Outcomes of two quality improvement implementation interventions for depression services in adults with substance use problems

ABSTRACT

Background: Comorbid depression and substance use disorders (SUDs) are associated with poor health and social outcomes disproportionately affecting under-resourced communities.

Objectives: To test the hypothesis that a coalition approach to collaborative care (CC) for depression would improve outcomes of hazardous drinking and behavioral health hospitalizations, relative to technical assistance, for individuals with comorbid substance use problems. Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months.

Methods: Two depression CC implementation approaches were compared: Resources for Services (RS) provided expert technical support for CC toolkits to individual programs. Community engagement and planning (CEP) supported multi-sector coalitions in collaborating in planning, adapting, implementing and monitoring CC toolkits. One thousand eighteen individuals with depression (PHQ-8 ≥10) enrolled. Regression analyses estimated intervention effects in participants with comorbid substance use problems (n = 588, 281 females, 307 males). Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months.

Results: There were no significant baseline differences by intervention status among participants with depression and substance use problems. Intervention effects on primary outcomes including depression were not significant at 6 months. Compared to RS, CEP significantly reduced alcohol consumption (CEP = 1.6, RS = 2.1, p = .038), probability of behavioral health hospitalizations (OR = 0.50, p = .036), and use of specialty mental health visits (IRR = 0.52, p = .027), while increasing use of faith-based depression services (IRR = 3.4, p = .001).

Conclusions: Given feasibility and possible benefits, CEP should be considered a promising approach to implementing depression CC with potential benefits to adults with comorbid substance use problems.

KEYWORDS:

• Community-based participatory research
• collaborative care
• depression
• mental health
• addiction
• substance use disorder

Acknowledgements

We thank 95 participating health care and community-based agencies, the CPIC Council and members of the Association of Clinical and Translational Science Team Science Award for CPIC (2014) and Campus-Community Partnerships for Health 2015 Annual Award for supporting the study concept, design, and implementation. We acknowledge posthumously the contributions to study design and implementation of Loretta Jones MA, ThD, who passed away during the preparation of this manuscript.

Disclosures of Interest

No conflicts of interest to report.

Supplementary material

Supplemental data for this article can be accessed publisher’s website.

Additional information

Funding

This study was supported by the National Institute on Minority Health and Health Disparities and the parent CPIC study by [R01MH078853, P30MH082760, and P30MH068639] from the National Institute of Mental Health. The parent CPIC study was also funded by [64244] from the Robert Wood Johnson Foundation, [CMCH-12- 97088] from the California Community Foundation, [G08LM011058] from the National Library of Medicine, and [UL1TR000124] from the NIH/National Center for Advancing Translational Science UCLA CTSI. The RAND Corporation, UCLA Semel Institute and the Los Angeles County Departments of Mental Health, Public Health and Health services provided institutional support.