This is a competing continuation for an NIMH R01 (Pathways to Outcomes of Care in Depression), which funded five-year follow-up of participants in Partners in Care, a group-level randomized trial of quality improvement interventions versus usual care for depression. Our continuation proposes a new follow-up study in response to key findings from the existing grant: 1) Quality improvement interventions for depression had stronger effects on improving outcomes among minorities than whites during the active intervention period, despite similar effects on quality of care across ethnic groups; 2) by five-year follow-up, ethnic-related health outcome disparities apparent among controls were eliminated among intervention subjects. We propose a 3-stage study of quality improvement (QI) effects on health outcome disparities: 1) Stage 1: 7-year follow-up of the full PIC sample (N=1182) to examine how initial QI affected intermediate outcomes such as concerns about stigma of depression; occurrence of life events; use of social supports; having a regular provider; use of appropriate treatments. 2) Stage 2: a qualitative study of the minority subjects, using a series of telephone interviews, to examine how subjects respond to depressive symptoms, stressful life events, and healthcare visits, in real time. 3) Stage 3: an ethnographically-based further follow-up of Latinos in Los Angeles, stratified by gender, intervention status and 7-year outcome, to learn more about how depressed patients are managing their lives within the context of their own environment. Data from Stage 1 will be used to test hypotheses about QI effects on intermediate outcomes and differences in such effects for minorities and whites; data from Stages 2 and 3 will be used to confirm or refute findings from Stage 1, provide richer detail on pathways to outcome improvement, and generate hypotheses about mechanisms for outcome improvement among minorities. The continuation application uses mixed methods and the investigators are an interdisciplinary team of clinicians, anthropologists, sociologists, statisticians, and cultural experts. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
2R01MH061570-04
Application #
6730134
Study Section
Special Emphasis Panel (ZMH1-SRV-H (01))
Program Officer
Oliver, Karen Anderson
Project Start
2000-04-01
Project End
2008-03-31
Budget Start
2004-04-01
Budget End
2005-03-31
Support Year
4
Fiscal Year
2004
Total Cost
$640,126
Indirect Cost
Name
Rand Corporation
Department
Type
DUNS #
006914071
City
Santa Monica
State
CA
Country
United States
Zip Code
90401
Miranda, Jeanne; Bromley, Elizabeth; Izquierdo, Adriana et al. (2017) Surviving Depression: Clinical Qualitative Analysis of Long-Term Survival for Ethnically Diverse, Depressed Patients. J Nerv Ment Dis 205:589-599
Bromley, Elizabeth; Kennedy, David; Miranda, Jeanne et al. (2016) The Fracture of Relational Space in Depression: Predicaments in Primary Care Help Seeking. Curr Anthropol 57:610-631
Klap, Ruth; Tang, Lingqi; Schell, Terry et al. (2009) How quality improvement interventions for depression affect stigma concerns over time: a nine-year follow-up study. Psychiatr Serv 60:258-61
Wells, Kenneth B; Tang, Lingqi; Miranda, Jeanne et al. (2008) The effects of quality improvement for depression in primary care at nine years: results from a randomized, controlled group-level trial. Health Serv Res 43:1952-74
Sherbourne, Cathy Donald; Edelen, Maria Orlando; Zhou, Annie et al. (2008) How a therapy-based quality improvement intervention for depression affected life events and psychological well-being over time: a 9-year longitudinal analysis. Med Care 46:78-84
Wells, Kenneth B; Sherbourne, Cathy D; Miranda, Jeanne et al. (2007) The cumulative effects of quality improvement for depression on outcome disparities over 9 years: results from a randomized, controlled group-level trial. Med Care 45:1052-9
Wells, Kenneth B; Miranda, Jeanne (2007) Reducing the burden of depression: building villages for coordinated care. JAMA 298:1451-2
Masaquel, Anthony; Wells, Kenneth; Ettner, Susan L (2007) How does the persistence of depression influence the continuity and type of health insurance and coverage limits on mental health therapy? J Ment Health Policy Econ 10:133-44
Watkins, Katherine E; Paddock, Susan M; Zhang, Lily et al. (2006) Improving care for depression in patients with comorbid substance misuse. Am J Psychiatry 163:125-32
Patel, Kavita K; Butler, Brittany; Wells, Kenneth B (2006) What is necessary to transform the quality of mental health care. Health Aff (Millwood) 25:681-93

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