Promoting Emotional Stability to Improve Cardiovascular Health in Chicago’s South Side Community

Summary

Adults with high blood pressure, also known as hypertension, often also have depression.¹ When people with hypertension also have depression, they are more likely to have worse blood pressure control and are at greater risk for developing cardiovascular disease.² Depression makes it more difficult to follow through with taking blood pressure medication and attending medical follow-up. In the United States, African American adults are twice as likely to have both depression and high blood pressure compared to non-Hispanic white adults.^3,4 Some research studies have shown that treating depression can improve blood pressure control among adults with hypertension.^5-7 However, these studies have been done in health clinics and do not account for the unique barriers that many African American adults experience in accessing, engaging in, and benefiting from health services (e.g., systemic racism⁸).

First, we will identify neighborhood factors, such as the number of grocery stores and fitness clubs, that may influence depression among adults with hypertension in Chicago’s South Side neighborhood. We will link people’s health data (electronic health records from the Chicago Area Patient Centered Outcomes Research Network [CAPriCORN] project^9,10) with data about the community they live in (from the Meaningful, Active, Productive Science in Service to Communities [MAPSCorps] project^11,12 and the City of Chicago Data Portal). Second, we will work with a Community Advisory Board (CAB) of South Side of Chicago residents to select and adapt a depression intervention for their community. They will also provide oversight of a clinical trial and distribution of the findings to a variety of audiences. Third, we will conduct a small clinical trial of the adapted intervention in the South Side and assess its impact on depressive symptoms and blood pressure control for South Side adults with hypertension. Additionally, we will evaluate whether the intervention can be implemented in a way that is acceptable to and well-received by participants, the organization, and the South Side of Chicago more broadly.

The study team includes academic researchers with expertise in mental and cardiovascular health, behavioral interventions, health disparities, and implementation science. The community partners are members of the Total Resource Community Development Organization (TRCDO), a non-profit group that offers a variety of services to community members, including Housing Counseling, Utility Assistance, and Food Pantry. TRCDO also has an overarching interest in promoting emotional stability (i.e., mental health) across the lifespan.

Significance

To date, we worked with the CAB to select and adapt the depression intervention and prepare to implement the intervention in the clinical trial. For example, the CAB elected to include both men and women in the study sample and they identified appropriate community-based settings for hosting the intervention sessions (e.g., local churches). Throughout these preparatory activities, the CAB members themselves gained valuable education and skills in conducting research. Specifically, CAB members received education about systematic reviews and intervention design and trials. They received hands-on skills training in preparing materials to receive ethics approval for research activities, developing recruitment materials, and conducting focus groups (e.g., CAB members served as focus group moderators). Additionally, one of the CAB activities included assembling a list of local Mental Health Resources. Members and collaborators have used and shared this list as a resource for others in their community. Finally, we shared the results and outputs of our preliminary work via numerous venues, including academic conferences, community poster presentations, and a CAB-hosted Town Hall event.

The high rate of depression among African American adults with hypertension likely contributes to the higher rates of poor blood pressure control and cardiovascular disease in this population. Unfortunately, this population also experiences profound rates of mental health-related stigma and faces greater barriers to treatment engagement. To address this gap, we plan to implement an adapted M-Body intervention, a mindfulness-based stress reduction treatment. The original M-Body intervention has been culturally adapted for African American adults.^13-15 We have adapted it further for African American adults in faith-based organizations. By bringing evidence-based treatments to the community and adapting them for the community, we seek to reduce the cardiovascular disease disparities among African American adults living on the South Side of Chicago.

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

Build community capacity for participation in research using community-based participatory research principles. potential.

Clinical

Investigative procedures

Improve blood pressure control using an evidence-based, culturally adapted intervention for depression. potential.

Clinical

Therapeutic procedures

Train community members to deliver evidence-based, culturally adapted interventions in the community. potential.

Community

Community health services

Build infrastructure to sustain resources in the community, beyond the length of the grant period. potential.

Community

Community health services

Reduce risk for future or recurrent cardiovascular disease by treating emotional stability/mental health. potential.

Community

Disease prevention & reduction

Increase access to emotional stability/mental health resources with trusted community members. potential.

Community

Health care accessibility

Increase quality of emotional stability/mental health resources by using a culturally adapted intervention (M-Body). potential.

Community

Health care quality

Increase quality of emotional stability/mental health resources by implementing the M-Body intervention in faith-based organizations. potential.

Community

Health care quality

Increase awareness of “emotional stability” in the community by engaging community members in education and discussion. potential.

Community

Health education resources

Develop and provide a list of available emotional stability/mental health resources in the community. demonstrated.

Community

Health education resources

Improve quality-of-life for M-Body participants and the community more broadly through improved emotional stability/mental health. potential.

Community

Life expectancy & quality of life

Provide no- to reduced-cost group-based intervention to community members, as compared to traditional psychotherapy costs. potential.

Economic

Cost savings

Improve physical health conditions and decrease health care utilization for emergent needs by treating emotional stability/mental health symptoms. potential.

Economic

Societal & financial cost of illness

Participate in other advisory boards and promote emotional stability/mental health and our work. potential.

Policy

Committee participation

Write and submit study findings to academic journals. potential.

Policy

Scientific research reports

This research has clinical, community, economic, and policy implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.¹⁶

Clinical

The clinical benefits of this work stem from engaging the community and from using a culturally adapted intervention. First, the community advisory board has been and will continue to be engaged in the full research process, from selection, to adaptation, to implementation and evaluation of the intervention. Community engagement, including community advisory boards, help to make research studies more acceptable, trustworthy, and ultimately impactful. Second, behavioral interventions (such as the M-Body intervention) that are designed and adapted for particular groups, such as African American adults, have better engagement and comparable (if not better) clinical outcomes than standard behavioral interventions.^17,18

Community

We are very hopeful about the potential impact of this project and our partnership on the community. This project will increase community awareness of emotional stability in the community by engaging community members in education, discussion, and intervention. Already, an output of the CAB was a list of local mental health resources, which is freely available and has been shared with interested community organizations and individual community members. The capacity of the community to provide support for the emotional stability of its members may be enhanced through this work because we will train community members to conduct the M-Body intervention. Additionally, the trial will increase the availability of and access to appropriate and effective mental health resources (the M-Body intervention). By building this capacity up front, we are increasing the likelihood of sustainment of these critical resources. More broadly, it is possible that, if the M-Body intervention improves emotional stability and blood pressure control, this work may improve quality of life, both for individual community members and for the community in general.

Economic

This project will result in direct economic benefit to the community members who participate in the intervention, as they will receive an evidence-based therapeutic intervention at no cost, compared to the cost of traditional psychotherapy. More broadly, it is possible that, if the M-Body intervention improves emotional stability and blood pressure control, this work may decrease future healthcare utilization, particularly for more emergent issues (e.g., cardiovascular disease).

Policy

This work has the potential to have policy impacts through dissemination by the CAB and research team members. First, our CAB members are highly involved in the community and contribute their time and expertise to other advisory boards and committees focused on improving the health of the community. Second, our community and research team members have presented the results of this project thus far at institutional, regional, and national academic conferences. Our team will continue to prepare abstracts and manuscripts about this project’s process and findings to be submitted to academic conferences and relevant journals.

Lessons Learned

Our team has always liked to assess the “ripple effects” of our work, particularly work conducted in the community setting. By thinking broadly about the variety of impacts that may result from our work in advance, we are better able to build the infrastructure to support those impacts. For example, we can develop applicable assessments, engage the right community leaders, and disseminate our findings through appropriate channels.