Collaborative Care to Reduce Depression and Increase Cancer Screening Among Low-Income Urban Women Project (Prevention Care Manager 3 Project)

Bronx County, New York is the poorest urban county in the U.S.A., and residents are almost
entirely Latino or African American. Cancer is the leading cause of premature death in the
Bronx, with morality rates significantly higher than for New York City as a whole.
Low-income/minority populations are more likely to be diagnosed with preventable and
late-stage cancers than the general population, in part, due to lower screening rates. While
research has addressed screening barriers in low-income/minority groups, depression, a
common,potentially critical barrier, has received scant attention. Research suggests that
depressed women are less likely to engage in cancer screening, especially mammography and
Pap testing. The link between mental health and cancer screening is particularly important
to address in the Bronx, which has the highest rates of self-reported serious psychological
distress (a measure closely related to depression) in New York City. Depression affects
almost 1 in 4 minority women, and while minorities often seek help for depression in primary
care, primary care depression management often does not meet evidence-based standards.
Drawing on the expertise and close collaboration of Bronx medical and social service
providers and patient stakeholders, this study will determine whether a collaborative care
intervention that addresses both depression and cancer screening needs simultaneously among
women ages 50-64 is more effective at improving cancer screening and patient-reported
outcomes for women with depression than an existing evidence-based cancer screening
intervention alone.

To achieve this, the investigators will compare the effectiveness of these two interventions
using a randomized controlled trial (RCT). In partnership with three Bronx Federally
Qualified Health Centers (FQHCs), the investigators will recruit approximately 756 women
ages 50-64 who screen positive for depression and are non-adherent with recommended
cervical, breast, and/or colorectal cancer screenings. The investigators specific aims are
to: 1) compare the impact of the two interventions on patient-reported outcomes, including
cancer screening knowledge and attitudes, self-efficacy, depression-related stigma, provider
referrals, participation in mental health care, medication adherence, quality of life,
satisfaction with care and treatment decisions, and depression; 2) compare the effectiveness
of the two interventions in increasing breast, cervical, and colorectal cancer screening; 3)
determine whether reducing depression increases the likelihood that low-income women 50-64
will receive cancer screening; 4) determine whether effectiveness of the two interventions
in increasing cancer screening varies according to patient characteristics, such as duration
of depression, presence of other chronic conditions, and obesity.

This study is designed to increase the investigators understanding of how to enhance primary
care systems' ability to improve a range of outcomes related to cancer screening and
depression among low-income minority women, and how to best support this population in
making cancer-screening decisions.