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

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) (ß = -1.67, p = 0.01). There was significant modification of the intervention effect by age; there was a different effect on older participants (ß = -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.

Differences in Caregiving Outcomes and Experiences by Sexual Orientation and Gender Identity.

PURPOSE: The purpose of this study was to determine whether caregiving experiences and their health-related outcomes differ by sexual orientation and gender identity in a representative U.S. caregiver sample. METHODS: A secondary data analysis was performed of the cross-sectional, nationally representative National Alliance for Caregiving online survey that was conducted in 2014. To account for the study design, we used sampling weights and then added propensity score weighting to account for imbalances between LGBT respondents and their heterosexual and cisgender counterparts, that is, non-LGBT caregivers. Outcomes consisted of caregivers' self-reported health, financial strain, physical strain, and emotional stress. RESULTS: LGBT caregivers were significantly younger, more racially and ethnically diverse, less likely to be married, and more likely to be of low socioeconomic status than their non-LGBT counterparts. Caregiving experiences and intensity were similar, but after controlling for demographic and caregiving characteristics, LGBT caregivers were significantly more likely to report financial strain and showed trends toward elevated levels of poor health and emotional stress. Physical strain was similar by LGBT status. CONCLUSION: Caregiving itself is universal, yet LGBT caregivers differed demographically and were more likely to report financial strain compared with non-LGBT caregivers.