Building community capacity in mental health care with the Strong Minds-Strong Communities programme: a randomised controlled trial in the USA.

Abstract

Background: Provider shortages and lack of culturally responsive care limit mental health services in reaching multicultural populations worldwide. We examined the effectiveness of a psychoeducational intervention aimed at building community capacity to address depression and anxiety among racial, ethnic, and linguistic minoritised adults.

Methods: Strong Minds-Strong Communities (SM-SC) was a 6-month, multicentre, longitudinal, randomised trial done in 37 community-based organisations and clinics in two US sites (Massachusetts and North Carolina). Adults aged 18 years and older speaking English, Spanish, Mandarin, or Cantonese, with moderate to severe depression or anxiety symptoms assessed using the Computerized Adaptive Test for Mental Health (CAT-MH), were eligible for inclusion. Participants were randomly assigned (1:1) to a psychoeducational intervention provided by community health workers or a usual care condition, which constituted receiving a US National Institutes of Health booklet about anxiety and depression. Both conditions included referrals for social determinants of health needs. Randomisation was stratified by site using computer-generated blocks of size 2. Investigators and participants were not masked to treatment allocation, but outcome assessors were. Primary outcomes were changes from baseline at months 6 and 12 in self-reported depression and anxiety symptoms using the Hopkins Symptom Checklist-25 (HSCL-25), level of functioning using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2·0), and perceived quality of care using the Global Evaluation of Care domain of the Perceptions of Care Outpatient Survey (PoC-OP) in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT04092777, and has been completed.

Findings: From Sept 4, 2019, to March 3, 2023, 5265 potential participants were approached for study inclusion. 2681 were excluded and 2584 were assessed for eligibility. A further 1417 were excluded, and 1167 were deemed eligible for study inclusion. 1044 participants were randomly assigned, 524 to the SM-SC intervention and 520 to the usual care group. The mean age of participants was 42·6 years (SD 13·3) and 875 (83·8%) were female, 165 (15·8%) were male, and four (0·4%) were other. Between baseline and 6 months, intervention participants reported greater improvements in depression and anxiety symptoms (standardised effect size, 0·39 [95% CI 0·27-0·52]), functioning (standardised effect size, 0·28 [0·16-0·39]), and perceived quality of care (standardised effect size, 0·47 [0·31-0·62]). These greater improvements in depression and anxiety symptoms, functioning, and perceived quality of care attenuated but remained significant 6 months post-intervention (standardised effect sizes of 0·28 [95% CI 0·16-0·40] for depression and anxiety, 0·21 [0·08-0·33]) for functioning, and 0·33 [0·16 -0·50] for perceived quality of care).

Interpretation: The intervention shows that a culturally adapted intervention can improve depression and anxiety symptoms in Black, Latino, and Asian populations and provides an alternative to mental health care shortages by building community capacity.

Funding: National Institute of Mental Health.

Translations: For the Spanish and Mandarin translations of the abstract see Supplementary Materials section.