active treatment may share similarities with those related to maintaining gains after treatment, although differences arose in the reverse mediation models. Limitations of the methodology and implications of anxiety treatment for depression outcomes are discussed.
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Affiliation(s)
- Jessica Bomyea
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Ariel Lang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,VA San Diego Health Care System Center of Excellence for Stress and Mental Health, San Diego, La Jolla, CA, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Denise A. Chavira
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - Raphael D. Rose
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Stacy S. Welch
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Greer Sullivan
- RAND Corporation, Santa Monica, CA, USA,Department of Psychiatry University of Arkansas for Medical Sciences, Little Rock, AR, USA,VA South Central Mental Illness Research, Education, and Clinical Center University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alexander Bystritsky
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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Stucky BD, Sherbourne CD, Edelen MO, Eberhart NK. Understanding asthma-specific quality of life: moving beyond asthma symptoms and severity. Eur Respir J 2015; 46:680-7. [PMID: 25882804 DOI: 10.1183/09031936.00225014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/10/2014] [Indexed: 11/05/2022]
Abstract
This study identifies the unique contributions of asthma severity, symptoms, control and generic measures of quality of life (QoL) to asthma-specific QoL, as measured by the 12-item RAND Negative Impact of Asthma on Quality of Life scale (RAND-IAQL-12).Using a sample of 2032 adults with asthma, we conducted multiple regression analyses that sequentially examined hypothesised predictors of asthma-specific QoL. The change in variance accounted for and total unique variance accounted for is calculated as hypothesised predictors are added in each step.Our results indicate that asthma severity and asthma symptoms are strong predictors of asthma-specific QoL only when not controlling for aspects of asthma control. In regression models that include other aspects of asthma control, the contributions of both asthma symptoms and severity were substantially reduced, with asthma control and aspects of QoL related to social roles and activities emerging as the strongest predictors of asthma-specific QoL.These findings suggest that researchers measuring the impact of asthma on QoL should also consider the importance of asthma control as measured by the RAND Asthma Control Measure (RAND-ACM) and generic QoL scales that measure aspects of daily life that are uniquely affected by asthma.
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Grubbs KM, Cheney AM, Fortney JC, Edlund C, Han X, Dubbert P, Sherbourne CD, Craske MG, Stein MB, Roy-Byrne PP, Sullivan JG. The role of gender in moderating treatment outcome in collaborative care for anxiety. Psychiatr Serv 2015; 66:265-71. [PMID: 25727114 PMCID: PMC4453769 DOI: 10.1176/appi.ps.201400049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to test whether gender moderates intervention effects in the Coordinated Anxiety Learning and Management (CALM) intervention, a 12-month, randomized controlled trial of a collaborative care intervention for anxiety disorders (panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and social anxiety disorder) in 17 primary care clinics in California, Washington, and Arkansas. METHODS Participants (N=1,004) completed measures of symptoms (Brief Symptom Inventory [BSI]) and functioning (mental and physical health components of the 12-Item Short Form [MCS and PCS] and Healthy Days, Restricted Activity Days Scale) at baseline, six, 12, and 18 months. Data on dose, engagement, and beliefs about psychotherapy were collected for patients in the collaborative care group. RESULTS Gender moderated the relationship between treatment and its outcome on the BSI, MCS, and Healthy Days measures but not on the PCS. Women who received collaborative care showed clinical improvements on the BSI, MHC, and Healthy Days that were significantly different from outcomes for women in usual care. There were no differences for men in collaborative care compared with usual care on any measures. In the intervention group, women compared with men attended more sessions of psychotherapy, completed more modules of therapy, expressed more commitment, and viewed psychotherapy as more helpful. CONCLUSIONS These findings contribute to the broader literature on treatment heterogeneity, in particular the influence of gender, and may inform personalized care for people seeking anxiety treatment in primary care settings.
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Affiliation(s)
- Kathleen M Grubbs
- Dr. Grubbs and Dr. Dubbert are with the Mental Illness Research, Education, and Clinical Center (MIRECC) and Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock (e-mail: ). Dr. Cheney, Dr. Fortney, and Ms. Han are with the Center for Mental Health Outcomes Research, CAVHS. They are also with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, where Dr. Sullivan is affiliated. Ms. Edlund is with MIRECC and the Department of Psychiatry, University of Arkansas for Medical Sciences. Dr. Sherbourne is with the Health Program of RAND, Santa Monica, California. Dr. Craske is with the Department of Clinical Psychiatry, University of California, Los Angeles. Dr. Stein is with the Department of Psychiatry and the Department of Family and Preventive Medicine, University of California, San Diego. Dr. Roy-Byrne is with the Department of Psychiatry, Harborview Medical Center, University of Washington School of Medicine, Seattle
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Niles AN, Dour HJ, Stanton AL, Roy-Byrne PP, Stein MB, Sullivan G, Sherbourne CD, Rose RD, Craske MG. Anxiety and depressive symptoms and medical illness among adults with anxiety disorders. J Psychosom Res 2015; 78:109-15. [PMID: 25510186 PMCID: PMC4297513 DOI: 10.1016/j.jpsychores.2014.11.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/19/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Anxiety is linked to a number of medical conditions, yet few studies have examined how symptom severity relates to medical comorbidity. PURPOSE The current study assessed associations between severity of anxiety and depression and the presence of medical conditions in adults diagnosed with anxiety disorders. METHOD Nine-hundred eighty-nine patients diagnosed with panic, generalized anxiety, social anxiety, and posttraumatic stress disorders reported on the severity of anxiety and depressive symptoms and on diagnoses of 11 medical conditions. RESULTS Severity of anxiety and depressive symptoms was strongly associated with having more medical conditions over and above control variables, and the association was as strong as that between BMI and disease. Odds of having asthma, heart disease, back problems, ulcer, migraine headache and eyesight difficulties also increased as anxiety and depressive symptom severity increased. Anxiety symptoms were independently associated with ulcer, whereas depressive symptoms were independently associated with heart disease, migraine, and eyesight difficulties. CONCLUSIONS These findings add to a growing body of research linking anxiety disorders with physical health problems and indicate that anxiety and depressive symptoms deserve greater attention in their association with disease.
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Affiliation(s)
- Andrea N. Niles
- University of California, Los Angeles, Department of Psychology
| | - Halina J. Dour
- University of California, Los Angeles, Department of Psychology
| | - Annette L. Stanton
- University of California, Los Angeles, Department of Psychology,University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences
| | - Peter P. Roy-Byrne
- University of Washington at Harborview Medical Center, Center for Healthcare
| | - Murray B. Stein
- University of California, San Diego, Department of Psychiatry and Department of Family & Preventive Medicine
| | - Greer Sullivan
- University of Arkansas for Medical Sciences, Department of Psychiatry
| | | | - Raphael D. Rose
- University of California, Los Angeles, Department of Psychology
| | - Michelle G. Craske
- University of California, Los Angeles, Department of Psychology,University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences
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Sherbourne CD, Stucky BD, Edelen MO, Eberhart NK, Kleerup E, Lara M. Assessing the validity of the RAND negative impact of asthma on quality of life short forms. J Allergy Clin Immunol 2014; 134:900-7. [PMID: 24746752 PMCID: PMC4186891 DOI: 10.1016/j.jaci.2014.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/24/2014] [Accepted: 03/10/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In response to recommendations from the 2010 National Institutes of Health Asthma Outcomes Workshop, we developed a system for measuring the negative impact of asthma on quality of life (QoL), which was referred to as the RAND Negative Impact of Asthma on Quality of Life (RAND-IAQL) item bank. The bank contains 65 items that focus on the patient's perception of the impact or bother of asthma on his or her life. OBJECTIVE Evidence for the validity of 2 short forms, the RAND-IAQL 4-item and 12-item Short Forms, from the bank is presented. METHODS Using a sample of 2032 adults with asthma, we validated our short forms against the Asthma Quality of Life Questionnaire-Marks (AQLQ-M), the Asthma Control Test, and generic measures of QoL developed by the Patient-reported Outcomes Measurement Information System (PROMIS). Discriminant validity was examined by comparing scores of respondents who differed according to multiple health indicators. RESULTS Our sample ranged in age from 18 to 99 years (mean, 43 years), with 14% Hispanic, 11% Asian, 19% African American, and 56% non-Hispanic white race/ethnicity. Men had a significantly worse impact of asthma on QoL than women. The impact of asthma on QoL was greatest in African American and Hispanic subjects compared with that seen in non-Hispanic white subjects. Our measures correlated highly with the AQLQ-M and more strongly with the PROMIS global physical than mental scales. They differentiated between adults with asthma according to their perceived severity, level of control, presence or absence of exacerbations, and physical comorbidity. CONCLUSION The RAND-IAQL item bank, measuring the impact of asthma on QoL, will complement other patient-reported outcomes, such as measures of asthma symptoms, functioning, and control.
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Affiliation(s)
| | | | | | | | - Eric Kleerup
- David Geffen School of Medicine, Division of Pulmonary and Critical Care Medicine, University of California-Los Angeles, Los Angeles, Calif
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18
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Abstract
Patient-based measures for asthma control are important in assessing the worldwide impact of this highly prevalent chronic illness. We sought to refine an asthma symptom scale that RAND had previously developed to shorten it and validate it further, as well as reflect updated international expert definitions of asthma control. We conducted rigorous psychometric testing of new and adapted self-administered survey items in a sample of 2032 adults with asthma. The reliability and preliminary validity of the resulting measure, henceforth referred to as the RAND Asthma Control Measure (RAND-ACM), matched or exceeded that of the original RAND measure and others in the literature. RAND-ACM scores for worse asthma control were significantly associated with worse asthma-related quality of life, increased asthma-related healthcare use, Hispanic ethnicity and lower educational level. Evidence for internal consistency was strong with a Cronbach's α of 0.84. We also found adequate concordance between the RAND-ACM and the Global Initiative for Asthma categories of "uncontrolled", "partly controlled" and "controlled" asthma. The RAND-ACM, a five-item self-reported asthma control survey measure, performs well in a large ethnically-diverse sample of US adults with asthma and provides a cost-free alternative to other asthma control measures currently available.
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Dour HJ, Wiley JF, Roy-Byrne P, Stein MB, Sullivan G, Sherbourne CD, Bystritsky A, Rose RD, Craske MG. Perceived social support mediates anxiety and depressive symptom changes following primary care intervention. Depress Anxiety 2014; 31:436-42. [PMID: 24338947 PMCID: PMC4136523 DOI: 10.1002/da.22216] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/20/2013] [Accepted: 10/22/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The current study tested whether perceived social support serves as a mediator of anxiety and depressive symptom change following evidence-based anxiety treatment in the primary care setting. Gender, age, and race were tested as moderators. METHODS Data were obtained from 1004 adult patients (age M = 43, SD = 13; 71% female; 56% White, 20% Hispanic, 12% Black) who participated in a randomized effectiveness trial (coordinated anxiety learning and management [CALM] study) comparing evidence-based intervention (cognitive-behavioral therapy and/or psychopharmacology) to usual care in the primary care setting. Patients were assessed with a battery of questionnaires at baseline, as well as at 6, 12, and 18 months following baseline. Measures utilized in the mediation analyses included the Abbreviated Medical Outcomes (MOS) Social Support Survey, the Brief Symptom Index (BSI)-Somatic and Anxiety subscales, and the Patient Health Questionnaire (PHQ-9). RESULTS There was a mediating effect over time of perceived social support on symptom change following treatment, with stronger effects for 18-month depression than anxiety. None of the mediating pathways were moderated by gender, age, or race. CONCLUSIONS Perceived social support may be central to anxiety and depressive symptom changes over time with evidence-based intervention in the primary care setting. These findings possibly have important implications for development of anxiety interventions.
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Affiliation(s)
| | | | - Peter Roy-Byrne
- University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, Washington
| | | | - Greer Sullivan
- VA South Central Mental Illness Research, Education, and Clinical Center,RAND Corporation, Santa Monica, California
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Stucky BD, Edelen MO, Sherbourne CD, Eberhart NK, Lara M. Developing an item bank and short forms that assess the impact of asthma on quality of life. Respir Med 2013; 108:252-63. [PMID: 24411842 DOI: 10.1016/j.rmed.2013.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 12/06/2013] [Accepted: 12/16/2013] [Indexed: 01/24/2023]
Abstract
The present work describes the process of developing an item bank and short forms that measure the impact of asthma on quality of life (QoL) that avoids confounding QoL with asthma symptomatology and functional impairment. Using a diverse national sample of adults with asthma (N = 2032) we conducted exploratory and confirmatory factor analyses, and item response theory and differential item functioning analyses to develop a 65-item unidimensional item bank and separate short form assessments. A psychometric evaluation of the RAND Impact of Asthma on QoL item bank (RAND-IAQL) suggests that though the concept of asthma impact on QoL is multi-faceted, it may be measured as a single underlying construct. The performance of the bank was then evaluated with a real-data simulated computer adaptive test. From the RAND-IAQL item bank we then developed two short forms consisting of 4 and 12 items (reliability = 0.86 and 0.93, respectively). A real-data simulated computer adaptive test suggests that as few as 4-5 items from the bank are needed to obtain highly precise scores. Preliminary validity results indicate that the RAND-IAQL measures distinguish between levels of asthma control. To measure the impact of asthma on QoL, users of these items may choose from two highly reliable short forms, computer adaptive test administration, or content-specific subsets of items from the bank tailored to their specific needs.
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Joesch JM, Golinelli D, Sherbourne CD, Sullivan G, Stein MB, Craske MG, Roy-Byrne PP. Trajectories of change in anxiety severity and impairment during and after treatment with evidence-based treatment for multiple anxiety disorders in primary care. Depress Anxiety 2013; 30:1099-106. [PMID: 23801589 PMCID: PMC3902647 DOI: 10.1002/da.22149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/02/2013] [Accepted: 06/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coordinated Anxiety Learning and Management (CALM) is a model for delivering evidence-based treatment for anxiety disorders in primary care. Compared to usual care, CALM produced greater improvement in anxiety symptoms. However, mean estimates can obscure heterogeneity in treatment response. This study aimed to identify (1) clusters of participants with similar patterns of change in anxiety severity and impairment (trajectory groups); and (2) characteristics that predict trajectory group membership. METHODS The CALM randomized controlled effectiveness trial was conducted in 17 primary care clinics in four US cities in 2006-2009. 1,004 English- or Spanish-speaking patients age 18-75 with panic, generalized anxiety, social anxiety, and/or posttraumatic stress disorder participated. The Overall Anxiety Severity and Impairment Scale was administered repeatedly to 482 participants randomized to CALM treatment. Group-based trajectory modeling was applied to identify trajectory groups and multinomial logit to predict trajectory group membership. RESULTS Two predicted trajectories, representing about two-thirds of participants, were below the cut-off for clinically significant anxiety a couple of months after treatment initiation. The predicted trajectory for the majority of remaining participants was below the cut-off by 9 months. A small group of participants did not show consistent improvement. Being sicker at baseline, not working, and reporting less social support were associated with less favorable trajectories. CONCLUSIONS There is heterogeneity in patient response to anxiety treatment. Adverse circumstances appear to hamper treatment response. To what extent anxiety symptoms improve insufficiently because adverse patient circumstances contribute to suboptimal treatment delivery, suboptimal treatment adherence, or suboptimal treatment response requires further investigation.
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Affiliation(s)
- Jutta M. Joesch
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine and, Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically, Vulnerable Populations (CHAMMP), Seattle, Washington
| | | | | | - Greer Sullivan
- Department of Psychiatry and VA South Central Mental Illness Research, Education, and Clinical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Murray B. Stein
- Departments of Psychiatry and Family and Preventive Medicine, University of California, La Jolla, California
| | - Michelle G. Craske
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Peter P. Roy-Byrne
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine and, Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically, Vulnerable Populations (CHAMMP), Seattle, Washington
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Eberhart NK, Sherbourne CD, Edelen MO, Stucky BD, Sin NL, Lara M. Development of a measure of asthma-specific quality of life among adults. Qual Life Res 2013; 23:837-48. [PMID: 24062237 DOI: 10.1007/s11136-013-0510-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE A key goal in asthma treatment is improvement in quality of life (QoL), but existing measures often confound QoL with symptoms and functional impairment. The current study addresses these limitations and the need for valid patient-reported outcome measures by using state-of-the-art methods to develop an item bank assessing QoL in adults with asthma. This article describes the process for developing an initial item pool for field testing. METHODS Five focus group interviews were conducted with a total of 50 asthmatic adults. We used "pile sorting/binning" and "winnowing" methods to identify key QoL dimensions and develop a pool of items based on statements made in the focus group interviews. We then conducted a literature review and consulted with an expert panel to ensure that no key concepts were omitted. Finally, we conducted individual cognitive interviews to ensure that items were well understood and inform final item refinement. RESULTS Six hundred and sixty-one QoL statements were identified from focus group interview transcripts and subsequently used to generate a pool of 112 items in 16 different content areas. CONCLUSIONS Items covering a broad range of content were developed that can serve as a valid gauge of individuals' perceptions of the effects of asthma and its treatment on their lives. These items do not directly measure symptoms or functional impairment, yet they include a broader range of content than most existent measures of asthma-specific QoL.
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Affiliation(s)
- Nicole K Eberhart
- The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA,
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Bomyea J, Lang AJ, Craske MG, Chavira D, Sherbourne CD, Rose RD, Golinelli D, Campbell-Sills L, Welch SS, Sullivan G, Bystritsky A, Roy-Byrne P, Stein MB. Suicidal ideation and risk factors in primary care patients with anxiety disorders. Psychiatry Res 2013; 209:60-5. [PMID: 23608160 PMCID: PMC3745797 DOI: 10.1016/j.psychres.2013.03.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 03/12/2013] [Accepted: 03/18/2013] [Indexed: 11/18/2022]
Abstract
The presence of an anxiety disorder is associated with greater frequency of suicidal thoughts and behaviors. Given the high personal and societal costs of suicidal behaviors, suicide prevention is a priority. Understanding factors present within individuals with anxiety disorders that increase suicide risk may inform prevention efforts. The aims of the present study were to examine the prevalence of suicidal ideation and behaviors, as well as factors associated with suicide risk in patients with anxiety disorders in primary care. Data from a large scale randomized controlled study were analyzed to assess prevalence of suicidal thoughts and behaviors, as well as factors associated with suicide risk. Results revealed that suicidal ideation and behaviors were relatively common in this group. When examining mental and physical health factors jointly, presence of depression, mental health-related impairment, and social support each uniquely accounted for variance in suicide risk score. Methodological limitations include cross-sectional data collection and lack of information on comorbid personality disorders. Moreover, patients included were from a clinical trial with exclusion criteria that may limit generalizability. Results highlight the complex determinants of suicidal behavior and the need for more nuanced suicide assessment in this population, including evaluation of comorbidity and general functioning.
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Affiliation(s)
- Jessica Bomyea
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA 92037, USA.
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Niles AN, Sherbourne CD, Roy-Byrne PP, Stein MB, Sullivan G, Bystritsky A, Craske MG. Anxiety treatment improves physical functioning with oblique scoring of the SF-12 short form health survey. Gen Hosp Psychiatry 2013; 35:291-6. [PMID: 23332608 PMCID: PMC3747957 DOI: 10.1016/j.genhosppsych.2012.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/10/2012] [Accepted: 12/11/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE No studies have found a positive effect of anxiety treatment on physical functioning, but recent investigations of the 12-item Short Form Health Questionnaire (SF-12), which is frequently used to assess physical functioning, have suggested that orthogonal scoring of the summary measure may distort representations of physical health. The current study reanalyzes whether anxiety treatment improves physical functioning using oblique scoring in the Coordinated Anxiety Learning and Management (CALM) randomized clinical trial for the treatment of anxiety disorders. Replication was tested in reanalysis of data from the earlier Collaborative Care for Anxiety and Panic (CCAP) randomized clinical trial for the treatment of panic disorder. METHOD The CALM study included 1004 primary care patients with panic, social anxiety, generalized anxiety or posttraumatic stress disorders. Patients received usual care (UC) or an evidence-based intervention (cognitive behavioral therapy, psychotropic medication or both; ITV). Physical functioning (SF-12v2) was assessed at baseline and at 6, 12 and 18 months. Oblique and orthogonal scoring methods for the physical functioning aggregate measure from SF-12 scale items were compared. RESULTS In CALM, physical functioning improved to a greater degree in ITV than UC for oblique but not orthogonal scoring. Findings were replicated in the CCAP data. CONCLUSIONS Evidence-based treatment for anxiety disorders in primary care improves physical functioning when measured using oblique scoring of the SF-12. Due to this scoring issue, effects of mental health treatment on physical functioning may have been understated.
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Affiliation(s)
- Andrea N. Niles
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - Peter P. Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, Seattle, WA, USA
| | - Murray B. Stein
- Departments of Psychiatry and Family and Preventative Medicine, University of California, San Diego, CA, USA
| | - Greer Sullivan
- South Central VA Mental Illness Research Education and Clinical Center, North Little Rock, Arkansas and University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, CA, USA,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA,Corresponding author. Tel.: +310 825 8403; fax: +310 206 5895.
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Campbell-Sills L, Sherbourne CD, Roy-Byrne P, Craske MG, Sullivan G, Bystritsky A, Lang AJ, Chavira DA, Rose RD, Welch SS, Stein MB. Effects of co-occurring depression on treatment for anxiety disorders: analysis of outcomes from a large primary care effectiveness trial. J Clin Psychiatry 2012; 73:1509-16. [PMID: 23290323 PMCID: PMC3692282 DOI: 10.4088/jcp.12m07955] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Co-occurring depression is common in patients seeking treatment for anxiety; however, the literature on the effects of depression on anxiety treatment outcomes is inconclusive. The current study evaluated prescriptive and prognostic effects of depression on anxiety treatment outcomes in a large primary care sample. METHOD Data were analyzed from a randomized controlled effectiveness trial that compared coordinated anxiety learning and management (CALM) to usual care. The study enrolled 1,004 patients between June 2006 and April 2008. Patients were referred by their primary care provider and met DSM-IV criteria for generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and/or social anxiety disorder. They were treated for approximately 3 to 12 months with CALM (computer-assisted cognitive-behavioral therapy, medication management, or their combination) or usual care. Outcomes were evaluated by blinded assessment at 6, 12, and 18 months. Effects of baseline major depressive disorder (MDD) on anxiety symptoms, anxiety-related disability, and response/remission rates were evaluated using statistical models accounting for baseline anxiety and patient demographics. RESULTS MDD did not moderate the effects of CALM (relative to usual care) on anxiety symptoms, anxiety-related disability, or response/remission rates. Greater improvements in anxiety symptoms and anxiety-related disability were observed in depressed patients, regardless of treatment assignment (P values < .005). However, cross-sectionally depressed patients displayed higher anxiety symptom and anxiety-related disability scores at baseline and all subsequent assessments (P values < .001). Depressed patients also displayed lower remission rates at each follow-up (P values < .001). CONCLUSIONS CALM had comparable advantages over usual care for patients with and without MDD. Depressed patients displayed more severe anxiety symptoms and anxiety-related disability at baseline, but their clinical improvement was substantial and larger in magnitude than that observed in the nondepressed patients. Results support the use of empirically supported interventions for anxiety disorders in patients with co-occurring depression. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00347269.
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Affiliation(s)
- Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, USA.
| | | | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Greer Sullivan
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA,VA South Central Mental Illness Research, Education, and Clinical Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alexander Bystritsky
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ariel J. Lang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,VA San Diego Health Care System Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Denise A. Chavira
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,California State University San Marcos, Department of Human Development, San Marcos, CA, USA
| | - Raphael D. Rose
- VA South Central Mental Illness Research, Education, and Clinical Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stacy Shaw Welch
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
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Bomyea J, Lang AJ, Golinelli D, Craske MG, Chavira DA, Sherbourne CD, Rose RD, Campbell-Sills L, Welch SS, Sullivan G, Bystritsky A, Roy-Byrne P, Stein MB. Trauma Exposure in Anxious Primary Care Patients. J Psychopathol Behav Assess 2012; 35:254-263. [PMID: 23729989 DOI: 10.1007/s10862-012-9327-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present study examined rates of trauma exposure, clinical characteristics associated with trauma exposure, and the effect of trauma exposure on treatment outcome in a large sample of primary care patients without posttraumatic stress disorder (PTSD). Individuals without PTSD (N = 1263) treated as part of the CALM program (Roy-Byrne et al., 2010) were assessed for presence of trauma exposure. Those with and without trauma exposure were compared on baseline demographic and diagnostic information, symptom severity, and responder status six months after beginning treatment. Trauma-exposed individuals (N = 662, 53%) were more likely to meet diagnostic criteria for Obsessive Compulsive Disorder and had higher levels of somatic symptoms at baseline. Individuals with and without trauma exposure did not differ significantly on severity of anxiety, depression, or mental health functioning at baseline. Trauma exposure did not significantly impact treatment response. Findings suggest that adverse effects of trauma exposure in those without PTSD may include OCD and somatic anxiety symptoms. Treatment did not appear to be adversely impacted by trauma exposure. Thus, although trauma exposure is prevalent in primary care samples, results suggest that treatment of the presenting anxiety disorder is effective irrespective of trauma history.
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Affiliation(s)
- J Bomyea
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, University of California, San Diego
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27
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Joesch JM, Sherbourne CD, Sullivan G, Stein MB, Craske MG, Roy-Byrne P. Incremental benefits and cost of coordinated anxiety learning and management for anxiety treatment in primary care. Psychol Med 2012; 42:1937-1948. [PMID: 22152230 PMCID: PMC3340455 DOI: 10.1017/s0033291711002893] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Improving the quality of mental health care requires integrating successful research interventions into 'real-world' practice settings. Coordinated Anxiety Learning and Management (CALM) is a treatment-delivery model for anxiety disorders encountered in primary care. CALM offers cognitive behavioral therapy (CBT), medication, or both; non-expert care managers assisting primary care clinicians with adherence promotion and medication optimization; computer-assisted CBT delivery; and outcome monitoring. This study describes incremental benefits, costs and net benefits of CALM versus usual care (UC). METHOD The CALM randomized, controlled effectiveness trial was conducted in 17 primary care clinics in four US cities from 2006 to 2009. Of 1062 eligible patients, 1004 English- or Spanish-speaking patients aged 18-75 years with panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) and/or post-traumatic stress disorder (PTSD) with or without major depression were randomized. Anxiety-free days (AFDs), quality-adjusted life years (QALYs) and expenditures for out-patient visits, emergency room (ER) visits, in-patient stays and psychiatric medications were estimated based on blinded telephone assessments at baseline, 6, 12 and 18 months. RESULTS Over 18 months, CALM participants, on average, experienced 57.1 more AFDs [95% confidence interval (CI) 31-83] and $245 additional medical expenses (95% CI $-733 to $1223). The mean incremental net benefit (INB) of CALM versus UC was positive when an AFD was valued ≥$4. For QALYs based on the Short-Form Health Survey-12 (SF-12) and the EuroQol EQ-5D, the mean INB was positive at ≥$5000. CONCLUSIONS Compared with UC, CALM provides significant benefits with modest increases in health-care expenditures.
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Affiliation(s)
- J M Joesch
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA 98104-2499, USA.
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Curran GM, Sullivan G, Mendel P, Craske MG, Sherbourne CD, Stein MB, McDaniel A, Roy-Byrne P. Implementation of the CALM intervention for anxiety disorders: a qualitative study. Implement Sci 2012; 7:1-11. [PMID: 22404963 PMCID: PMC3319426 DOI: 10.1186/1748-5908-7-14] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Investigators recently tested the effectiveness of a collaborative-care intervention for anxiety disorders: Coordinated Anxiety Learning and Management(CALM) []) in 17 primary care clinics around the United States. Investigators also conducted a qualitative process evaluation. Key research questions were as follows: (1) What were the facilitators/barriers to implementing CALM? (2) What were the facilitators/barriers to sustaining CALM after the study was completed? METHODS Key informant interviews were conducted with 47 clinic staff members (18 primary care providers, 13 nurses, 8 clinic administrators, and 8 clinic staff) and 14 study-trained anxiety clinical specialists (ACSs) who coordinated the collaborative care and provided cognitive behavioral therapy. The interviews were semistructured and conducted by phone. Data were content analyzed with line-by-line analyses leading to the development and refinement of themes. RESULTS Similar themes emerged across stakeholders. Important facilitators to implementation included the perception of "low burden" to implement, provider satisfaction with the intervention, and frequent provider interaction with ACSs. Barriers to implementation included variable provider interest in mental health, high rates of part-time providers in clinics, and high social stressors of lower socioeconomic-status patients interfering with adherence. Key sustainability facilitators were if a clinic had already incorporated collaborative care for another disorder and presence of onsite mental health staff. The main barrier to sustainability was funding for the ACS. CONCLUSIONS The CALM intervention was relatively easy to incorporate during the effectiveness trial, and satisfaction was generally high. Numerous implementation and sustainability barriers could limit the reach and impact of widespread adoption. Findings should be interpreted with the knowledge that the ACSs in this study were provided and trained by the study. Future research should explore uptake of CALM and similar interventions without the aid of an effectiveness trial.
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Affiliation(s)
- Geoffrey M Curran
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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29
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Stein MB, Roy-Byrne PP, Craske MG, Campbell-Sills L, Lang AJ, Golinelli D, Rose RD, Bystritsky A, Sullivan G, Sherbourne CD. Quality of and patient satisfaction with primary health care for anxiety disorders. J Clin Psychiatry 2011; 72:970-6. [PMID: 21367351 PMCID: PMC3111814 DOI: 10.4088/jcp.09m05626blu] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 12/31/2009] [Indexed: 10/18/2022]
Abstract
BACKGROUND Most patients with anxiety disorders receive their care from primary care practitioners (PCPs). The purpose of this study was to evaluate quality of and patient satisfaction with primary health care for anxiety disorders. METHOD A survey was performed among 1,004 outpatients with anxiety disorders (diagnosed according to DSM-IV) referred by their PCPs from 17 primary care clinical settings (3 of which were university-affiliated) in 4 regions of the United States for participation in the Coordinated Anxiety Learning and Management (CALM) study, a therapeutic trial. Participating research institutions were the University of Washington at Seattle, the University of California at San Diego and Los Angeles, and the University of Arkansas for Medical Sciences at Little Rock. Enrollment took place between June 2006 and April 2008. Patients were contacted by telephone after enrollment to provide information about previous care received (during the 6 months prior to referral) and satisfaction with that care. Quality-of-care indicators were self-reported type, dose, and duration of antianxiety medication treatment and self-reported psychotherapy with cognitive-behavioral therapy (CBT) elements. RESULTS A total of 576 patients (57.4%) had received an appropriate antianxiety medication in the previous 6 months, but only 289 patients (29.4% of 983 who answered this question) had received the medication at adequate dose for at least 2 months. A total of 465 patients (46.3%) had received some counseling with at least 1 element of CBT, but only 213 patients (21.2%) had received counseling with a strong (3+ elements) CBT focus. Overall, 416 patients (41.4%) had received quality pharmacotherapy or psychotherapy, and 81 patients (8.1%) had received both. Only 432 patients (44.8% of 964 who answered this question) were at least somewhat satisfied with their mental health care. Receipt of quality psychotherapy was the sole positive predictor (adjusted odds ratio = 2.71; 95% CI, 1.94-3.80; P < .0005) of satisfaction with mental health care for anxiety. Moreover, there was a dose-response relationship between the number of CBT elements consistently delivered and satisfaction with care (test for trend, z = 4.06, P < .0005). CONCLUSIONS Despite recognition of these patients' anxiety disorders and referral by their PCPs to an anxiety treatment study, fewer than half of the patients had in the prior 6 months received quality pharmacologic and/or psychosocial mental health care. Receipt of CBT-oriented, quality psychosocial (but not pharmacologic) care showed a strong dose-response relationship with satisfaction with mental health care.
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Affiliation(s)
- Murray B. Stein
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, Phone 858-534-6451, Fax 858-534-6460,
- Department of Family & Preventive Medicine, University of California San Diego
| | - Peter P. Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), Seattle
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Laura Campbell-Sills
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, Phone 858-534-6451, Fax 858-534-6460,
| | - Ariel J. Lang
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, Phone 858-534-6451, Fax 858-534-6460,
| | | | - Raphael D. Rose
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), Seattle
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Greer Sullivan
- Department of Psychiatry, University of Arkansas for Medical Science, North Little Rock, AR
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Meredith LS, Sherbourne CD, Gaillot SJ, Hansell L, Ritschard HV, Parker AM, Wrenn G. Promoting Psychological Resilience in the U.S. Military. Rand Health Q 2011; 1:2. [PMID: 28083176 PMCID: PMC4945176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
As U.S. service members deploy for extended periods on a repeated basis, their ability to cope with the stress of deployment may be challenged. A growing number of programs and strategies provided by the military and civilian sectors are available to encourage and support psychological resilience to stress for service members and families. Though previous research from the field of psychology delineating the factors that foster psychological resilience is available, there has been no assessment of whether and how well the current military resilience programs are addressing these factors in their activities. Further, little is known about the effectiveness of these programs on developing resilience. To assist the Department of Defense in understanding methodologies that could be useful in promoting resilience among service members and their families, the research team conducted a focused literature review to identify evidence-informed factors for promoting psychological resilience. The team also reviewed a subset of military resilience programs to determine the extent to which they included those evidence-informed factors. This article describes the context, approach, and findings from these research activities.
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Stecker T, Fortney JC, Sherbourne CD. An Intervention to Increase Mental Health Treatment Engagement Among OIF Veterans: A Pilot Trial. Mil Med 2011; 176:613-9. [DOI: 10.7205/milmed-d-10-00428] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Goebel JR, Compton P, Zubkoff L, Lanto A, Asch SM, Sherbourne CD, Shugarman L, Lorenz KA. Prescription sharing, alcohol use, and street drug use to manage pain among veterans. J Pain Symptom Manage 2011; 41:848-58. [PMID: 21256706 DOI: 10.1016/j.jpainsymman.2010.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 07/20/2010] [Accepted: 07/29/2010] [Indexed: 12/19/2022]
Abstract
CONTEXT Efforts to promote awareness and management of chronic pain have been accompanied by a troubling increase in prescription medication abuse. At the same time, some patients may misuse substances in an effort to manage chronic pain. OBJECTIVES This study examines self-reported substance misuse for pain management among veterans and identifies the contributing factors. METHODS We analyzed cross-sectional data from the Help Veterans Experience Less Pain study. RESULTS Of 343 veterans, 35.3% reported an aberrant pain management behavior (24% reported using alcohol, 11.7% reported using street drugs, and 16.3% reported sharing prescriptions to manage pain). Poorer mental health, younger age, substance use disorders (SUDs), number of nonpain symptoms, and greater pain severity and interference were associated with aberrant pain management behaviors. In multivariate analysis, SUDs (odds ratio [OR]: 3.9, 95% confidence interval [CI]: 2.3-6.7, P<0.000) and poorer mental health (OR: 2.3, 95% CI: 1.3-4.3, P=0.006) were associated with using alcohol or street drugs to manage pain; SUDs (OR: 2.4, 95% CI: 1.3-4.4, P=0.006) and pain interference (OR: 1.1, 95% CI: 1.0-1.2, P=0.047) were associated with prescription sharing; and SUDs (OR: 3.6, 95% CI: 2.2-6.1, P<0.000) and number of nonpain symptoms (OR: 6.5, 95% CI: 1.2-35.4, P=0.031) were associated with any aberrant pain management behavior. CONCLUSION Veterans with a history of SUDs, greater pain interference, more nonpain symptoms, and mental health concerns should be carefully managed to deter substance misuse for pain management.
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Affiliation(s)
- Joy R Goebel
- School of Nursing, California State University at Long Beach, Long Beach, California 90840-0108, USA.
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Sherbourne CD, Sullivan G, Craske MG, Roy-Byrne P, Golinelli D, Rose RD, Chavira DA, Bystritsky A, Stein MB. Functioning and disability levels in primary care out-patients with one or more anxiety disorders. Psychol Med 2010; 40:2059-2068. [PMID: 20146834 PMCID: PMC2965310 DOI: 10.1017/s0033291710000176] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anxiety disorders are the most prevalent mental health disorders and are associated with substantial disability and reduced well-being. It is unknown whether the relative impact of different anxiety disorders is due to the anxiety disorder itself or to the co-occurrence with other anxiety disorders. This study compared the functional impact of combinations of anxiety disorders in primary care out-patients. METHOD A total of 1004 patients with panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) or post-traumatic stress disorder (PTSD) provided data on their mental and physical functioning, and disability. Multivariate regressions compared functional levels for patients with different numbers and combinations of disorders. RESULTS Of the patients, 42% had one anxiety disorder only, 38% two, 16% three and 3% all four. There were few relative differences in functioning among patients with only one anxiety disorder, although those with SAD were most restricted in their work, social and home activities and those with GAD were the least impaired. Functioning levels tended to deteriorate as co-morbidity increased. CONCLUSIONS Of the four anxiety disorders examined, GAD appears to be the least disabling, although they all have more in common than in distinction when it comes to functional impairment. A focus on unique effects of specific anxiety disorders is inadequate, as it fails to address the more pervasive impairment associated with multiple anxiety disorders, which is the modal presentation in primary care.
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Affiliation(s)
- C D Sherbourne
- Health Program, RAND Corporation, Santa Monica, CA 90407-2138, USA.
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Shugarman LR, Goebel JR, Lanto A, Asch SM, Sherbourne CD, Lee ML, Rubenstein LV, Wen L, Meredith L, Lorenz KA. Nursing staff, patient, and environmental factors associated with accurate pain assessment. J Pain Symptom Manage 2010; 40:723-33. [PMID: 20692807 DOI: 10.1016/j.jpainsymman.2010.02.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 02/10/2010] [Accepted: 02/11/2010] [Indexed: 11/22/2022]
Abstract
CONTEXT Although pain ranks highly among reasons for seeking care, routine pain assessment is often inaccurate. OBJECTIVES This study evaluated factors associated with nurses (e.g., registered) and other nursing support staff (e.g., licensed vocational nurses and health technicians) discordance with patients in estimates of pain in a health system where routine pain screening using a 0-10 numeric rating scale (NRS) is mandated. METHODS This was a cross-sectional, visit-based, cohort study that included surveys of clinic outpatients (n=465) and nursing staff (n=94) who screened for pain as part of routine vital sign measurement during intake. These data were supplemented by chart review. We compared patient pain levels documented by the nursing staff (N-NRS) with those reported by the patient during the study survey (S-NRS). RESULTS Pain underestimation (N-NRS<S-NRS) occurred in 25% and overestimation (N-NRS>S-NRS) in 7% of the cases. Nursing staff used informal pain-screening techniques that did not follow established NRS protocols in half of the encounters. Pain underestimation was positively associated with more years of nursing staff work experience and patient anxiety or post-traumatic stress disorder and negatively associated with better patient-reported health status. Pain overestimation was positively associated with nursing staff's use of the full NRS protocol and with a distracting environment in which patient vitals were taken. CONCLUSION Despite a long-standing mandate, pain-screening implementation falls short, and informal screening is common.
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Zubkoff L, Lorenz KA, Lanto AB, Sherbourne CD, Goebel JR, Glassman PA, Shugarman LR, Meredith LS, Asch SM. Does screening for pain correspond to high quality care for veterans? J Gen Intern Med 2010; 25:900-5. [PMID: 20229139 PMCID: PMC2917664 DOI: 10.1007/s11606-010-1301-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 10/07/2009] [Accepted: 02/08/2010] [Indexed: 10/24/2022]
Abstract
BACKGROUND Routine numeric screening for pain is widely recommended, but its association with overall quality of pain care is unclear. OBJECTIVE To assess adherence to measures of pain management quality and identify associated patient and provider factors. DESIGN A cross-sectional visit-based study. PARTICIPANTS One hundred and forty adult VA outpatient primary care clinic patients reporting a numeric rating scale (NRS) of moderate to severe pain (four or more on a zero to ten scale). Seventy-seven providers completed a baseline survey regarding general pain management attitudes and a post-visit survey regarding management of 112 participating patients. MEASUREMENT AND MAIN RESULTS We used chart review to determine adherence to four validated process quality indicators (QIs) including noting pain presence, pain character, and pain control, and intensifying pharmacological intervention. The average NRS was 6.7. Seventy-three percent of charts noted the presence of pain, 13.9% the character, 23.6% the degree of control, and 15.3% increased pain medication prescription. Charts were more likely to include documentation of pain presence if providers agreed that "patients want me to ask about pain" and "pain can have negative consequences on patient's functioning". Charts were more likely to document character of pain if providers agreed that "patients are able to rate their pain". Patients with musculoskeletal pain were less likely to have chart documentation of character of pain. CONCLUSIONS Despite routine pain screening in VA, providers seldom documented elements considered important to evaluation and treatment of pain. Improving pain care may require attention to all aspects of pain management, not just screening.
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Affiliation(s)
- Lisa Zubkoff
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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Shugarman LR, Asch SM, Meredith LS, Sherbourne CD, Hagenmeier E, Wen L, Cohen A, Rubenstein LV, Goebel J, Lanto A, Lorenz KA. Factors Associated with Clinician Intention to Address Diverse Aspects of Pain in Seriously Ill Outpatients. Pain Med 2010; 11:1365-72. [DOI: 10.1111/j.1526-4637.2010.00931.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goebel JR, Sherbourne CD, Asch SM, Meredith L, Cohen AB, Hagenmaier E, Lanto AB, Simon B, Rubenstein LV, Shugarman LR, Lorenz KA. Addressing Patients' Concerns about Pain Management and Addiction Risks. Pain Manag Nurs 2010; 11:92-8. [DOI: 10.1016/j.pmn.2009.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 02/22/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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Roy-Byrne P, Craske MG, Sullivan G, Rose RD, Edlund MJ, Lang AJ, Bystritsky A, Welch SS, Chavira DA, Golinelli D, Campbell-Sills L, Sherbourne CD, Stein MB. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA 2010; 303:1921-8. [PMID: 20483968 PMCID: PMC2928714 DOI: 10.1001/jama.2010.608] [Citation(s) in RCA: 292] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Improving the quality of mental health care requires moving clinical interventions from controlled research settings into real-world practice settings. Although such advances have been made for depression, little work has been performed for anxiety disorders. OBJECTIVE To determine whether a flexible treatment-delivery model for multiple primary care anxiety disorders (panic, generalized anxiety, social anxiety, and posttraumatic stress disorders) would be better than usual care (UC). DESIGN, SETTING, AND PATIENTS A randomized controlled effectiveness trial of Coordinated Anxiety Learning and Management (CALM) compared with UC in 17 primary care clinics in 4 US cities. Between June 2006 and April 2008, 1004 patients with anxiety disorders (with or without major depression), aged 18 to 75 years, English- or Spanish-speaking, were enrolled and subsequently received treatment for 3 to 12 months. Blinded follow-up assessments at 6, 12, and 18 months after baseline were completed in October 2009. INTERVENTION CALM allowed choice of cognitive behavioral therapy (CBT), medication, or both; included real-time Web-based outcomes monitoring to optimize treatment decisions; and a computer-assisted program to optimize delivery of CBT by nonexpert care managers who also assisted primary care clinicians in promoting adherence and optimizing medications. MAIN OUTCOME MEASURES Twelve-item Brief Symptom Inventory (BSI-12) anxiety and somatic symptoms score. Secondary outcomes included proportion of responders (> or = 50% reduction from pretreatment BSI-12 score) and remitters (total BSI-12 score < 6). RESULTS A significantly greater improvement for CALM vs UC in global anxiety symptoms was found (BSI-12 group mean differences of -2.49 [95% confidence interval {CI}, -3.59 to -1.40], -2.63 [95% CI, -3.73 to -1.54], and -1.63 [95% CI, -2.73 to -0.53] at 6, 12, and 18 months, respectively). At 12 months, response and remission rates (CALM vs UC) were 63.66% (95% CI, 58.95%-68.37%) vs 44.68% (95% CI, 39.76%-49.59%), and 51.49% (95% CI, 46.60%-56.38%) vs 33.28% (95% CI, 28.62%-37.93%), with a number needed to treat of 5.27 (95% CI, 4.18-7.13) for response and 5.50 (95% CI, 4.32-7.55) for remission. CONCLUSION For patients with anxiety disorders treated in primary care clinics, CALM compared with UC resulted in greater improvement in anxiety symptoms, depression symptoms, functional disability, and quality of care during 18 months of follow-up. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00347269.
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Affiliation(s)
- Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations, Seattle, Washington 98104, USA.
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Abstract
OBJECTIVES Many veterans return from combat experiencing a variety of mental health concerns. Previous research has documented a stigma associated with seeking treatment that interferes with the decision to seek treatment. This study, conceptualized using the theory of planned behavior, assessed beliefs about mental health treatment in order to understand mental health treatment seeking behavior among a group of returning National Guard soldiers who served in the war in Iraq. METHODS Participants were one hundred and fifty Operation Iraqi Freedom National Guard soldiers who screened positive for depression, posttraumatic stress disorder, generalized anxiety disorder, panic disorder or alcohol abuse disorder on the Mini International Neuropsychiatric Interview (MINI). Participants were asked to complete a questionnaire assessing beliefs about mental health treatment and treatment-seeking behavior. RESULTS Beliefs related to symptom reduction and work were significantly related to mental health treatment-seeking behavior. CONCLUSIONS Interventions developed to engage veterans into care must be directed toward cognitive factors that motivate treatment seeking in addition to traditionally targeted structural barriers.
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Affiliation(s)
- Tracy Stecker
- Psychiatric Research Center, Dartmouth Medical School, Lebanon, NH, USA
- VA Health Services Research and Development, White River Junction Veterans Administration, White River Junction, VT, USA
| | - John Fortney
- VA Health Services Research and Development (HRS&D), Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Francis Hamilton
- Psychiatric Research Center, Dartmouth Medical School, Lebanon, NH, USA
- VA Health Services Research and Development, White River Junction Veterans Administration, White River Junction, VT, USA
| | | | - Icek Ajzen
- Department of Psychology, University of Massachusetts, Amherst, MA, USA
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Goebel JR, Doering LV, Shugarman LR, Asch SM, Sherbourne CD, Lanto AB, Evangelista LS, Nyamathi AM, Maliski SL, Lorenz KA. Heart failure: the hidden problem of pain. J Pain Symptom Manage 2009; 38:698-707. [PMID: 19733032 PMCID: PMC2908037 DOI: 10.1016/j.jpainsymman.2009.04.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 04/08/2009] [Accepted: 04/09/2009] [Indexed: 12/17/2022]
Abstract
Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67+/-11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2). Single items from the BPI interference and the quality of life-end of life measured social and spiritual well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual factors associated with pain. Fifty-three (55.2%) HF patients reported pain, with a majority (36 [37.5%]) rating their pain as moderate to severe (pain>or=4/10). The presence of pain was reported more frequently than dyspnea (67 [71.3%] vs. 58 [61.7%]). Age (P=0.02), psychological (depression: P=0.002; anxiety: P=0.001), social (P<0.001), spiritual (P=0.010), and physical (health status: P=0.001; symptom frequency: P=0.000; functional status: P=0.002) well-being were correlated with pain severity. In the resulting model, 38% of the variance in pain severity was explained (P<0.001); interference with relations (P<0.001) and symptom number (P=0.007) contributed to pain severity. The association of physical, psychological, social, and spiritual domains with pain suggests that multidisciplinary interventions are needed to address the complex nature of pain in HF.
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Affiliation(s)
- Joy R Goebel
- School of Nursing, California State University, Long Beach, Long Beach, California 90840-1006, USA.
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Lorenz KA, Krebs EE, Bentley TGK, Sherbourne CD, Goebel JR, Zubkoff L, Lanto AB, Asch SM. Exploring Alternative Approaches to Routine Outpatient Pain Screening. Pain Med 2009; 10:1291-9. [PMID: 19818039 DOI: 10.1111/j.1526-4637.2009.00709.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karl A Lorenz
- Veterans Administration Greater Los Angeles Healthcare System, Division of General Internal Medicine, Los Angeles, CA 90073, USA.
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Chavira DA, Stein MB, Golinelli D, Sherbourne CD, Craske MG, Sullivan G, Bystritsky A, Roy-Byrne PP. Predictors of clinical improvement in a randomized effectiveness trial for primary care patients with panic disorder. J Nerv Ment Dis 2009; 197:715-21. [PMID: 19829198 PMCID: PMC2925849 DOI: 10.1097/nmd.0b013e3181b97d4d] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study's aim was to prospectively examine and identify a model of demographic, clinical, and attitudinal variables that impact improvement among patients with panic disorder. Subjects were 232 primary care patients meeting criteria for DSM-IV panic disorder. Eligible patients were randomly assigned to a collaborative care intervention or to treatment as usual. Assessments occurred at 3-month intervals during the course of 1 year. In final multivariate logistic regression models, patients with higher anxiety sensitivity and higher neuroticism scores at baseline were less likely to show clinical improvement (using a criterion of 20 or less on the Anxiety Sensitivity Index) at 3 months. Those who were non-white, had higher anxiety sensitivity, and higher overall phobic avoidance at baseline were less likely to show clinical improvement at 12 months. A greater understanding of these predictors may help clinicians identify who is at greatest risk for persistent panic-related symptoms and to plan the intensity of interventions accordingly.
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Affiliation(s)
- Denise A. Chavira
- Department of Psychiatry, University of California, San Diego, 8939 Villa La Jolla Drive, Ste. 200, La Jolla, CA 92037
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, 8939 Villa La Jolla Drive, Ste. 200, La Jolla, CA 92037,Department of Family & Preventive Medicine, University of California San Diego
| | - Daniela Golinelli
- The RAND Corporation, 1776 Main St., PO Box 2138, Santa Monica, CA 90407
| | | | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Greer Sullivan
- VA South Central Mental Illness Research Education and Clinical Center (MIRECC) and University of Arkansas for Medical Science, Little Rock
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Peter P. Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
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Sherbourne CD, Asch SM, Shugarman LR, Goebel JR, Lanto AB, Rubenstein LV, Wen L, Zubkoff L, Lorenz KA. Early identification of co-occurring pain, depression and anxiety. J Gen Intern Med 2009; 24:620-5. [PMID: 19308333 PMCID: PMC2669878 DOI: 10.1007/s11606-009-0956-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/06/2009] [Accepted: 03/04/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Depression and anxiety frequently co-occur with pain and may affect treatment outcomes. Early identification of these co-occurring psychiatric conditions during routine pain screening may be critical for optimal treatment. OBJECTIVE To determine aspects of pain related to psychological distress, and, among distressed patients, to determine whether pain factors are related to provider identification of distress. DESIGN Cross-sectional interview of primary care patients and their providers participating in a Veteran's Administration HELP-Vets study. SUBJECTS A total of 528 predominately male Veterans MEASUREMENTS AND MAIN RESULTS We measured self-reported pain, including a 0-10 numeric rating scale and interference items from the Brief Pain Inventory. To evaluate distress, brief indicators of depression, anxiety and PTSD were combined. A substantial number of patients had psychological distress (41%), which was even higher (62%) among patients with moderate-severe current pain. Only 29% of those with distress reported talking to their provider about emotional problems during their visit. In multivariate analyses, other pain factors related to distress included interference with enjoyment of life and relationships with others, pain in multiple locations and joint pains. Prior diagnoses of depression and anxiety were also related to current distress. Only prior diagnosis and patient reported headaches and sleep interference because of pain were related to provider identification of distress. CONCLUSIONS VA patients with moderate-severe pain are at high risk for psychological distress, which often goes unrecognized. Providers need to be more vigilant to mental health problems in patients experiencing high pain levels. Targeted screening for co-occurring conditions is warranted.
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Affiliation(s)
- Cathy D Sherbourne
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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Goebel JR, Doering LV, Evangelista LS, Nyamathi AM, Maliski SL, Asch SM, Sherbourne CD, Shugarman LR, Lanto AB, Cohen A, Lorenz KA. A comparative study of pain in heart failure and non-heart failure veterans. J Card Fail 2009; 15:24-30. [PMID: 19181290 PMCID: PMC3170527 DOI: 10.1016/j.cardfail.2008.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 09/08/2008] [Accepted: 09/11/2008] [Indexed: 01/03/2023]
Abstract
BACKGROUND Progress has been made in addressing pain in specific diseases such as cancer, but less attention has focused on understanding pain in nonmalignant states, including heart failure (HF). METHODS AND RESULTS From March 2006 to June 2007, 672 veterans were surveyed and scores for the Brief Pain Inventory, pain distress, clinically significant pain levels (moderate to severe pain), and pain locations were compared using univariate and multivariate models. Fifteen percent of the final sample had HF (95/634). In our study, the HF patients were older (P < .000), reported lower levels of general health (P = .018), had more co-morbidities (P < .000), were more likely to have a history of cancer (P = .035), and suffered more chest pain and fewer headaches (P = .026, P = .03, respectively) than their non-HF cohorts. When controlling for age, co-morbidity and cancer disorders, HF and non-HF patients did not differ in pain severity, interference, distress or locations. Of the patients currently experiencing pain, 67.3% of HF patients and 68.4% of non-HF patients rated their pain as moderate or severe (pain >or=4 on a 0 to 10 scale). CONCLUSIONS Although HF has not been identified as a painful condition, this study suggests the burden of pain is significant for both HF and non-HF ambulatory care patients.
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Affiliation(s)
- Joy R Goebel
- Department of Nursing, California State University Long Beach (CSULB), Long Beach, CA 90840-0301, USA
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Means-Christensen AJ, Roy-Byrne PP, Sherbourne CD, Craske MG, Stein MB. Relationships among pain, anxiety, and depression in primary care. Depress Anxiety 2008; 25:593-600. [PMID: 17932958 DOI: 10.1002/da.20342] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Pain, anxiety, and depression are commonly seen in primary care patients and there is considerable evidence that these experiences are related. This study examined associations between symptoms of pain and symptoms and diagnoses of anxiety and depression in primary care patients. Results indicate that primary care patients who endorse symptoms of muscle pain, headache, or stomach pain are approximately 2.5-10 times more likely to screen positively for panic disorder, generalized anxiety disorder, or major depressive disorder. Endorsement of pain symptoms was also significantly associated with confirmed diagnoses of several of the anxiety disorders and/or major depression, with odds ratios ranging from approximately 3 to 9 for the diagnoses. Patients with an anxiety or depressive disorder also reported greater interference from pain. Similarly, patients endorsing pain symptoms reported lower mental health functioning and higher scores on severity measures of depression, social anxiety, and posttraumatic stress disorder. Mediation analyses indicated that depression mediated some, but not all of the relationships between anxiety and pain. Overall, these results reveal an association between reports of pain symptoms and not only depression, but also anxiety. An awareness of these relationships may be particularly important in primary care settings where a patient who presents with reports of pain may have an undiagnosed anxiety or depressive disorder.
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Wells KB, Tang L, Miranda J, Benjamin B, Duan N, Sherbourne CD. The effects of quality improvement for depression in primary care at nine years: results from a randomized, controlled group-level trial. Health Serv Res 2008; 43:1952-74. [PMID: 18522664 DOI: 10.1111/j.1475-6773.2008.00871.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine 9-year outcomes of implementation of short-term quality improvement (QI) programs for depression in primary care. DATA SOURCES Depressed primary care patients from six U.S. health care organizations. STUDY DESIGN Group-level, randomized controlled trial. DATA COLLECTION Patients were randomly assigned to short-term QI programs supporting education and resources for medication management (QI-Meds) or access to evidence-based psychotherapy (QI-Therapy); and usual care (UC). Of 1,088 eligible patients, 805 (74 percent) completed 9-year follow-up; results were extrapolated to 1,269 initially enrolled and living. Outcomes were psychological well-being (Mental Health Inventory, five-item version [MHI5]), unmet need, services use, and intermediate outcomes. PRINCIPAL FINDINGS At 9 years, there were no overall intervention status effects on MHI5 or unmet need (largest F (2,41)=2.34, p=.11), but relative to UC, QI-Meds worsened MHI5, reduced effectiveness of coping and among whites lowered tangible social support (smallest t(42)=2.02, p=.05). The interventions reduced outpatient visits and increased perceived barriers to care among whites, but reduced attitudinal barriers due to racial discrimination and other factors among minorities (smallest F (2,41)=3.89, p=.03). CONCLUSIONS Main intervention effects were over but the results suggest some unintended negative consequences at 9 years particularly for the medication-resource intervention and shifts to greater perceived barriers among whites yet reduced attitudinal barriers among minorities.
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Affiliation(s)
- Kenneth B Wells
- The RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
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Mendel P, Meredith LS, Schoenbaum M, Sherbourne CD, Wells KB. Interventions in organizational and community context: a framework for building evidence on dissemination and implementation in health services research. Adm Policy Ment Health 2008; 35:21-37. [PMID: 17990095 PMCID: PMC3582701 DOI: 10.1007/s10488-007-0144-9] [Citation(s) in RCA: 240] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 10/17/2007] [Indexed: 10/22/2022]
Abstract
The effective dissemination and implementation of evidence-based health interventions within community settings is an important cornerstone to expanding the availability of quality health and mental health services. Yet it has proven a challenging task for both research and community stakeholders. This paper presents the current framework developed by the UCLA/RAND NIMH Center to address this research-to-practice gap by: (1) providing a theoretically-grounded understanding of the multi-layered nature of community and healthcare contexts and the mechanisms by which new practices and programs diffuse within these settings; (2) distinguishing among key components of the diffusion process-including contextual factors, adoption, implementation, and sustainment of interventions-showing how evaluation of each is necessary to explain the course of dissemination and outcomes for individual and organizational stakeholders; (3) facilitating the identification of new strategies for adapting, disseminating, and implementing relatively complex, evidence-based healthcare and improvement interventions, particularly using a community-based, participatory approach; and (4) enhancing the ability to meaningfully generalize findings across varied interventions and settings to build an evidence base on successful dissemination and implementation strategies.
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Affiliation(s)
- Peter Mendel
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
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Abstract
BACKGROUND Few studies have assessed clinician adherence to depression practice guidelines and the relationship between clinician adherence and depression outcomes. OBJECTIVE To estimate how frequently specific guideline recommendations are followed and to assess whether following guideline recommendations is linked to improved depression outcomes. DESIGN Observational analysis of data collected from 1996 to 1998 in 3 randomized clinical trials. SETTING 45 primary care practices in 13 U.S. states. PATIENTS 1131 primary care patients with depression. MEASUREMENTS Expert panel methods were used to develop a patient survey-based index that measured adherence to clinical practice guidelines on depression. Rates of adherence to the 20 indicators that form the index were evaluated. Multivariable regression that controlled for case mix was used to assess how index scores predicted continuous and dichotomous depression measures at 12, 18, and 24 months. RESULTS Quality of care was high (clinician adherence > or =79%) for 6 indicators, including primary care clinician detection of depression. Quality of care was low (adherence, 20% to 38%) for 8 indicators, including management of suicide risk (3 indicators), alcohol abuse (2 indicators), and elderly patients; assessment of symptoms and history of depression; and treatment adjustment for patients who did not respond to initial treatment. Greater adherence to practice guidelines significantly predicted fewer depressive symptoms on continuous measures (P < 0.001 for 12 months, P < 0.01 for 18 months, and P < 0.001 for 24 months) and dichotomous measures (P < 0.05 for 18 and 24 months). LIMITATIONS Data are based on patient self-report. Possible changes in practice since 1998 may limit the generalizability of the findings. CONCLUSIONS Adherence to guidelines was high for one third of the recommendations that were measured but was very low for nearly half of the measures, pointing to specific needs for quality improvement. Guideline-concordant depression care appears to be linked to improved outcomes in primary care patients with depression.
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Rubenstein LV, Rayburn NR, Keeler EB, Ford DE, Rost KM, Sherbourne CD. Predicting outcomes of primary care patients with major depression: development of a depression prognosis index. Psychiatr Serv 2007; 58:1049-56. [PMID: 17664515 DOI: 10.1176/ps.2007.58.8.1049] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression research and practice focus increasingly on diverse patient populations with varying probabilities of response to clinical care. Prognostic indices use preexisting patient characteristics to estimate the probability of subsequent negative clinical outcomes and are useful tools for improving the study and care of diverse populations. Few such measures, however, have been developed for mental health conditions. This study developed and validated a depression prognosis measure for primary care patients with major depression. METHODS Consecutive patients in 108 primary care practices were screened for depression, and 1,471 with major depression were enrolled. A Depression Prognosis Index (DPI) predicting persistent depression six months after baseline was developed for a random one-third subsample and validated with the remaining two-thirds. Models included prior treatment, demographic characteristics, comorbidities, and other physical, psychological, and social predictors. RESULTS Sixty-four percent to 65% of patients classified by baseline DPI score as being in the sample quartile with the worst prognosis had probable major depression six months later, compared with 14% to 15% in the best-prognosis quartile. The DPI had an R2 of .40 in the development sample and .27 in the validation sample. Important predictors included severity of depression symptoms at baseline, social support, common physical symptoms, and having completed three months of antidepressants at sample entry. CONCLUSIONS The ability of the DPI to predict six-month outcomes compares favorably to that of prognostic indices for general medical problems. These results validate the DPI and provide conceptual guidance for further development of depression risk stratification instruments for clinical and research use.
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Affiliation(s)
- Lisa V Rubenstein
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System. Los Angeles, CA, USA.
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Stockdale SE, Wells KB, Tang L, Belin TR, Zhang L, Sherbourne CD. The importance of social context: neighborhood stressors, stress-buffering mechanisms, and alcohol, drug, and mental health disorders. Soc Sci Med 2007; 65:1867-81. [PMID: 17614176 PMCID: PMC2151971 DOI: 10.1016/j.socscimed.2007.05.045] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Indexed: 12/01/2022]
Abstract
This study examines the relationship among neighborhood stressors, stress-buffering mechanisms, and likelihood of alcohol, drug, and mental health (ADM) disorders in adults from 60 US communities (n=12,716). Research shows that larger support structures may interact with individual support factors to affect mental health, but few studies have explored buffering effects of these neighborhood characteristics. We test a conceptual model that explores effects of neighborhood stressors and stress-buffering mechanisms on ADM disorders. Using Health Care for Communities with census and other data, we found a lower likelihood of disorders in neighborhoods with a greater presence of stress-buffering mechanisms. Higher neighborhood average household occupancy and churches per capita were associated with a lower likelihood of disorders. Cross-level interactions revealed that violence-exposed individuals in high crime neighborhoods are vulnerable to depressive/anxiety disorders. Likewise, individuals with low social support in neighborhoods with high social isolation (i.e., low-average household occupancy) had a higher likelihood of disorders. If replicated by future studies using longitudinal data, our results have implications for policies and programs targeting neighborhoods to reduce ADM disorders.
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Affiliation(s)
| | - Kenneth B. Wells
- UCLA Semel Institute Health Service Research Center and the RAND Corp.,
| | - Lingqi Tang
- UCLA Semel Institute Health Services Research Center,
| | | | - Lily Zhang
- UCLA Semel Institute Health Services Research Center,
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