Browsing by Author "Williams, Michelle"

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    Longer-Term Mental Health Consequences of COVID-19 Infection: Moderation by Race and Socioeconomic Status
    (2022-05) Williams, Michelle; Stewart, Jesse; Hirsh, Adam T.; Zapolski, Tamika C.
    While evidence suggests that the mental health consequences of coronavirus disease 2019 (COVID-19) can persist for several months following infection, little is known about the longer-term mental health consequences and whether certain sociodemographic groups may be particularly impacted. The study objectives were to characterize the longer-term mental health consequences of COVID-19 infection and examine whether such consequences are more pronounced in Black people and people with lower socioeconomic status. 277 Black and White adults (age ≥ 30 years) with a history of COVID-19 (cases; tested positive ≥ 6 months prior to participation) or no history of COVID-19 infection (controls) completed a 45-minute online questionnaire battery. Unadjusted t-tests revealed that cases had greater depressive (d = 0.24), anxiety (d = 0.34), PTSD (d = 0.32), and insomnia (d = 0.31) symptoms than controls. These differences remained significant for symptoms of anxiety, PTSD, and insomnia after adjusting for age, sex, race, education, income, and smoking status. No case-control differences were detected for perceived stress and general psychopathology. Cases had more than double the odds of clinically significant symptoms of anxiety (OR = 2.22) and PTSD (OR = 2.40). Case-control status was more strongly and positively associated with depressive, anxiety, PTSD, perceived stress, and general psychopathology symptoms at lower education levels. Race and income were not moderators of the relationships. The mental health consequences of COVID-19 may be significant, widespread, and persist for at least 6 months after infection, and people with lower education levels may face a greater burden of these consequences.
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    Modernized Collaborative Care for Depression: Impact on Psychological Risk and Protective Factors for Diabetes and Intervention Outcomes Among Diverse Sociodemographic Groups
    (2024-08) Williams, Michelle; Stewart, Jesse; Hirsh, Adam; Johnson, India; Gupta, Samir
    Objective: We examined the effect of a modernized collaborative care intervention for depression on multiple psychological risk and protective factors for diabetes and characterized intervention process outcomes using data from the eIMPACT-DM trial. Methods: Forty-six primary care patients with depression and elevated diabetes risk from a safety net healthcare system (Mage = 50 years, 78% women, 72% Black, Meducation = 13 years, 33% with income <$10,000/year) were randomized to 6 months of the eIMPACT-DM intervention (our modernized collaborative care intervention for depression involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants; n=24) or active control (depression education, depressive symptom monitoring, and usual primary care for depression; n=22). Depressive symptoms (Patient Health Questionnaire-9 [PHQ-9], anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]), trait positive affect (Positive and Negative Affect Schedule- Positive Affect Subscale [PANAS-PA]), life satisfaction (Satisfaction With Life Scale [SWLS]), and intervention process outcomes were measured across the treatment period. Results: Effect size metrics (standardized regression coefficients; bY) indicated that, compared to active control, the intervention group demonstrated clinically meaningful medium-to-large improvements in depressive symptoms (PHQ-9 bY = -0.69), anxiety symptoms (GAD-7 bY = - 0.76), and trait positive affect (PANAS-PA bY = 0.61) as well as small-to-medium improvements in life satisfaction (bY = 0.43). Although only 27% of participants assigned to iCBT had good engagement and 60% had good iCBT comprehension, the intervention group reported high skills implementation and treatment satisfaction. Conclusion: These findings demonstrate the potential of a modernized collaborative care intervention to improve multiple psychological risk and protective factors for diabetes in a diverse primary care population. Such an intervention could ultimately serve to bolster future diabetes prevention in diverse groups, helping to reduce diabetes-related health disparities.