What was the research about? Getting screened for cancer at a doctor's visit can lead to early detection and treatment. But it can be hard for people with depression and limited resources to stay up to date with their care by scheduling regular visits and screenings.

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BackgroundSome patients’ depression persists despite evidence-based interventions; understanding factors associated with depression persistence could inform screening and treatment. We used a novel mixed-methods approach to examine demographic, clinical, and social factors affecting depression persistence among older, low-income women; we also assessed the utility of this approach for evaluating intervention fidelity.MethodsData used for this study were generated from a comparative effectiveness study comparing the impact of prevention care management (PCM) versus a collaborative care intervention (CCI) on depression among women overdue for cancer screening: We reviewed 700 care manager logs to identify themes among patients’ experiences and analyzed language use using NVivo®’s natural language processing (NLP) functionality. 757 women age 50-64 who screened positive for depression at baseline using the Patient Health Questionnaire (PHQ)-9 and were overdue for ≥1 cancer screening test (breast, cervical, and/or colorectal) participated. All received primary care in XXX Federally Qualified Health Centers. We used NLP to quantify differences in language use across intervention groups and explored how often themes appeared in logs of participants whose depression did not meaningfully improve based on PHQ-9 scores. Differences in demographic, clinical, and social factors were examined.ResultsParticipants with persistent depression were more likely to discuss pain, fear, and transportation. Asthma and anxiety were associated with lower likelihood of depression remission, while no differences were observed in depression remission rates among those with diabetes or hypertension. Patient-centered words, including “needs” and “feelings”, were more common in the CCI group, while procedure-related words, like “screening” and “mammography”, appeared more frequently in the PCM group.ConclusionsPatient-related factors and social barriers contributed to depression persistence. NLP identified patterns of language use in case logs, suggesting unmet needs among depressed patients. NLP is an efficient, effective method for identifying themes in unstructured text and monitoring intervention fidelity.

Low-income women of color receive fewer cancer screenings and have higher rates of depression, which can interfere with cancer screening participation. This study assessed the comparative effectiveness of two interventions for improving colorectal, breast, and cervical cancer screening participation and reducing depression among underserved women in Bronx, NY, with depression. This comparative effectiveness randomized controlled trial (RCT) with assessments at study entry, 6, and 12 months utilized an intent-to-treat statistical approach. Eligible women were aged 50 to 64, screened positive for depression, and were overdue for ≥ 1 cancer screening (colorectal, breast, and/or cervical). Participants were randomized to a collaborative depression care plus cancer screening intervention (CCI + PCM) or cancer screening intervention alone (PCM). Interventions were telephone-based, available in English or Spanish, delivered over 12 months, and facilitated by a skilled care manager. Cancer screening data were extracted from electronic health records. Depression was measured with a validated self-report instrument (PHQ-9). Seven hundred fifty seven women consented and were randomized (CCI + PCM, n = 378; PCM, n = 379). Analyses revealed statistically significant increases in up-to-date status for all three cancer screenings; depression improved in both intervention groups. There were no statistically significant differences between the interventions in improving cancer screening rates or reducing depression. CCI and PCM both improved breast, cervical, and colorectal cancer screening and depression in clinical settings in underserved communities; however, neither intervention showed an advantage in outcomes. Decisions about which approach to implement may depend on the nature of the practice and alignment of the interventions with other ongoing priorities and resources.