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Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial.

Abstract：

OBJECTIVE:To determine whether evidence-based socioculturally adapted collaborative depression care improves receipt of depression care and depression and diabetes outcomes in low-income Hispanic subjects. RESEARCH DESIGN AND METHODS:This was a randomized controlled trial of 387 diabetic patients (96.5% Hispanic) with clinically significant depression recruited from two public safety-net clinics from August 2005 to July 2007 and followed over 18 months. Intervention (INT group) included problem-solving therapy and/or antidepressant medication based on a stepped-care algorithm; first-line treatment choice; telephone treatment response, adherence, and relapse prevention follow-up over 12 months; plus systems navigation assistance. Enhanced usual care (EUC group) included standard clinic care plus patient receipt of depression educational pamphlets and a community resource list. RESULTS:INT patients had significantly greater depression improvement (> or =50% reduction in Symptom Checklist-20 depression score from baseline; 57, 62, and 62% vs. the EUC group's 36, 42, and 44% at 6, 12, and 18 months, respectively; odds ratio 2.46-2.57; P < 0.001). Mixed-effects linear regression models showed a significant study group-by-time interaction over 18 months in diabetes symptoms; anxiety; Medical Outcomes Study Short-Form Health Survey (SF-12) emotional, physical, and pain-related functioning; Sheehan disability; financial situation; and number of social stressors (P = 0.04 for disability and SF-12 physical functioning, P < 0.001 for all others) but no study group-by-time interaction in A1C, diabetes complications, self-care management, or BMI. CONCLUSIONS:Socioculturally adapted collaborative depression care improved depression, functional outcomes, and receipt of depression treatment in predominantly Hispanic patients in safety-net clinics.

journal_name

Diabetes Care

journal_title

Diabetes care

authors

Ell K,Katon W,Xie B,Lee PJ,Kapetanovic S,Guterman J,Chou CP

doi

10.2337/dc09-1711

subject

Has Abstract

pub_date

2010-04-01 00:00:00

pages

706-13

issue

eissn

0149-5992

issn

1935-5548

pii

dc09-1711

journal_volume

pub_type

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Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial.