Diversity in randomized clinical trials of depression: A 36-year review

Polo, Antonio J.; Makol, Bridget A.; Castro, Ashley S.; Colón-Quintana, Nicole; Wagstaff, Amanda E.; Guo, Sisi

doi:10.1016/j.cpr.2018.09.004

Cited by 92 publications

(116 citation statements)

References 63 publications

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“…For example, a review of randomized clinical trials conducted in the U.S. between 2001 to 2010 for common mental disorders showed that racial and ethnic minorities were seriously underrepresented, accounting for 19% of the total sample in these trials; with some populations being represented less than 1% (e.g., American Indians, Alaska Natives) [17]. Despite major efforts to address this longstanding problem, the underrepresentation of vulnerable population persists in the U.S. [17,25] and globally [26]. This same problem is present for other health conditions (e.g., prostate cancer) [27][28][29].…”

Section: Focus On Reach From the Very Beginningmentioning

confidence: 99%

“…Given the underrepresentation of vulnerable populations in these trials, the generalizability of guidelines and standards of care is questionable, particularly when the EBIs are implemented in routine practice settings. The absence of these populations in the generation of evidence of intervention effectiveness is a common limitation in implementation studies as it results in the adoption of interventions that often neglect the unique needs and context of these communities [18,25].…”

Section: Focus On Reach From the Very Beginningmentioning

confidence: 99%

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Reframing implementation science to address inequities in healthcare delivery

Baumann

Cabassa

2020

BMC Health Serv Res

269

273

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Background: Research has generated valuable knowledge in identifying, understanding, and intervening to address inequities in the delivery of healthcare, yet these inequities persist. The best available interventions, programs and policies designed to address inequities in healthcare are not being adopted in routine practice settings. Implementation science can help address this gap by studying the factors, processes, and strategies at multiple levels of a system of care that influence the uptake, use, and the sustainability of these programs for vulnerable populations. We propose that an equity lens can help integrate the fields of implementation science and research that focuses on inequities in healthcare delivery. Main text: Using Proctor et al.' (12) framework as a case study, we reframed five elements of implementation science to study inequities in healthcare. These elements include: 1) focus on reach from the very beginning; 2) design and select interventions for vulnerable populations and low-resource communities with implementation in mind; 3) implement what works and develop implementation strategies that can help reduce inequities in care; 4) develop the science of adaptations; and 5) use an equity lens for implementation outcomes. Conclusions: The goal of this paper is to continue the dialogue on how to critically infuse an equity approach in implementation studies to proactively address healthcare inequities in historically underserved populations. Our examples provide ways to operationalize how we can blend implementation science and healthcare inequities research.

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Section: Focus On Reach From the Very Beginningmentioning

confidence: 99%

Section: Focus On Reach From the Very Beginningmentioning

confidence: 99%

Reframing implementation science to address inequities in healthcare delivery

Baumann

Cabassa

2020

BMC Health Serv Res

269

273

View full text Add to dashboard Cite

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“…However, SES factors such as education and employment have frequently been found associated with depression [9,11,21,22], as have other SES factors [23,24], as well as sociodemographic factors [11,[25][26][27][28][29]. Those socio-economic-demographic (SED) factors could be independently [5,30,31] or dependently [3,13,20,22,[32][33][34]-directly or indirectly [12]-associated with depression.…”

Section: Introductionmentioning

confidence: 99%

Socio-economic-demographic determinants of depression in Indonesia: A hospital-based study

Mumang¹,

Liaury²,

Syamsuddin³

et al. 2020

PLoS ONE

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The association of socio-economic-demographic (SED; e.g., income-related) factors with depression is widely confirmed in the literature. We conducted a hospital-based case–control study of 160 patients with psychiatrist-diagnosed clinical depression. The control group comprised 160 participants recruited from local communities. We used a questionnaire to collect SED data from all participants. We replaced missing values using multiple imputation analyses and further analyzed the pooled data of five imputations. We also recorded the results from the original analysis and each imputation. Univariate analyses showed income was associated with depression. Multiple logistic regression analyses revealed that, among all SED variables, high income (odds ratio = 2.088 [95% confidence interval = 1.178–3.700]; p = 0.012), middle-level (completed junior or senior high school) education (1.688 [1.042–2.734]; p = 0.033) and cohabitating with four or more family members (1.632 [1.025–2.597]; p = 0.039) were significant predictors for the case group. We conclude that cash income is a determinant of depression in hospital outpatients in Indonesia. This study suggests health policy implications toward better hospital access and service for people with depression in middle- or low-income households, and recommends considering high income as correlated with a high risk of depression, owing to socio-cultural changes.

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“…Moreover, even when members of non-dominant ethnic and racial groups are included in samples, frequent failure to report ethnic and racial characteristics restricts understanding about service delivery to these populations [22]. In a review of clinical trials for depression spanning a 36-year period [23], researchers reported that over time, participation by persons of low socioeconomic status (SES) and those of minority ethnic and racial backgrounds has increased. Nonetheless, persons of European backgrounds remained the most highly represented group.…”

Section: Introductionmentioning

confidence: 99%

Minding the Gatekeepers: Referral and Recruitment of Postpartum Mothers with Depression into a Randomized Controlled Trial of a Mobile Internet Parenting Intervention to Improve Mood and Optimize Infant Social Communication Outcomes

Baggett

Davis

Sheeber

et al. 2020

IJERPH

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Mothers in the United States (U.S.) who are of non-dominant culture and socioeconomically disadvantaged experience depression during postpartum at a rate 3 to 4 times higher than mothers in the general population, but these mothers are least likely to receive services for improving mood. Little research has focused on recruiting these mothers into clinical intervention trials. The purpose of this article is to report on a study that provided a unique context within which to view the differential success of three referral approaches (i.e., community agency staff referral, research staff referral, and maternal self-referral). It also enabled a preliminary examination of whether the different strategies yielded samples that differed with regard to risk factors for adverse maternal and child outcomes. The examination took place within a clinical trial of a mobile intervention for improving maternal mood and increasing parent practices that promote infant social communication development. The sample was recruited within the urban core of a large southern city in the U.S. and was comprised primarily of mothers of non-dominant culture, who were experiencing severe socioeconomic disadvantage. Results showed that mothers self-referred at more than 3.5 times the rate that they were referred by either community agency staff or research staff. Moreover, compared to women referred by research staff, women who self-referred and those who were referred by community gatekeepers were as likely to eventually consent to study participation and initiate the intervention. Results are discussed with regard to implications for optimizing referral into clinical intervention trials.

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Diversity in randomized clinical trials of depression: A 36-year review

Cited by 92 publications

References 63 publications

Reframing implementation science to address inequities in healthcare delivery

Reframing implementation science to address inequities in healthcare delivery

Socio-economic-demographic determinants of depression in Indonesia: A hospital-based study

Minding the Gatekeepers: Referral and Recruitment of Postpartum Mothers with Depression into a Randomized Controlled Trial of a Mobile Internet Parenting Intervention to Improve Mood and Optimize Infant Social Communication Outcomes

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