Purpose:
The overall aim of this study is to employ Community Health Workers (CHWs) to screen for
depression in 30 Black churches and compare the effectiveness of Screening, Brief
Intervention, and Referral to Treatment (SBIRT) (Intervention arm) to Referral As Usual
(Control arm) on treatment engagement for depression. The investigators will assess
patient-level outcomes (Mental-Health Related Quality of Life and depressive symptoms) at 3-
and 6-months post-screening and conduct a mixed-methods process evaluation to assess
multi-level facilitators and barriers of screening uptake.
Study summary:
African American adults (AAs), compared to White adults, are half as likely to be screened
for depression in primary care settings. Disparities in depression screening contribute to
poor clinical outcomes, as AAs with depression are more disabled, sicker longer, and less
likely to seek treatment compared to Whites. Black churches are trusted settings that provide
"de facto" mental health services for depression. Indeed, in the first study of its kind, the
study team found that 20% of adults in Black churches screened positive for depression using
the Patient Health Questionnaire-9 (PHQ-9). However, no subjects with a positive screen
(PHQ-9 ≥10) accepted a treatment referral when offered by research coordinators onsite for
each screening.
Community Health Workers (CHWs), who are trusted para-professionals from the target
community, may bridge the gap between depression screening and treatment. The investigators
have trained and certified 102 CHWs from 42 Black churches in Harlem, New York to deliver an
evidence-based intervention called Screening, Brief Intervention, and Referral to Treatment
(SBIRT), which is centered on culturally tailored Motivational Interviewing (MI). Thus, the
scientific premise of this study is that employing CHWs to implement depression screening in
Black churches will bridge the gap between church-based depression-screening and engagement
with clinical services.
Using a Hybrid Type 1 Effectiveness-Implementation design, the investigators propose a 2-arm,
mixed-methods Cluster-Randomized Controlled Trial within 30 Black churches our CHWs currently
attend. Based on our pilot data, the investigators expect 20% of adults (n=600) to have a
positive depression screen. Adults will be randomized based on church study site to either
SBIRT (n=15 churches) or Referral As Usual (RAU, n=15 churches). The investigators will then
compare the effectiveness of SBIRT (Intervention arm) to RAU (Usual Care arm) on treatment
engagement (primary outcome), defined as attending a depression-related clinical visit for
which the subject reported receiving information, referral, counseling, or medication for
depression (Aim 1). The investigators will then compare changes in Mental Health Related
Quality of Life and depressive symptoms (secondary outcomes) at 3- and 6-months
post-screening (Aim 2). Finally, the investigators will conduct a concurrent, mixed-methods
(qualitative-quantitative) process evaluation to assess contextual facilitators and barriers
of screening and referral (Aim 3).
Criteria:
Inclusion Criteria:
- Adults 18 years and older
- Fluent in English
- Patient Health Questionnaire-9 score ≥ 10
Exclusion Criteria:
- Reporting active suicidality, or verbally endorsing homicidal ideation or psychotic
symptoms
- Currently receiving formal mental health treatment