JAMA network open
Volume 2, Issue 1, 2019

Evaluation of the Integrated Intervention for Dual Problems and Early Action Among Latino Immigrants With Co-occurring Mental Health and Substance Misuse Symptoms: A Randomized Clinical Trial (Article) (Open Access)

Alegría M. , Falgas-Bague I. , Collazos F. , Carmona Camacho R. , Lapatin Markle S. , Wang Y. , Baca-García E. , Lê Cook B. , Chavez L.M. , Fortuna L. , Herrera L. , Qureshi A. , Ramos Z. , González C. , Aroca P. , Albarracín García L. , Cellerino L. , Villar A. , Ali N. , Mueser K.T. , Shrout P.E.
  • a Department of Medicine and Psychiatry, Harvard Medical School, Boston, MA, Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
  • b Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
  • c Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • d Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • e Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
  • f Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
  • g Psychiatry Department, Autonoma University of MadridMadrid, Spain, Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Madrid, Spain, Department of Psychiatry, General Hospital of Villalba, Villalba, Madrid, Spain, Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Madrid, Spain, Centro de Investigación en Salud Mental (CIBERSAM), Carlos III Institute of HealthMadrid, Spain, Department of Psychiatry, Universidad Católica del Maule, Talca, Chile, Department of Psychiatry, Instituto de Investigación Sanitaria, Fundación Jiménez DíazMadrid, Spain
  • h Department of Psychiatry, Harvard Medical School, Boston, MA
  • i Behavioral Sciences Research Institute, University of Puerto Rico, Medical Sciences CampusSan Juan, Puerto Rico
  • j Boston Medical Center, Department of Psychiatry, Boston University School of Medicine, Boston, MA
  • k Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
  • l Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Biomedical Network Research Centre on Mental Health, CIBERSAM, University of Barcelona, Barcelona, Spain
  • m Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
  • n Department of Psychiatry, Instituto de Investigación Sanitaria, Fundación Jiménez DíazMadrid, Spain
  • o Department of Psychiatry, Instituto de Investigación Sanitaria, Fundación Jiménez DíazMadrid, Spain
  • p Department of Psychiatry, Instituto de Investigación Sanitaria, Fundación Jiménez DíazMadrid, Spain
  • q Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • r Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • s Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston
  • t Center for Psychiatric Rehabilitation, Boston University, Boston, MA
  • u Department of Psychology, New York University, New York City, United States

Abstract

Importance: Immigrants are at an increased risk for co-occurring mental health and substance misuse symptoms; however, effective treatments are lacking. Objective: To evaluate the effectiveness of the Integrated Intervention for Dual Problems and Early Action (IIDEA) program compared with enhanced usual care. Design, Setting, and Participants: This effectiveness randomized clinical trial was conducted from September 2, 2014, to February 2, 2017, in 17 clinics or emergency departments and 24 community sites in Boston, Massachusetts, as well as in Madrid and Barcelona, Spain. Equal randomization (1:1) in 2-person blocks was used, assigning participants to either the IIDEA treatment group (n = 172) or the enhanced usual care control group (n = 169). Intent-to-treat analyses assessed effectiveness, and post hoc analyses examined whether results varied by symptom severity or treatment dose. Eligible participants were between 18 and 70 years of age, self-identified as Latino, screened positive for co-occurring symptoms, and were not receiving specialty behavioral health services. Interventions: Participants were randomized to a 10-session IIDEA treatment or to enhanced usual care. Main Outcomes and Measures: Primary outcomes were changes in alcohol and drug misuse and results of a urine test for drug metabolites but not for alcohol misuse. Secondary outcomes were symptoms of depression, generalized anxiety, posttraumatic stress disorder, and overall mental health. Results: In total, 341 participants were randomized to either the IIDEA treatment group (n = 172; 94 [54.7%] female, mean [SD] age, 33.5 [11.6] years) or the enhanced usual care control group (n = 169; 80 [47.3%] female, mean [SD] age, 34.3 [11.8] years). No statistically significant effects of IIDEA were found for primary drug and alcohol outcomes (ASI Lite-drug score: β = -0.02 [SE, 0.69; P = .88; Cohen d, 0.00; 95% CI, -0.17 to 0.17]; ASI Lite-alcohol score: β = -0.01 [SE, 1.19; P = .66; Cohen d, 0.00; 95% CI, -0.12 to 0.12]; urine drug test result: β = -0.36 [SE, 0.43; P = .50; OR, 0.70; 95% CI, 0.30-1.61]), but statistically significant effects were observed for secondary mental health outcomes. The IIDEA treatment was effective in reducing depressive symptoms per the Public Health Questionnaire-9 score (β = -1.14; SE, 0.47; P = .02; Cohen d, 0.20 [95% CI, 0.04-0.36]), posttraumatic stress disorder symptoms per the Posttraumatic Stress Disorder Checklist-5 score (β = -3.23; SE, 1.59; P = .04; Cohen d, 0.25 [95% CI, 0.01-0.37]), and overall mental health symptoms per the Hopkins Symptom Checklist-20 (β = -0.20; SE, 0.07; P = .01; Cohen d, 0.25 [95% CI, 0.08-0.42]) and composite mental health (β = -3.70; SE, 1.75; P = .04; Cohen d, 0.19 [95% CI, 0.01-0.36]) scores at the 6-month follow-up. Exploratory analyses suggested that 6-month treatment effects occurred for patients whose drug misuse was moderate to severe at the baseline assessment. Among patients with moderate to severe substance misuse, IIDEA substantially reduced substance use per the urine test results (odds ratio, 0.25 [95% CI, 0.09-0.67]; P = .01). Treatment dose showed small to large effect sizes by outcome. Conclusions and Relevance: The IIDEA treatment did not change drug misuse but did improve secondary mental health and substance misuse outcomes for a heterogeneous population with moderate to severe symptoms; this finding provides a path for treating Latino immigrants with co-occurring mental health and substance misuse symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT02038855.

Author Keywords

[No Keywords available]

Index Keywords

mindfulness Alcohol Drinking drinking behavior multicenter study clinical trial mental health human middle aged controlled study Substance-Related Disorders randomized controlled trial psychiatric diagnosis substance abuse drug dependence ethnology procedures Hispanic Americans Mental Disorders mental disease Humans migrant psychology Hispanic male Emigrants and Immigrants female psychological rating scale Psychiatric Status Rating Scales Outcome Assessment (Health Care) Diagnosis, Dual (Psychiatry) adult outcome assessment Substance Abuse Detection
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064238553&doi=10.1001%2fjamanetworkopen.2018.6927&partnerID=40&md5=229dc7b54c7e423aafaa0a8dd9daa28e
DOI: 10.1001/jamanetworkopen.2018.6927
ISSN: 25743805
Cited by: 3
Original Language: English