A team of researchers at the Disparities Research Unit at Massachusetts General Hospital (MGH) - in collaboration with two teams in Spain and collaborators in the U.S. and Puerto Rico - has tested a novel preventive intervention designed to provide tailored treatment for Latino immigrants with both mental health and substance misuse symptoms. Their report is being published online in JAMA Network Open.
"We know that Latino patients benefit when treatments are culturally tailored, evidence based and accessible," says Margarita Alegria, PhD, chief of the Disparities Research Unit and a professor in the Departments of Medicine and Psychiatry at Harvard Medical School. "We sought to provide a customized treatment to Latino immigrants in different contexts - in the U.S. and Spain - to see how best to serve this growing and important demographic population in our communities."
The authors note that immigrants face enormous barriers to access appropriate behavioral health treatments. A variety of structural and institutional barriers mean that Latinos who need mental health and substance use services may be less likely to receive evidenced-based care and have worse outcomes than non-immigrant Latino adults. Therefore, the study team conducted outreach to people not seeking care, inviting them to be screened for elevated co-occurring mental health and substance use symptoms. If the screenings revealed mild to severe symptoms, they were invited to participate.
The study team developed the Integrated Intervention for Dual Problems and Early Action (IIDEA) program to provide culturally tailored care that incorporates evidence-based practices - including cognitive restructuring and mindfulness-based therapy along with substance-craving reduction and coping strategies. The intervention was offered in both the Greater Boston area and in Madrid and Barcelona, Spain, to Latino adults aged 18 to 70 who screened positive for co-occurring symptoms. IIDEA is an integrated therapy that involves 10 to 12 weekly sessions that include motivational interviewing, cultural formulation, assessment of barriers to care, psychoeducation, cognitive behavioral therapy, mindfulness exercises, communication skills and reduction of risk behaviors.
Bilingual/bicultural staff across sites identified individuals in primary care and emergency departments, as well as non-clinical settings such as Latino-serving community-based organizations. A total of 341 participants were randomized to receive either the IIDEA intervention or take part in an enhanced usual care group with regular telephone check-ins to assure safety. Participants were assessed on enrollment and 2, 4, 6, and 12 months after enrollment.
Results showed that the intervention reduced mental health symptoms but did not show an effect on alcohol and drug outcomes for participants overall, a large proportion of whom had mild symptoms upon enrollment. However, secondary analyses indicated that IIDEA was effective in reducing both substance use and mental health symptoms for participants who initially screened with moderate to severe symptoms. Those participating in four or more sessions also saw decreasing drug use and mental health symptoms.
Lead author Alegria notes, "These results point to the potential for an adequate dose of tailored therapy, even as few as four sessions, to improve outcomes for those with moderate to severe symptoms." More than half of participants completed the full course of treatment, supporting previous findings showing that premature termination of treatment may be reduced by the use of culturally adapted interventions and by matching patients with therapists who share their culture or language. Study authors also point to the importance of maintaining the effects of the therapy over time and hope to continue to address this in future work.
The Disparities Research Unit (DRU) in the MGH Department of Medicine has a goal of generating innovative health services research that helps shape policy, practice and service delivery to reduce disparities and improve the well-being of multicultural populations. Utilizing collaborative approaches with researchers, clinicians and community agencies, the DRU supports an array of research activities as well as nurtures a core of junior researchers. The DRU has a strong focus on community-based and applied interventions to improve service delivery for multicultural populations.
Additional co-authors across sites are Irene Falgas-Bague, MD; Sheri Lapatin Markle, MIA; Ye Wang, PhD; Francisco Collazos, MD; Rodrigo Carmona Camacho, MD; Enrique Baca-Garcia, MD; Benjamin Le Cook, PhD; Ligia M. Chavez, PhD; Lisa Fortuna, MD; Lizbeth Herrera, MSc; Adil Qureshi, PhD; Zorangeli Ramos, PhD; Claudia Gonzalez, MSc; Paloma Aroca, MA; Lucia Albarracin Garcia, MSc; Lucia Cellerino, MSc; Ana Villar; Naomi Ali; Kim T. Mueser, PhD and Patrick E. Shrout, PhD.
Support for the study includes National Institute on Drug Abuse grant R01 DA034952, National Institute of Mental Health grant R01 MH100155-01S1, Instituto de Salud Carlos III grants ISCII PI13/02200 and PI16/01852, Delegación del Gobierno para el Plan Nacional de Drogas grant 20151073, and American Foundation for Suicide Prevention grant LSRG-1-005-16.
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $900 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2018 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."