In work published in the July 2 issue of the Journal of the American Medical Association, the researchers found that medication and cognitive behavioral psychotherapy (CBT) treatments are effective options for young Latinas and African-American women. The study was funded by the National Institute of Mental Health.
These common therapies were found to improve depression, even among women with ample reason to be depressed. Sixty percent of the women participating in this study were at or below the federal poverty guidelines, more than one-third had not graduated from high school or received a GED, and many were single mothers. More than one-third reported having been raped and/or abused as a child, and nearly one-half had experienced domestic violence.
"Structured care reduces major depression in these diverse and impoverished patients," said principal investigator and lead author Jeanne Miranda, a professor at the UCLA Neuropsychiatric Institute. "This study is the first to let providers know that treating depression in women with what may appear to be overwhelming life problems results in significant improvement in the way these women feel and function."
Although the landmark U.S. Surgeon General's 2001 "Mental Health: Culture, Race, Ethnicity" noted that people with the lowest socioeconomic status are about two to three times more likely than those in a higher social strata to have a mental disorder, no Latinos and only 27 African Americans were among the 3,860 patients in studies used by the American Psychiatric Association to develop guidelines for the treatment of depression. The Georgetown-UCLA study is the first confirmation that these treatments are appropriate for low-income minority women.
The researchers followed 267 primarily working poor Latina and African-American women diagnosed with major depression, and randomly assigned each to one of three different treatment arms: antidepressant medication, group CBT or referrals to local community providers. Women treated with medication (paroxetine, sold as Paxil, or buproprion, sold as Wellbutrin SR) fared the best, significantly reducing their depression symptoms and improving their ability to function socially. Women who received CBT also saw much improvement in their symptoms, although slightly less than those on medication. The women referred to local providers gained little benefit, as 78 percent of this group did not attend even one treatment session in the community. Race did not affect treatment response.
During the randomized, five-year WECare (Women Entering Care) study, mental health services were made easily accessible to the predominantly low-income participants. More than 16,000 women from four counties in the Washington, D.C., area who had not previously sought mental health treatment were screened for major depression. Most women were approached while attending county-run Women, Infants and Children (WIC) food subsidy programs and Title X family planning clinics.
Once enrolled in the study, women were provided with babysitting and transportation assistance in order to attend treatment sessions, bilingual clinicians and materials for Spanish speakers, and intensive outreach efforts that aided their ability to remain in the trial and receive care.
"There is no question that more needs to be done to understand what poor young women are struggling with, and how we can best help them," said Dr. Joyce Chung, clinical associate professor of psychiatry at Georgetown University Medical Center and one of the Georgetown investigators. "The majority of these women work incredibly hard but don't have enough money for health insurance, have children whose needs they put before their own, and live in less than ideal situations. The competing demands and pressures are extreme. We have a responsibility to fix the health-care system in a way that makes care accessible, compassionate and ultimately effective. This study gives us a blueprint for improving the quality of mental health services for poorer women."
The UCLA Neuropsychiatric Institute is an interdisciplinary research and education institute devoted to the understanding of complex human behavior, including the genetic, biological, behavioral and sociocultural underpinnings of normal behavior, and the causes and consequences of neuropsychiatric disorders.
The Department of Psychiatry at Georgetown University Medical Center has established the Center for Mental Health Outreach, which provides mental health services and expertise for underserved populations in collaboration with community-based service providers in the greater Washington, D.C., area.
Online resources:
- UCLA Neuropsychiatric Institute: www.npi.ucla.edu
- Georgetown University Medical Center: www.gumc.georgetown.edu
Journal
JAMA