Treatment Moderators and Effectiveness of Engagement and Counseling for Latinos Intervention on Worry Reduction in a Low-Income Primary Care Sample

Objective: We conducted a secondary analysis of randomized controlled trial data to determine if the Engagement and Counseling for Latinos (ECLA) intervention, a brief, evidence-based, and culturally adapted cognitive-behavioral intervention specifically designed for and effective at treating depression, also reduced co-occurring worry symptoms. We also explored whether delivery modality (telephone, face-to-face) and sociodemographic patient characteristics moderated treatment effectiveness. Method: Between May 2011 and September 2012, low-income Latino primary care patients (N = 257) with depression from Boston and San Juan were randomized to usual care (n = 86), face-to-face ECLA (n = 84), or telephone ECLA (n = 87) and completed a psychosocial assessment at baseline and 4 months after randomization. We used intention-to-treat analyses with linear regression models with change in worry (4 months from randomization) as the primary outcome and treatment condition as the primary predictor. Results: Patients in ECLA experienced significant reductions in worry at 4 months from randomization than those in usual care (PSWQ Delta = -3.28, p < .05). Among patients receiving ECLA, those in the telephone condition exhibited greater worry reductions than those in the face-to-face condition (telephone: M = -7.83, SD = 11.45; face-to-face: M = -6.73, SD = 12.23; p < .05). Employment status was the only significant treatment moderator. Unemployed patients did not exhibit any changes in worry irrespective of condition, whereas employed patients exhibited the greatest worry reductions across conditions. Conclusions: Although worry was not a treatment target in ECLA, it also reduced worry among low-income Latinos, which suggests ECLA may have transdiagnostic clinical implications. Telephone-delivered ECLA might hold promise for increasing the uptake of mental health care among employed low-income Latinos. What is the public health significance of this article? This study suggests that a brief, culturally adapted, cognitive-behavioral intervention (Engagement and Counseling for Latinos, ECLA) for depression also reduces worry, especially among employed and low-income Latino primary care patients. Our results also suggest that telephone-delivered ECLA, in comparison to face-to-face-delivered ECLA, may hold strong promise as a method to increase access to effective and high-quality mental health treatments for Latino populations.