Discussion
mental illness, depressive, depressive symptoms, depression, hypertension
UNCONTROLLED HYPERTENSION, HYPERTENSION, CHRONIC DISEASES, SECONDARY
In this study, we used the CES-D-R (CES-D-10) scale to measure self-reported depressive symptoms among low-income AA women between 40 to 75 years old with uncontrolled hypertension who participated in PTSC program in Washington, DC between 2017–2018. Our findings showed that the PTSC intervention effectively reduced women's depressive symptoms at 3 months and 15 months after the intervention. To our knowledge, there are very few studies to which we can compare our results. However, the decrease in depressive symptomology is similar to other group-based interventions. The reductions we observed may be due to aspects of the Sister Circles themselves, insofar as PTSC provided an environment that helped participants gain stress management skills with their peers. Being in a group of women with similar chronic diseases and mental health issues helped participants discuss their own situations, which could have lowered their stress and ameliorated other aspects of their psychosocial health associated with depression.Findings from our previous work showed that low-income AA women with hypertension have unmet depression care needs. Our cross-sectional analysis revealed that a majority of the women in the PTSC-RCT had experienced some level of depression, measured by CES-D-10 scores greater than 10.There is an overall lack of access to treatment for mental illness in Americans, particularly among Black/African Americans.This study has several important limitations. First, the study population was AA women ages 40–75 with low-income and uncontrolled hypertension who received primary care from a facility in Washington, DC. Our findings may not be generalizable to higher-income AA women or low-income AA women who cannot maintain consistent access to care. Second, the primary outcome of this RCT was hypertension, and the CES-D-10 scale (which is a screening tool) was collected as the secondary outcome to measure potential changes in depressive symptoms. While we powered the PTSC-RCT to detect changes in hypertension outcomes, we did not conduct power analyses to discern the impact of the intervention on depressive symptomology. This limits our ability to conclusively state that the PTSC intervention was solely responsible for reducing self-reported depressive symptoms among our study population. Third, we assumed the randomness of missing data with respect to our analyses; yet, given the sociodemographic profile of our study population, it is likely that missingness was linked to adverse social determinants of health that precluded full participation in the intervention and data collection strategies. Finally, we did not include other measures of psychosocial distress in the analyses, partially due to the unavailability of data.Despite these limitations, this study has several strengths. The PTSC-RCT measured depressive symptoms in a largely homogeneous population with respect to race/ethnicity, socioeconomic and demographic characteristics, health status, and geography