Community health worker intervention improved anxiety, depression in minority patients

A culturally adapted psychoeducational intervention helped improve depression and anxiety symptoms in Black, Latino, and Asian patients, a randomized controlled trial found.

The Strong Minds-Strong Communities (SM-SC) trial was a six-month, multicenter, longitudinal study carried out in 37 community-based organizations and clinics in Massachusetts and North Carolina. Researchers randomly assigned adults who spoke English, Spanish, Mandarin, or Cantonese and had moderate to severe depression or anxiety symptoms to either a language-concordant psychoeducational intervention provided by community health workers in 10 sessions over six months (n=524) or usual care (n=520). All participants received referrals for needs related to social determinants of health. Mean patient age was 42.6 years, and 83.8% were female.

The intervention included approaches adapted from cognitive behavioral therapy, mindfulness exercises, psychoeducation on healthy habits, and motivational interviewing, while usual care patients received a booklet about anxiety and depression. Primary outcomes included changes from baseline in self-reported depression and anxiety symptoms, function, and perceived quality of care. Findings were published by The Lancet on August 23.

At six months, the intervention group reported greater improvements in depression and anxiety symptoms (standardized effect size, 0.39; 95% CI, 0.27 to 0.52), function (standardized effect size, 0.28; 95% CI, 0.16 to 0.39), and perceived quality of care (standardized effect size, 0.47; 95% CI, 0.31 to 0.62) compared with the usual care group. Improvements attenuated at six months after the intervention but remained significant (standardized effect sizes, 0.28 [95% CI, 0.16 to 0.40] for depression and anxiety, 0.21 [95% CI, 0.08 to 0.33] for function, and 0.33 [95% CI, 0.16 to 0.50] for perceived quality of care). Nine adverse events were reported, including seven participants who reported a suicide attempt (three in the intervention group and four in the control group).

Limitations include the length of follow-up and a small sample size of Cantonese-speaking patients.

“The use of community health workers permits a more rapid expansion of the mental health care workforce by offering an alternate pathway for community members with a shared language and lived experience to enter the mental health field and offer much-needed services,” the researchers wrote.

An accompanying editorial called the findings timely, “given the interest in leveraging community-based specialists to support an overburdened mental health-care infrastructure.”

However, the editorialists cautioned that relying too much on community health workers raises its own challenges. “Community health workers must be empowered to operate at the top of their scope, with appropriate safeguards in place to prevent role drift into clinical care roles, vicarious trauma and burnout, and ineffective dissemination,” the editorialists wrote.