(PS5-A23) Anxiety and Depression Outcomes for Cognitive Behavioral Therapy in Community Mental Health Centers

Friday, November 18, 2022

3:00 PM – 4:00 PM EST

Location: Westside Ballroom, 5th Floor

Author(s)

QV

Quynh Vo, B.S.

Research Assistant
Harbor-UCLA Medical Center
Los Angeles, California

Co-Author(s)

AK

Ah-Yeon Kwon, None

Research Assistant
Harbor-UCLA Medical Center
Fullerton, California
AW

Aleeza West, None

Research Assistant
Harbor-UCLA Medical Center
Carson, California
OR

Oliver V. Ressler, None

Research Assitant
Harbor-UCLA Medical Center
Costa Mesa, California
JT

Jonathan Tsou, B.S.

Research Assistant
Harbor-UCLA Medical Center
Arcadia, California
AK

Alexandra King, Ph.D.

Postdoctoral Fellow
Harbor-UCLA Medical Center
Torrence, California

Depression and anxiety have increased among Americans since the COVID-19 pandemic, particularly in Black, Indigenous, and people of color (BIPOC) communities (Warren et al., 2020). Cognitive Behavioral Therapy (CBT) as treatment for anxiety and depression has been studied broadly (van Dis et al., 2020), but there is a lack of literature on outcomes of BIPOC clients (Schraufnagel et al., 2006). Community mental health clinics (CMHCs) see diverse clientele, thus making them an opportune setting to conduct research (Cook et al., 2013). In this study, COVID-19 infection, functional impairment, anxiety, and depression outcomes of a racially diverse sample of patients at a CMHC were tracked over the course of treatment. We hypothesized that patient outcomes would improve over the course of CBT, such that White clients would exhibit better treatment outcomes and lower COVID-19 rates than BIPOC clients.

Participants were 115 adult clients receiving CBT from a Los Angeles County-funded community clinic from April 2020 to February 2022. Sixty-nine clients did not have racial/ethnicity information. The breakdown of the remaining 46 was 21.7% White, 6.5% Asian, 37.0% Black/African American, 23.9% Hispanic/Latinx, 2.2% Native American/Indigenous, and 8.7% more than one. Twenty-seven percent reported suspecting they had contracted COVID-19 at some point and 48% reported someone close to them had. Clients took a baseline survey assessing demographics, functioning across domains, and psychopathology (e.g., General Anxiety Disorder [GAD-7; Spitzer et al., 2006], Patient Health Questionnaire [PHQ-9; Kroenke et al., 2001], Work and Social Adjustment Scale [WSAS; Mundt et al., 2002]) and weekly surveys with the same outcome measures. Clients were excluded if they completed less than 2 weeks of treatment. They submitted 2-62 weekly measures (M=9.56, SD=10.97) over 2-87 weeks of treatment (M=18.94, SD=16.08).

Hierarchical linear modeling was used to evaluate changes in symptoms over the course of treatment. Three models were run, with the GAD-7, PHQ-9, and WSAS as the dependent variables and the week of treatment as the predictor, testing fixed and random effects. Race/ethnicity and suspected COVID-19 were run as covariates. Results indicated reductions in symptoms across all measures. For the GAD-7 and WSAS, fixed effects were not significant (p′≥.23), while random effects were significant (p≤.005). For the PHQ-9, fixed (p=.01) and random effects (p< .01) were significant. Race/ethnicity and suspected COVID-19 were not significant covariates. However, 𝟀2 analyses indicated significant differences in suspected COVID-19 cases (p=.03), with 41.2-75% of BIPOC groups reporting suspected COVID and 0% of White clients.

Our hypothesis that the client's outcomes would improve was supported; however, there were no significant differences by race/ethnicity or COVID-19 infection. Given the small sample size and limited demographic information, these findings are difficult to interpret, but suggest that CMHCs may provide effective CBT during the pandemic. Further investigation is needed with more consistently collected demographic information to explore the impact of CBT for BIPOC clients in CMHCs and identify potential areas for improvement.