Randomized Controlled Trial of a Remotely Delivered Self-Management Program (TEAM-Red) for Depressed Young Black Women at Risk for Hypertension

Abstract

Objective

Few studies have simultaneously addressed self-management of cardiovascular disease and mental health in Black women at cardiovascular risk. This 24-week pilot prospective crossover randomized-controlled trial tested TEAM-Red, a 5-session, biweekly, nurse and peer-educator remotely delivered group self-management intervention for young Black women, compared to an enhanced waitlist control (eWL) group.

Methods

The TEAM-Red intervention, adapted from an evidence-based program and culturally tailored based on stakeholder input, enrolled 50 depressed Black women ages 18-49 with at least one risk factor for hypertension. Participants were randomized to TEAM-Red (n = 25) or eWL (n = 24) and assessed at screening, baseline, 12 weeks, and 24 weeks. Those in eWL crossed over to receive TEAM-Red at 12 weeks and all participants were followed to 24 weeks. The primary goal was acceptability and feasibility. The primary outcome was change in depression severity from baseline to 12 weeks assessed by the 9-item Patient Health Questionnaire (PHQ-9). Secondary outcomes were perceived stress, mental health quality of life, diet quality, energy expended, social support, hypertension knowledge, and alcohol use.

Results

Among women depressed at baseline (N = 31), TEAM-Red participants had 17.1 times higher odds of depression remission at week 12 (OR = 17.14, 95% CI: 1.78, 164.97; P = .014). At 12 weeks, TEAM-Red participants also showed significantly lower PHQ-9 scores (P = .042), improved diet quality (P = .025), higher mental health quality of life (P = .032), and reduced perceived stress (P = .038) compared to those in the eWL. Treatment satisfaction and engagement in the intervention group was high (89% found it useful), with 22% attrition.

Conclusions

The TEAM-Red intervention demonstrated significant clinical benefits with a 17-fold higher odds of depression remission and meaningful improvements in mental health quality of life, diet quality, and perceived stress compared to controls. Despite limitations including small sample size and short follow-up period, this culturally tailored intervention showed promise for reducing cardiovascular risk and improving mental health outcomes in young Black women at risk for hypertension. These results need replication in a larger sample as part of a fully powered trial.