Treating depression in predominantly low-income young minority women: a randomized controlled trial.
BACKGROUND
Impoverished minority women experience a higher burden from depression than do white women because they are less likely to receive appropriate care. Little is known about the effectiveness of guideline-based care for depression with impoverished minority women, most of whom do not seek care.


OBJECTIVE
To determine the impact of an intervention to deliver guideline-based care for depression compared with referral to community care with low-income and minority women.


METHODS
A randomized controlled trial conducted in the Washington, DC, suburban area from March 1997 through May 2002 of 267 women with current major depression, who attended county-run Women, Infants, and Children food subsidy programs and Title X family planning clinics. Outcomes Hamilton Depression Rating Scale measured monthly from baseline through 6 months; instrumental role functioning (Social Adjustment Scale) and social functioning (Short Form 36-Item Health Survey) measured at baseline and 3 and 6 months.


METHODS
Participants were randomly assigned to an antidepressant medication intervention (trial of paroxetine switched to buproprion, if lack of response) (n = 88), a psychotherapy intervention (8 weeks of manual-guided cognitive behavior therapy) (n = 90), or referral to community mental health services (n = 89).


RESULTS
Both the medication intervention (P<.001) and the psychotherapy intervention (P =.006) reduced depressive symptoms more than the community referral did. The medication intervention also resulted in improved instrumental role (P =.006) and social (P =.001) functioning. The psychotherapy intervention resulted in improved social functioning (P =.02). Women randomly assigned to receive medications were twice as likely (odds ratio, 2.04; 95% confidence interval, 0.98-4.27; P =.057) to achieve a Hamilton Depression Rating Scale score of 7 or less by month 6 as were those referred to community care.


CONCLUSIONS
Guideline-concordant care for major depression is effective for these ethnically diverse and impoverished patients. More women engaged in a sufficient duration of treatment with medications compared with psychotherapy, and outcome gains were more extensive and robust for medications.
Miranda
Jeanne
J
Health Services Research Center, University of California at Los Angeles Neuropsychiatric Institute, CA 90024, USA. mirandaj@ucla.edu
Chung
Joyce Y
JY
Green
Bonnie L
BL
Krupnick
Janice
J
Siddique
Juned
J
Revicki
Dennis A
DA
Belin
Tom
T
D000328:Adult; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003156:Community Mental Health Services; D003866:Depressive Disorder / Q000191:economics / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008913:Minority Groups; D011203:Poverty; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D016896:Treatment Outcome
D000928:Antidepressive Agents