URMC Conducting $1.9M Study on Underserved Women & Depression

May. 21, 2013
Conventional Treatments Not Always the Right Fit for this High-Risk Group

Women who live in poverty experience high rates of depression, but typical treatment plans don’t work well for many of them.  Not only does this have a negative impact on their lives, it can also affect their children – who may experience related health and behavioral problems.  In response, a research team at the University of Rochester Medical Center is examining alternative approaches that could change the way disadvantaged women with depression are cared for nationwide.

Supported by a $1.9 million grant from the Patient-Centered Outcomes Research Institute (PCORI), Ellen L. Poleshuck, Ph.D. and Catherine Cerulli, J.D., Ph.D., associate professors of Psychiatry, will lead the three-year study.  It was designed in partnership with a community advisory board, comprised of area professionals, advocates and students who are familiar with the challenges faced by women from underserved communities.  Two-hundred patients from URMC’s Women’s Health Clinic will be selected to participate.

Poleshuck decided to conduct the study using an obstetrics and gynecology practice, because that is the most common place for disadvantaged women to seek health care.

“The Ob/Gyn practices are their primary resource for both biomedical and behavioral health care, and they tend not to seek care in traditional psychiatric settings,” she says. “At the same time, Ob/Gyn practices struggle to adequately assess and treat women’s depression.”

The PCORI study participants will be screened for a broad range of behavioral health and social problems, including depression and substance abuse. All participants will receive a screening report and referrals to help them address areas of concern.  Half of the women will then be paired with a patient navigator.

The patient navigator is a trained lay person who will help patients prioritize their needs, as well as access health care and support services. This will include activities such as helping patients keep track of appointments, communicate with their providers, interpret medical information, and deal with insurance concerns.  In addition, navigators will serve as patient advocates and help patients address social challenges such as partner violence, housing, transportation, and legal issues.  Researchers are collecting data to determine how the prioritized care plans and patient navigators impact the effectiveness of conventional depression management.

“Many of these patients attribute their depressive symptoms to social concerns,” says Poleshuck.  “Providers often try to convince patients to undergo treatment for depression, including medication, while sometimes missing relevant social concerns.”

Poleshuck says, because of this mismatch in expectations, many socio-economically disadvantaged women don’t “buy-in” to their prescribed treatments.   This leads to high dropout rates.  Without adequate treatment, the depression typically worsens and can lead to other unhealthy behaviors.

Researchers working on the PCORI study will assess patient satisfaction, depressive symptoms, and quality of life.  A national advisory board has also been formed to help disseminate results to Ob/Gyn practices across the country.