Integrated Care Improves Mental Health in a Medically Underserved US-Mexico Border Population

Introduction: Chronic conditions, particularly diabetes, and related health conditions continue to be a major concern in the United States, especially in Hispanic populations. This study evaluated the effect of an integrated behavioral health care model, including promotoras(es), on a primarily Hispanic population living with diabetes. Method: Seven hundred fifty-six participants were enrolled in an intervention (n = 329) or comparison group (n = 427) and followed up for 12 months. We used a quasiexperimental design to compare participants who received coordinated integrated behavioral health care with those who received usual care from a federally qualified health center. The outcomes were HbA1c, blood pressure, body mass index, depressive symptoms (Patient Health Questionnaire-9), and quality of life (QoL). These outcomes were analyzed as continuous variables using linear regression with backward model selection. Longitudinal analyses were conducted using a likelihood-based approach to general linear mixed models. Results: A total 563 intervention (n = 239) and comparison (n = 324) participants completed an end point assessment. After adjusting for important covariates, the intervention had a QoL score 5.36 points higher than the comparison participants on average after 12 months. The trajectories of QoL and Patient Health Questionnaire-9 scores differed over time, with intervention participants experiencing greater improvements. There were no statistically significant differences detected for other outcomes. Discussion: Enabling access to services and providers to enhance participants' ability to manage their chronic disease led to positive impacts on mental health. The connection between QoL and diabetes has been of great interest to researchers, including the effects of relationships with promotoras(es). The impact of integrating care on QoL in this vulnerable population is discussed.