In a New York City pilot study published in 2022, Sidney H. Hankerson and colleagues at Columbia University screened adults at 45 African American churches for depression using the standard nine-question Patient Health Questionnaire. Twenty percent screened positive. Not one person who screened positive accepted a referral to clinical treatment when offered by research personnel (Hankerson SH et al., Trials 2022, PMID 35101100).
That zero is the most useful number in Black mental-health research right now. It names a specific failure point that 30 years of "we need to screen more people for depression" has not closed for Black adults: the screen and the referral both happen, but the bridge between them does not. The Trial to Reduce Inequities in Untreated Mental Health among Persons in Houses of worship (TRIUMPH) is the federally-funded effort, currently underway across 30 New York City churches, to test whether 112 trained Community Health Workers from those same congregations can do what referrals alone do not. The intervention is called Screening, Brief Intervention, and Referral to Treatment, or SBIRT.
This article walks through three studies that explain why the Black church became the studied lever for this work, what the evidence does and does not show, and what a reader can do with that information.
What the evidence shows: three load-bearing findings
The first study is a 2012 systematic review by Hankerson and Myrna M. Weissman, also at Columbia, in Psychiatric Services (PMID 22388529). Hankerson and Weissman searched four databases for the 29-year window 1980 to 2009 and found 1,451 candidate studies on church-based health-promotion programs targeting mental disorders among African Americans. Only eight met inclusion criteria. Five focused on substance-related disorders. One focused on depression and enrolled seven people. The state of the field in 2012 was: African Americans underutilize traditional mental-health services compared with white Americans, the Black church has been demonstrably effective for several chronic-medical-condition programs (heart disease, diabetes, breast-cancer screening), but the published evidence on Black church-based programs for mental disorders was almost nonexistent.
The second study, also led by Hankerson, is the 2022 protocol for TRIUMPH. The pilot data behind the protocol is the 20-percent-positive-screen-with-zero-referral-acceptance finding above. The full trial is a hybrid type-1 effectiveness-implementation cluster randomized controlled trial with 600 church members across 30 churches, randomized to either the SBIRT intervention arm (delivered by trained CHWs from the participating congregations) or referral as usual. The primary outcome is treatment engagement: did the person actually attend a depression-related clinical visit. Secondary outcomes include depression-symptom severity measured by PHQ-9 and patient-reported intervention satisfaction.
The third study widens the lens beyond the church specifically to the cultural-adaptation question that any church-based mental-health intervention has to navigate. Gordon C. Nagayama Hall and colleagues at the University of Oregon published a meta-analysis in Behavior Therapy in 2016 (PMID 27993346) covering 78 studies and 13,998 participants, 95 percent of whom were non-European American. Culturally adapted psychological interventions produced an overall effect size of g = 0.67 against other conditions and g = 0.52 against unadapted versions of the same intervention. The effect was larger for treatment than for prevention. Participants who received culturally adapted interventions had 4.68 times the odds of remission from psychopathology compared with those who did not.
Read together, the three studies establish three points the body of this piece can hold: (1) traditional mental-health-services utilization by Black adults has been documented as substantially lower than by white adults for at least three decades; (2) the Black church is a structurally accessible, trusted setting where the bridge from screen to treatment can be built but has been built only rarely in research; (3) when psychological interventions are culturally adapted to the populations they serve, the average treatment effect is substantial (g around 0.50, which in the language of effect sizes is meaningful and clinically practical, beyond statistical detection alone).
Dr. Devon Osei, PhD, MPH, Health Research Lead at blackhealth.org, has been tracking the evolution of this framework across the cumulative Studies memo set since cycle 9 of our editorial coverage. The structural-racism framework that underlies these findings is well-established: African Americans are more likely than white Americans to encounter clinician bias, less likely to have a primary-care provider, less likely to be referred to mental-health specialists when they do present with depressive symptoms, and more likely to face direct cost barriers to a treatment referral once one is offered. The Black church is not a substitute for the clinical system. The church is a bridge over a clinical system that has not earned the trust of the population it is supposed to serve.
What the evidence does not yet tell us
The TRIUMPH trial is not yet complete. The pilot data and protocol are published; the cluster-randomized results are pending. Until then, the strongest empirical claim is that the SBIRT + Community Health Worker model is feasible, acceptable to participating congregations, and theoretically well-grounded. It is not yet a proven intervention with a published effectiveness estimate in this specific context.
The Hall et al. 2016 meta-analysis includes culturally adapted interventions across many minority populations and across many psychological-intervention types. It does not specifically isolate the effect of church-based versus other-setting interventions for African American adults with depression. A reader who wants to know the precise effect of a church-based SBIRT model on Black-adult depression should wait for TRIUMPH's primary outcome.
The 2012 Hankerson and Weissman systematic review was deliberately broad and intentionally identified the literature gap that TRIUMPH and similar trials have set out to close. The 2012 finding that only eight studies met inclusion criteria was not a verdict on whether church-based mental-health work is effective; it was a verdict on whether researchers had been doing rigorous studies of it. They had not. They are now starting to.
What a reader can do with this information
Three concrete actions, each grounded in the evidence above.
First, if you attend a Black church and your congregation does not yet have a partnership with a mental-health screening or referral program, you can ask your pastor or congregation health-ministry coordinator about it. Many of the 45 New York City Black churches that participated in the TRIUMPH pilot did so because a congregation member raised the idea. The Center for Healthy Minds, Bodies, and Spirits at Columbia, which Hankerson leads, has materials available for pastors and lay leaders who want to start. (Direct contact: Columbia University Department of Psychiatry, NYSPI.)
Second, if you or someone in your family has screened positive on a depression questionnaire in primary care and has not pursued the referral, you are inside the exact gap the TRIUMPH trial is designed to close. The evidence does not say the referral is wrong; the evidence says the referral has not historically been accepted by Black adults at meaningful rates. A trusted intermediary, whether a Community Health Worker, a culturally competent therapist, or a pastor who has done the training, dramatically increases the odds that the referral converts to a clinical visit. Asking your primary-care provider whether such an intermediary is available locally is a concrete next step.
Third, if you are a clinician, a public-health-funder, or a policymaker reading this, the 4.68-fold remission-odds finding in the Hall et al. meta-analysis is the most-cited empirical case for funding culturally adapted interventions specifically. Programs that pair clinical mental-health resources with community-trusted-intermediary delivery have measurable effects. The cluster-randomized TRIUMPH results, when published, will refine that case for the church-specific context.
Related coverage on blackhealth.org
This article is part of an ongoing cluster on Black mental-health coverage at blackhealth.org. Related pieces include our coverage of Black-male mental health (the DeRozan and Denzel Washington pieces under /black-mens-mental-health/), our piece on finding a Black therapist (the Factory 3 directory work), and our coverage of the recent FDA approval of Auvelity for Alzheimer's-related agitation, which surfaced parallel evidence on Black-patient under-treatment in psychiatric care.
Citations and primary sources
- Hankerson SH, Weissman MM. Church-based health programs for mental disorders among African Americans: a review. Psychiatric Services. 2012;63(3):243-9. PMID: 22388529. https://pubmed.ncbi.nlm.nih.gov/22388529/
- Hankerson SH, Shelton R, Weissman M, Wells KB, Teresi J, Mallaiah J et al. Study protocol for comparing Screening, Brief Intervention, and Referral to Treatment (SBIRT) to referral as usual for depression in African American churches. Trials. 2022;23(1):102. PMID: 35101100. https://pubmed.ncbi.nlm.nih.gov/35101100/
- Hall GCN, Ibaraki AY, Huang ER, Marti CN, Stice E. A Meta-Analysis of Cultural Adaptations of Psychological Interventions. Behavior Therapy. 2016;47(6):993-1014. PMID: 27993346. https://pubmed.ncbi.nlm.nih.gov/27993346/
