title: The Impact of Community Engagement on Health, Social, and Utilization Outcomes in Depressed, Impoverished Populations: Secondary Findings from a Randomized Trial.
abstract: Disparities in depression care exist among the poor. Community Partners in Care (CPIC) compared a community coalition model with technical assistance to improve depression services in under-resourced communities. We examine effects on health, social, and utilization outcomes among the poor and, non-poor depressed, and poor subgroups.
  
  
  
  This study analyzed clients living above (n = 268) and below (n = 750) the federal-poverty level and, among the poor, 3 nonoverlapping subgroups: justice-involved (n = 158), homeless and not justice-involved (n = 298), and other poor (n = 294). Matched programs (n = 93) from health and community sectors were randomly assigned to community engagement and planning (CEP) or resources for services (RS). Primary outcomes were poor mental health-related quality of life and 8-item Patient Health Questionnaire scores, whereas community-prioritized and utilization outcomes were secondary. Effects were scrutinized using false discovery rate-adjusted P values to account for multiple comparisons.
  
  
  
  In the impoverished group, CEP and RS clients of participating study programs did not differ in primary outcomes, but CEP more than RS improved mental wellness among the depressed poor (unadjusted P = .004) while providing suggestive evidence for other secondary outcomes. Within the poor subgroups, evidence favoring CEP was only suggestive but was strongest among justice-involved clients.
  
  
  
  A coalition approach to improving outcomes for low-income clients with depression, particularly those involved in the justice system, may offer additional benefits over standard technical assistance programs.
authors.affiliation: From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B) christinealam@mednet.ucla.edu.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Lam
authors.affiliation: From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B).
authors.forename: Cathy
authors.initials: C
authors.lastname: Sherbourne
authors.affiliation: From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B).
authors.forename: Lingqi
authors.initials: L
authors.lastname: Tang
authors.affiliation: From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B).
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Belin
authors.affiliation: From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B).
authors.forename: Pluscedia
authors.initials: P
authors.lastname: Williams
authors.affiliation: From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B).
authors.forename: Angela
authors.initials: A
authors.lastname: Young-Brinn
authors.affiliation: From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B).
authors.forename: Jeanne
authors.initials: J
authors.lastname: Miranda
authors.affiliation: From the Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Administration Greater Los Angeles Healthcare System, Sepulveda, CA (CAL); the Departments of Medicine (CAL) and Psychiatry and Biobehavioral Sciences (TRB, KBW), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (CAL); RAND Corp., Santa Monica, CA (CS, KBW); the Center for Health Services and Society, University of California, Los Angeles, Los Angeles (LT, JM, KBW); the Departments of Biostatistics (TRB) and Health Policy and Management (KBW), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles; Healthy African American Families II, Los Angeles, CA (PW); the Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA (PW); and the J.D. Pacada Foundation, Los Angeles, CA (AY-B).
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Wells
mesh_terms: D000328:Adult; D003156:Community Mental Health Services; D055812:Community-Based Participatory Research; D057237:Criminals / Q000523:psychology / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006265:Health Care Coalitions; D006290:Health Planning Technical Assistance; D054625:Healthcare Disparities; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty; D011788:Quality of Life; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Depression; Health Care Disparities; Homelessness; Populations; Social Determinants of Health; Underserved