A Community-based Participatory Research (CBPR) Guided Depression Screening and Suicidal Ideation Disclosure: Linking RCT Findings Back to Qualitative Inquiry in the CBPR to Reduce Women's Health Disparities thru Temporary Assistance for Needy Families Study

Background: Screening for depression and suicidal ideation presents challenges when working with disadvantaged groups because of issues with trust and willingness to disclose personal information. While there is increasing attention given to suicidal risk assessment in primary care settings, little is known about the trajectory of disclosure during routine health screening in this population.

Method: In a 4-year, CBPR randomized clinical trial (RCT) to test a public health nurse (PHN) intervention, 432 women in a Welfare Transition Program (WTP) were screened for depression and other chronic health problems. Prior to beginning the RCT, study investigators conducted focus groups in partnership with women in the WTP to select screening tools and develop culturally sensitive processes for evaluating depression and suicidal ideation. Descriptive and between-group analyses of suicidal ideation disclosure based on these tools and processes were conducted at baseline and 3 months.

Results: Between groups reporting A) no ideation at 0 or 3 months, and B) no ideation at baseline but positive ideation at 3 months, there was a parallel increase in depressive symptoms among Group B (p < 0.001). Within Group B, all participants increased in overall depressive symptoms (p < 0.001). Similarly, among groups reporting C) no change in ideation from baseline to 3 months, and D) positive ideation at baseline but no ideation at 3 months, there was a concurrent decrease in depressive symptoms among group D (p<0.001).

Conclusions: These findings suggest participants in the study exhibiting a higher level of depressive symptoms disclosed suicidal ideation openly at baseline, and did not feel the need to wait until their second visit with the PHN to do so. Moreover, findings suggest women who did disclose suicidal ideation at baseline – and as a result underwent a more intensive and focused suicidal risk assessment by the PHN – did not withhold reporting ideation at 3 months to avoid further discussion or evaluation of their suicidal thoughts. These data are consistent with the qualitative findings from the focus groups that were critical to intervention development, and inform practice efforts for PHNs working with disadvantaged women using a community-based participatory approach.