Study protocol for comparing Screening, Brief Intervention, and Referral to Treatment (SBIRT) to referral as usual for depression in African American churches

Abstract

Background Depression is a leading cause of disability worldwide. African American adults, 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 African Americans with depression are more disabled and sicker longer compared to Whites. African American churches are trusted settings that provide access to supports for depression. Indeed, in the first study of its kind, the investigators found that 20% of adults in African American 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 personnel. Community Health Workers, who are trusted paraprofessionals from the target community, may bridge the gap between depression screening and treatment. The investigators have trained and certified 112 Community Health Workers from 45 African American churches in New York City to deliver an evidence-based intervention called Screening, Brief Intervention, and Referral to Treatment (SBIRT). Thus, the aim of the current study is to test the impact of Community Health Worker-delivered depression screening in Black churches on engagement with clinical services. Methods Using a hybrid type 1 effectiveness-implementation design, we propose a 2-arm, mixed-methods cluster randomized controlled trial. Church study sites will be randomized to either SBIRT (intervention arm) or referral as usual (usual care arm). This trial will be conducted with 600 church members across 30 churches (300 intervention; 300 usual care). Our primary outcome is treatment engagement, defined as attending a depression-related clinical visit. Secondary outcomes will be changes in Mental Health-Related Quality of Life and depressive symptoms at 3 and 6 months post-screening. Lastly, we will conduct a concurrent, mixed-methods (qualitative-quantitative) process evaluation to assess contextual facilitators and barriers of screening and referral. Discussion This is the first randomized trial of a church-placed, community health worker-delivered intervention for depression in African American populations. This study may provide a novel and effective approach to increasing depression identification and treatment linkage in economically disadvantaged populations with high depression rates. Trial registration ClinicalTrials.govNCT04524767. Registered on 21 August 2020.

Supporting Faith-Based Communities Through and Beyond the Pandemic

“…In addition, future initiatives may consider incorporating linkage to care and examining the effects of the BCRP on treatment engagement. Hankerson and colleagues [ 32 ] have added connections with mental health professionals to their church-partnered programs to create a bridge between community resources and professional mental health treatment. This bridge is purported to overcome barriers caused by stigma and increase access to care [ 32 ].…”

“…Hankerson and colleagues [ 32 ] have added connections with mental health professionals to their church-partnered programs to create a bridge between community resources and professional mental health treatment. This bridge is purported to overcome barriers caused by stigma and increase access to care [ 32 ]. Overcoming stigma through connecting participants with care through a CHA may greatly benefit underserved communities, given help-seeking stigma is a major barrier to mental health treatment and a driver of population health inequities [ 33 ].…”

The weaponization of medicine: Early psychosis in the Black community and the need for racially informed mental healthcare

“…• In 2022, the first randomized trial of church-based counselling centres for depression counseling in African Americans started. The idea is to improve care in economically disadvantaged areas (136).…”