Mental Health Intervention Reduces Severe Depression, Anxiety for Vulnerable Groups

Living in a community without fluency in the local language or knowledge of its culture can add stressors for anyone. The experience is associated with heightened risk of mental health concerns and a range of problems related to quality of life. Yet newcomers and minorities in a community are more likely to lack access to affordable and effective mental health care services, compared to the population at large.

Now, in one of the nation’s largest mental health therapy clinical trials, researchers – including Gabriela Livas, chair of the Department of Human Development and Family Sciences at The University of Texas at Austin – have found a solution to significantly reduce depression and anxiety for vulnerable populations. The team reported findings earlier this year in The Lancet about a community health program that reduces mental health symptoms in 80% of participants, with many no longer considered to have clinical symptoms at all after the intervention.

The study highlights the importance of culturally responsive care, or care that is tailored to the needs of particular communities, including immigrants and people in minority populations. 

“One takeaway from the study is the importance of understanding the lived experience of each particular person,” said Livas, who also has experience as a clinical psychologist.

Over six months, the researchers conducted a randomized trial of more than 1,000 adults with moderate to severe depression or anxiety symptoms, examining the impact of a 10-session program, called Strong Minds, Strong Communities. (Half of the enrolled participants joined the program, and the other half received standard care.) The program incorporates education and counseling techniques to teach participants about their mental health conditions and drive behavior change with help from community health workers. 

At the end of the six months, only one-third of the Strong Minds, Strong Communities participants still had depression and anxiety symptoms, compared to about half of all those in the control group. They also had significantly higher functioning and perceptions of the quality of the care they received. Nearly all of these positive effects persisted one year after participants had joined the program. 

Funding for the clinical study was provided by the National Institute of Mental Health. 

Delivered in English, Spanish, Mandarin and Cantonese, the program addressed mental health literacy, social norms and participants’ cultural context. Patients benefited from learning strategies to help them notice and change unhelpful thoughts and focus on mindfulness practices. Participants also got to know and build relationships with the community health workers leading the sessions – an important component, Livas emphasized. 

“Often, providers learn that they are supposed to keep some distance to uphold professionalism, but that can sometimes come off as cold or impersonal to different cultural groups,” she explained. “We found that sharing some of your lived experience within professional boundaries can be helpful.” 

Many people experiencing a lot of stressors drop out of mental health care prematurely. But in this study, most participants finished the entire 10 sessions of the intervention, underscoring the value of the therapeutic relationships community health workers were able to build with the participants. Programs like Strong Minds, Strong Communities may be particularly needed in communities with mental health worker shortages, Livas said. Since the study was conducted, more than 1,000 people have received free mental health support through the program, and an additional 20 community health workers have been trained to serve patients in need with support from the North Carolina Department of Health and Human Services.

“We are in a mental health care crisis across the globe, and we need to think about how we can invest in a mental health care structure that provides support for as many people as we can,” Livas said. “A healthier population is going to be a more engaged population.”

Livas’s co-corresponding author was Margarita Alegría of Harvard University. Other researchers are based at Massachusetts General Hospital, the University of North Carolina Greensboro and New York University.