Feasibility of a telehealth-based contingency management intervention for alcohol use disorders using the phosphatidylethanol (PEth) 16:0/18:1 alcohol biomarker: a pilot randomized trial

Background: Phosphatidylethanol (PEth) is a blood-based biomarker for alcohol consumption that can be self-collected and has high sensitivity, specificity, and a longer detection window compared to other alcohol biomarkers.Objectives: We evaluated the feasibility and acceptability of a telehealth-based contingency management (CM) intervention for alcohol use disorder (AUD) using the blood-based biomarker PEth to assess alcohol consumption.Methods: Sixteen adults (7 female, 9 male) with AUD were randomized to Control or CM conditions. Control participants received reinforcers regardless of their PEth levels. CM participants received reinforcers for week-to-week decreases in PEth (Phase 1) or maintenance of PEth consistent with abstinence (<20 ng/mL, Phase 2). Blood samples were self-collected using the TASSO-M20 device. Acceptability was assessed by retention in weeks. Satisfaction was assessed with the Client Satisfaction Questionnaire (CSQ-8) and qualitative interviews. The primary efficacy outcome was PEth-defined abstinence. Secondary outcomes included the proportion of visits with PEth-defined heavy alcohol consumption, negative urine ethyl glucuronide results, and self-reported alcohol use.Results: Retention averaged 18.6 ± 8.8 weeks for CM participants. CM participants reported high levels of satisfaction (CSQ-8, Mean = 30.3 ± 1.5). Interview themes included intervention positives, such as staff support, quality of life improvement, and accountability. 72% of PEth samples from CM participants were consistent with abstinence versus 34% for Control participants (OR = 5.0, p = 0.007). PEth-defined heavy alcohol consumption was detected in 28% of CM samples and 52% of Control samples (OR = 0.36, p = 0.159). CM participants averaged 1.9 ± 1.7 drinks/day versus 4.2 ± 6.3 for Control participants (p = 0.304).Conclusion: Results support the acceptability and satisfaction of a telehealth PEth-based CM intervention, though a larger study is needed to assess its efficacy [NCT04038021].

"What We Have in Common": A Qualitative Analysis of Shared Experience in Peer-Delivered Services

"Shared experience" has been described as a key element of peer-delivered services, but it is not well-understood how it is used in practice, particularly among peer specialists working in more conventional mental health agencies. In-depth qualitative interviews were conducted with eight peer specialists and two supervisors working in a Peer Wellness Program within a Housing First agency to explore peer specialists' approach to service delivery, with a focus on the role of shared experience. Peer specialists rarely reported explicitly sharing experiences related to mental health with clients, but described how it was nevertheless ever-present through the unique ways it shaped features of their practice (e.g., empathy, patience, consistency, listening, unstructured time, and a client-centered approach). In contrast, explicit discussion of shared experiences related to other life domains, such as culture, physical health, and significant life events, were frequently relied upon to support and build rapport with clients.

Measurement, Education and Tracking in Integrated Care (METRIC): use of a culturally adapted education tool versus standard education to increase engagement in depression treatment among Hispanic patients: study protocol for a randomized control trial

Background

Significant mental health disparities exist for Hispanic populations, especially with regard to depression treatment. Stigma and poor communication between patients and their providers result in low use of antidepressant medications and early treatment withdrawal. Cultural factors which influence treatment decisions among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with co-morbid physical health conditions. Hispanics, in particular, are more likely to receive mental healthcare in primary care settings. Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for depression only if systems are in place to ensure adequate treatment and follow-up.

Methods

We are conducting a randomized controlled trial among 150 depressed adult Hispanics in a primary care safety net setting, testing the effectiveness of a culturally appropriate depression education intervention to reduce stigma and increase uptake in depression treatment among Hispanics, and implement a Measurement-Based Integrated Care (MBIC) model with collaborative, multidisciplinary treatment and culturally tailored care management strategies.

Discussion

This study protocol represents the first randomized control trial of the culturally adapted depression education fotonovela, Secret Feelings, among Hispanics in a primary care setting. The education intervention will be implemented after diagnosis using an innovative screening technology and enrolled in measurement-based integrated care for the treatment of depression, which will help build the evidence around cultural adaptations in treatment to reduce mental health disparities.

Trial registration

ClinicalTrials.gov, NCT02702596. Registered on 20 March 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2109-y) contains supplementary material, which is available to authorized users.

Socio-environmental risks for untreated depression among formerly incarcerated Latino men

To identify the levels of untreated depression and the socio-environmental factors associated with it among formerly incarcerated Latino men (FILM). Cross-sectional survey with 259 FILM ages 18-49 who were released from prison/jail within the prior 5 years. Depression was measured by the brief symptom inventory (BSI). Backward elimination was used to determine the best regression models. 26.9 % of the study sample reported depression. Low familism, residing farther away from family members, low utilization of health and social services, high levels of loneliness and high lifetime and current frequency of alcohol use were also associated with depression. Depression is a major problem among FILM. Addressing untreated depression among FILM must be a public health priority.