Enhanced Integrated Behavioral Health Model Improves Depressive Symptoms in a Low-Income, Uninsured, Primarily Hispanic Population Served by a Free and Charitable Clinic

Abstract

Background: Residents living in US-Mexico border communities have some of the worst health outcomes nationally. This randomized trial evaluated whether patients receiving enhanced integrated behavioral health (IBH) care at a southern Texas free and charitable were more likely to improve health outcomes after 12 months compared to patients receiving standard care. Theory & Methods: The IBH intervention featured brief intervention by a behavioral health specialist and enhanced coordinated care. The primary outcome was systolic blood pressure. Secondary outcomes were diastolic blood pressure, HbA1c, BMI, and depressive symptoms. Linear regression models were utilized to assess the impact of IBH on participants; secondary analyses examined possible effect modification. Results: After 12 months, intervention participants (n = 172) were more likely to have a lower PHQ-9 score than control participants (n = 198) (β = –1.67, p = 0.01). There was significant modification of the intervention effect by age; there was a different effect on older participants (β = –2.08, p = 0.01). There were no statistically significant findings for other outcomes. Conclusions: Collaborative, integrated behavioral health and primary care can improve depressive symptoms for low-income or uninsured individuals living in southern Texas border communities. These findings provide evidence that may help develop IBH programs to improve health of vulnerable populations experiencing health inequities.

Keywords

• integrated behavioral health
• depressive symptoms
• rct
• hispanic
• uninsured
• border region
• free clinic