What Role Can Community Health Workers Play in Connecting Rural Women with Depression to the “De Facto” Mental Health Care System?
The prevalence of depression among rural women is nearly twice the national average, yet limited mental health services and extensive social barriers restrict access to needed treatment. We conducted key informant interviews with community health workers (CHWs) and diverse health care professionals who provide care to Appalachian women with depression to better understand the potential roles that CHWs may play to improve women’s treatment engagement. In the gap created by service disparities and social barriers, CHWs can offer a substantial contribution through improving recognition of depression; deepening rural women’s engagement within existing services; and offering sustained, culturally appropriate support.
KeywordsDepression Community health worker Rural Women
The funding was supported by National Institutes of Health (Grant No. CTSA UL1TR000117), Office of Research on Women's Health (Grant No. K12 DA035150) and University of Kentucky Department of Behavioral Science. This research would not have been possible without the valuable perspectives of all of the participants who made time to share their expertise with us. Wayne Noble′s talents were critical for coordinating the study and other colleagues at the Center of Excellence in Rural Health offered vital feedback on interpreting the findings. We appreciate the insights of the editor and anonymous reviewers to strengthen the manuscript.
- Alcalde, M. G. (2016). Tracking the impact of the Affordable Care Act in Kentucky. In Health affairs blog (Vol. 2016). Bethesda, MD: Health Affairs.Google Scholar
- Appalachian Regional Commission. (2014). Socioeconomic data by county. Retrieved from http://www.arc.gov/data.
- Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. The Lancet, 380(9836), 37–43, https://doi.org/10.1016/S0140-6736(12)60240-2.CrossRefGoogle Scholar
- Bird, D. C., Dempsey, P., & Hartley, D. (2001). Addressing mental health workforce needs in underserved rural areas: Accomplishments and challenges. Portland: Maine Rural Health Research Center, Edmund S. Muskie School of Public Services, University of Southern Maine.Google Scholar
- BRFSS. (2013). Kentucky area development district (ADD) profiles. Frankfort, KY: Kentucky Public Health.Google Scholar
- Brooks, B. A., Davis, S., Frank-Lightfoot, L., Kulbok, P., Poree, S., & Sgarlata, L. (2014). Building a community health worker program: The key to better care, better outcomes, & lower costs. Chicago: CommunityHealth Works.Google Scholar
- Browning, D., Andrews, C., & Niemczura, C. (2000). Cultural influences on care seeking by depressed women in rural Appalachia. The American Journal for Nurse Practitioners, 4, 24–32.Google Scholar
- CDC. (2010). Current Depression among Adults: Untied States, 2006 and 2008. Morbidity and Mortality Weekly Report, 59(38), 1229–1235.Google Scholar
- Centers for Disease Control and Prevention. (2016). Community health worker (CHW) toolkit. Retrieved 2016 from http://www.cdc.gov/dhdsp/pubs/chw-toolkit.htm.
- Cook, J. A., Copeland, M. E., Corey, L., Buffington, E., Jonikas, J. A., Curtis, L. C., et al. (2010). Developing the evidence base for peer-led services: changes among participants following Wellness Recovery Action Planning (WRAP) education in two statewide initiatives. Psychiatric Rehabilitation Journal, 34(2), 113.PubMedCrossRefGoogle Scholar
- Cook, J. A., Copeland, M. E., Jonikas, J. A., Hamilton, M. M., Razzano, L. A., Grey, D. D., et al. (2011). Results of a randomized controlled trial of mental illness self-management using Wellness Recovery Action Planning. Schizophrenia Bulletin, 38, 881–891.PubMedPubMedCentralCrossRefGoogle Scholar
- Cook, J. A., & Mueser, K. T. (2015). Community health workers: Potential allies for the field of psychiatric rehabilitation? p. 207.Google Scholar
- Daniels, A., Grant, E., Filson, B., Powell, I., Fricks, L., & Goodale, L. (2010). Pillars of peer support: Transforming mental health systems of care through peer support services. Retrieved from http://www.pillarsofpeersupport.org.
- Duncan, C. M. (2000). Worlds apart: Why poverty persists in rural America. New Haven: Yale University Press.Google Scholar
- Fortney, J. C., Pyne, J. M., Mouden, S. B., Mittal, D., Hudson, T. J., Schroeder, G. W., et al. (2013). Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: A pragmatic randomized comparative effectiveness trial. American Journal of Psychiatry, 170(4), 414–425. https://doi.org/10.1176/appi.ajp.2012.12050696.PubMedCrossRefGoogle Scholar
- Healthcare, T. (2007). Ranking America’s Mental Health: An analysis of depression across the states. Washington, D.C.: Mental Health America.Google Scholar
- Hillemeier, M. M., Weisman, C. S., Chase, G. A., & Dyer, A.-M. (2008). Mental health status among rural women of reproductive age: findings from the Central Pennsylvania Women’s Health Study. American Journal of Public Health, 98(7), 1271–1279. https://doi.org/10.2105/AJPH.2006.107771.PubMedPubMedCentralCrossRefGoogle Scholar
- Ho, C. S., Feng, L., Fam, J., Mahendran, R., Kua, E. H., & Ng, T. P. (2014). Coexisting medical comorbidity and depression: Multiplicative effects on health outcomes in older adults. International Psychogeriatrics, 26(07), 1221–1229. https://doi.org/10.1017/S1041610214000611.PubMedCrossRefGoogle Scholar
- Jesse, D. E., & Swanson, M. S. (2007). Risks and resources associated with antepartum risk for depression among rural southern women. Nursing Research, 56(6), 378–386. https://doi.org/10.1097/01.nnr.0000299856.98170.19.PubMedCrossRefGoogle Scholar
- Katzen, A., & Morgan, M. (2014). Affordable Care Act opportunities for community health workers. Cambridge, MA: Harvard Law School Center for Health Law and Policy Innovation.Google Scholar
- Kentucky Health Facts. (2015). Mentally unhealthy days (per month), 2008–2010—county group. Retrieved January 26, 2015 from http://www.kentuckyhealthfacts.org/data/topic/map.aspx?ind=52.
- Mutamba, B. B., van Ginneken, N., Paintain, L. S., Wandiembe, S., & Schellenberg, D. (2013). Roles and effectiveness of lay community health workers in the prevention of mental, neurological and substance use disorders in low and middle income countries: A systematic review. BMC Health Services Research, 13(1), 412.PubMedPubMedCentralCrossRefGoogle Scholar
- Paudel, S., Gilles, N., Hahn, S., Hexom, B., Premkumar, R., Arole, S., et al. (2014). Impact of mental health training on village health workers regarding clinical depression in rural India. Community Mental Health Journal, 50(4), 480–486. https://doi.org/10.1007/s10597-013-9630-6.PubMedCrossRefGoogle Scholar
- Petersen, I., Bhana, A., & Baillie, K. (2012). The feasibility of adapted group-based interpersonal therapy (IPT) for the treatment of depression by community health workers within the context of task shifting in South Africa. Community Mental Health Journal, 48(3), 336–341. https://doi.org/10.1007/s10597-011-9429-2.PubMedCrossRefGoogle Scholar
- Rugkåsa, J., Canvin, K., Sinclair, J., Sulman, A., & Burns, T. (2014). Trust, deals and authority: Community mental health professionals’ experiences of influencing reluctant patients. Community Mental Health Journal, 50(8), 886–895. https://doi.org/10.1007/s10597-014-9720-0.PubMedCrossRefGoogle Scholar
- Schoenberg, N. E., Bardach, S. H., Manchikanti, K. N., & Goodenow, A. C. (2011). Appalachian residents’ experiences with and management of multiple morbidity. Qualitative Health Research.Google Scholar
- Schoenberg, N. E., Campbell, K. A., Garrity, J. E., Snider, L. B., & Main, K. (2001). The Kentucky homeplace project: Family health care advisers in underserved rural communities. The Journal of Rural Health, 17(3), 179–186. https://doi.org/10.1111/j.1748-0361.2001.tb00955.x.PubMedCrossRefGoogle Scholar
- Semansky, R., Willging, C., Ley, D. J., & Rylko-Bauer, B. (2012). Lost in the rush to national reform: Recommendations to improve impact on behavioral health providers in rural areas. Journal of Health Care for the Poor and Underserved, 23(2), 842–856. https://doi.org/10.1353/hpu.2012.0059.PubMedPubMedCentralCrossRefGoogle Scholar
- U.S. Department of Health and Human Services. (2012). Designated health professional shortage areas (HPSA) statistics. Washington, DC: U.S. Department of Health and Human ServicesGoogle Scholar
- Waitzkin, H., Getrich, C., Heying, S., Rodríguez, L., Parmar, A., Willging, C., et al. (2011). Promotoras as mental health practitioners in primary care: A multi-method study of an intervention to address contextual sources of depression. Journal of Community Health, 36(2), 316–331.PubMedCrossRefGoogle Scholar
- Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the united states: Results from the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 629–640. https://doi.org/10.1001/archpsyc.62.6.629.PubMedCrossRefGoogle Scholar
- Wennerstrom, A., Vannoy, S. D., Allen, C. E., Meyers, D., O’Toole, E., Wells, K. B., et al. (2011). Community-based participatory development of a community health worker mental health outreach role to extend collaborative care in Post-Katrina New Orleans. Ethnicity & Disease, 21(3 0 1), 45–51.Google Scholar
- Zhang, Z., Infante, A., Meit, M., English, N., Dunn, M., & Bowers, K. H. (2008). An analysis of mental health and substance abuse disparities & access to treatment services in the Appalachian region. Washington, D.C.: Appalachian Regional Commission.Google Scholar