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; addiction; collaborative care; depression; mental health; substance use disorder.

Conflict of interest statement

Disclosures of Interest

No conflicts of interest to report.

Figures

Figure 1.

Trial profile. Footnotes: aAgency eligibility criteria: agencies had to provide services for adults or parents of child clients and be financially stable, i.e., not expecting to close during the study time period. Agencies were entities with administrative responsibilities bProgram eligibility criteria: programs had to serve at least 15 clients per week, have one or more staff, not focused on psychotic disorders or home services, and be willing to identify a staff liaison cWithin sectors, programs were matched on client size and smaller programs (faith-based, hair salons) were joined based on established relationships. Programs/clusters were randomized within communities, but a few unique programs were randomized across communities. We used a random number generator and CPIC Council members who provided seed numbers to initiate randomization. Randomization was overseen by a statistician not involved in recruitment.