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Pilot Testing the Oh Happy Day Class:Pilot Testing the Oh Happy Day Class:A Culturally Adapted Depression InterventionA Culturally Adapted Depression Intervention

Earlise Ward, Ph.D.Earlise Ward, Ph.D.

Licensed PsychologistLicensed Psychologist

Assistant ProfessorAssistant Professor

ecward@wisc.eduecward@wisc.edu

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Wisconsin: DepressionWisconsin: DepressionAge-Adjusted Hospital Admission Age-Adjusted Hospital Admission

Rates Per 100,000 personsRates Per 100,000 persons

0

20

40

60

80

100

120

140

160

180

Af Am Am Ind Asian Latino Cau

Male

Female

145

171

Wisc. Minority Health Program

125

113

67

95

33

0

500

1,000

1,500

2,000

2,500

Af Am Am Ind Asian Latino Caucas

Male

Female

1’280; 523

2,114; 935

390;192

Wisc. Minority Health Program

WWWisconsin: Alcohol or DrugAge-Adjusted Hospital Admission Age-Adjusted Hospital Admission

Rates Per 100,000 personsRates Per 100,000 persons

44

Culturally Adapted Interventions (CAIs)Culturally Adapted Interventions (CAIs)

• CAIs involve changes in approaches to service delivery, nature of the therapeutic relationship, or in components of the treatment to accommodate the cultural beliefs, attitudes, and behaviors of the target population.7

• A recent meta-analysis of CAIs found CAIs were four times more effective than interventions provided to mixed groups of patients.8

• Literature review No CAI developed specifically for African American adults with depression.

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Addressing Depression AmongAddressing Depression AmongAfrican American AdultsAfrican American Adults

The OHDC was developed to address this deficit.

Developing the OHDC

• Adapted the Coping with Depression Course CWD),9,10,11

• Conducted extensive preliminary research in which African Americans’ beliefs about mental illness, stigma, preferred and treatment preferences were identified,12,13,14

• Incorporated an Afrocentric paradigm; Nugzo Saba 7 life principles (unity, self-determination, collective work and responsibility, cooperative economics, purpose, creativity, and faith)

Oh Happy Day Class (OHDC)Oh Happy Day Class (OHDC)

• The OHDC is a cognitive behavioral group counseling intervention, culturally adapted from the CWD.

• 2-hour weekly for 12 weeks.

• Community-based in churches, community & academic ctrs.

• Delivered jointly by 2 mental health therapist and a trained paraprofessional community member.

• Uses a support group & psychoeducational approach focusing on:

– Educating clients about depression & reducing symptoms.

– increasing healthy coping behaviors.

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OHDC Weekly TopicsOHDC Weekly Topics

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Purpose of Pilot StudyPurpose of Pilot Study

• Test the feasibility and acceptability of the OHDC.

• Examine preliminary efficacy of the OHDC in reducing symptoms of depression:– Mid intervention (week 6)– Immediately post-intervention (week 12)– 3 months post-intervention (week 24)

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MethodsMethods

Design– one-group pretest-posttest design– Mixed method (qualitative and quantitative)

Pilot 1• 16 African American women (community-dwelling)• Age range: 60-78 (M= 71 years)• Highest level of education- completed 8th grade• All retired

Pilot 2• 19 African Americans (n=11 men; n=8 women)• Age range: 35 to 61 (M = 49 years)• Highest level of education- completed high school

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MethodsData collection time points– Screening– Baseline– Wee 6 (mid intervention)– Week 12 (immediate end of intervention)– Week 13 qualitative interview– Week 24 (3 months post-intervention

Data Analysis– Descriptive statistics (mean scores) and T test for

comparison

– Qualitative analysis used dimensional analysis to identify thems relevant to satisfaction and acceptability

Results: FeasibilityResults: Feasibility

• Pilot 1– Enrolled 16 African-American women ages 60-78

(M = 71 years) within 2 months and retained 81%.

• Pilot 2 – Enrolled 19 African Americans [men n=11 and

women n=8] ages 35 to 61 (M = 49 years), within 3 months and retained 79%.

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Results - Acceptability

Is the OHDDI acceptable to participants?

Sample interview questions:

• Tell me about your experiences participating in OHDC.

• Tell me about your experiences participating in this research study.

Analysis:

• Dimensional analysis: Identified relevant themes

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Results - AcceptabilityStaff willing to help

“And if something didn’t go well, they were willing to help and try to solve the problem or come to a solution that we talked about. I think it was great for me, it was. I don’t know about nobody else, but it was beautiful to me because, I’m not a real talker with people.”

Talked and was comfortable

Oh, we talked about everything. We could soul with each other, you know. We didn’t have to make up stuff, you know. It made me feel comfortable. I felt at home. We become normal people, you know. I wish that others could have that same feeling that we had.

Trust

And we talked and we trusted one another. We didn’t go around throwing stones or talking about each other. We talked about what positive things are. We talked about that a lot. You know, and it was just a nice group. I don’t think I could get a better group.

Results: Efficacy Results: Efficacy

Was the OHDDI efficacious in reducing symptoms of depression?

Measure• Center for Epidemiological Studies Depression Scale (CES-D)

– 20-items and self-administered

– Items scored 0-3, with a possible range of scores from 0-60. – Standard cutoff score of 16 has been defined as indicating

clinical depression (Nguyen, Kitner-Triolo, Evans, & Zonderman, 2004).

– 16 to 24: borderline elevation of depressive symptoms.– 24 and above: significant elevation of depressive symptoms.

Analysis:• Descriptive statistics (mean scores) and T test for comparison

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Results: Efficacy of OHDC in reducing symptoms? P1

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16 cutoff16-24 borderline elevation24+ signif elevation

Results: Efficacy of OHDC in reducing symptoms? P2Results: Efficacy of OHDC in reducing symptoms? P2

1616

16 cutoff16-24 borderline elevation24+ signif elevation

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Summary of Preliminary Results

• Study was feasible with trained staff and financial resources.

• Participants found the OHDC acceptable and were satisfied.

• Intervention was found to be efficacious in reducing symptoms of depression.

Application to Caribbean Populations

• Research– Due to similar culture and health disparities it is feasible to

replicate current study in the Caribbean

• Possible Challenges– Funding to conduct study – Perceived stigma associated with mental illness – Recruitment and retention

• Anticipated outcomes– Reduction in symptoms of depression

Despite challenges, can it be done? Yes we can!!

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Future ResearchFuture Research

• Secure funding (R01) to test the intervention in a larger sample using RCT design

• Explore collaborations to replicate research in the Caribbean

AcknowledgementsUW Institute of Clinical and Translational ResearchUW School of Nursing National Institute of Nursing Research