Group psychotherapy can help many patients with mental illness. But how well it works may have a lot to do with a patient’s community, social and economic status, and other external factors that influence whether they regularly attend group therapy – or drop out.
People from poor, racially segregated neighborhoods suffering from adversity often face barriers to psychiatric treatment and receive less-than-adequate care. It’s an example of the issue of “health disparities” –the variations in treatment results between different populations—which has received little attention in the mental health field until now. Massachusetts General Hospital’s (MGH) Department of Psychiatry is interested in this area of public health.
Karin Hodges, PsyD ’09, AUNE adjunct professor and alumna, is a research fellow in the MGH Department of Psychiatry, where she is co-principal investigator with Kathleen Ulman, PhD, of a study of health disparities in group therapy.
Sticking With It Can Be Tough
Hodges’ hypothesis is that these patients likely have a harder time staying with group therapy, contributing to worse outcomes than for patients from more stable and affluent communities. It may be because it’s harder for the patient to use public transportation to get to the group meeting, or they may feel less psychologically connected with a therapist or physician of a higher socio-economic status.
But Hodges suspects that the study will also show that a patient’s personality affects how well he or she adheres to a treatment plan. For instance, some patients may draw in toward the therapeutic group when under more stress; others are more likely to turn away. So she is incorporating indicators of personality styles into the study. “It’s a complex model because it’s not just taking into account demographic factors, but also considering patient personalities,” she said.
The research team is analyzing data from the billing and medical files of 400 adult patients who have been in group therapy at the MGH Center for Group Psychotherapy over the last twenty years. It’s also incorporating social and economic data. “We’re being creative in order to get at information,” Hodges said. “For example, we’re using the homicide rate as one factor in community hardship. It’s an excellent marker for community hardship that is not usually used in clinical research.” She hopes that concrete, exhaustive analysis of the relationship between patients and the factors affecting the progress of their treatments will help illuminate the way to more successful results.
AUNE Students Play a Role
Hodges has involved AUNE PsyD students in the study from the beginning. “The experience that I offer at MGH has been well-suited for students who want to engage in the clinical research in the future, either in a central or a complimentary role.”
Katie Randall, a fourth-year AUNE student, assisted in coding schemes and organized the regulatory binder. “She also helped me to refine and articulate the rationale for this research. She has been an enormous help in moving our research project forward,” Hodges said. Randall presented data from the project to the Massachusetts Psychological Association.
First-year student Rachel Roberts will be working on the project now, coding and helping the project’s statistician, Xiaodong Liu of Brandeis University. “Rachel has a strong social-justice orientation, which motivates her to contribute meaningfully to our project. Additionally, she is clinically savvy, which makes her invaluable to our group,” Hodges said.
“Antioch students tend to have a rich and meaningful foundation in clinical practice that is complemented by a social justice focus,” she said. “Also, the Antioch system values clinical research being done in real-world clinical and community settings, so the students tend to care about real-world, as opposed to lab-based research.
“Our study is practically tailor-made for Antioch students to enjoy because of the social justice, clinical, and real-world focus. At the heart of health disparities research is the desire to bring any inequalities to light so that we can address them in clinical practice.”
Understanding disparities in group therapy can help mental health professionals develop best practices for treating the mentally ill. It will also benefit society in general: untreated mental illness costs the United States $79 billion a year.
The research project began in 2010. Hodges plans to have some preliminary analyses this year, with final analyses in 2015. Also assisting in the study are Ulman and Dr. Robert Waldinger, MGH Department of Psychiatry; consultant Les Greene, New Haven Veterans Administration, Yale University; and the MGH Endowment for the Advancement of Psychotherapy, which provided funding.
‘I Am in Good Company!’
Karin Hodges works with others interested in health disparities: Dr. Derri Shtasel, a leader at MGH and the founding director of the MGH Division of Public and Community Psychiatry, and Robert Waldinger, director of the Study of Adult Development. “I am in good company! The field of group therapy has a very long way to go when it comes to addressing health disparities, and so being at MGH to tackle this challenge, among such great minds, is a privilege,” Hodges said.