title: The association of patient relationship style and outcomes in collaborative care treatment for depression in patients with diabetes.
abstract: OBJECTIVE
  We sought to determine whether relationship style in patients with diabetes receiving depression treatment is associated with differential quality of care and depression outcomes.
  
  
  METHODS
  From 9 health maintenance organization clinics, 324 primary care patients with diabetes and comorbid major depression and/or dysthymia participated in the Pathways randomized controlled trial of collaborative care for depression (n = 160) versus usual care (n = 164). The intervention provided outreach, enhanced support of antidepressant medication use, and problem-solving treatment delivered by nurse case managers. Using attachment theory principles, we categorized patients as having an independent (n = 190) or interactive (n = 134) relationship style. We assessed whether patient relationship style moderated treatment group differences in quality of care and depression outcomes.
  
  
  RESULTS
  Among independent relationship style patients, the intervention resulted in significantly greater satisfaction with depression care in the first 6 months and 47 more depression-free days (P < 0.0003) based on the Hopkins Symptom Checklist at 12 months, compared with usual care. There were no significant treatment group differences in satisfaction with care or depression outcomes among patients with interactive relationship style. Among patients receiving the intervention, those with an independent relationship style received significantly more problem-solving treatment sessions as compared with patients with an interactive relationship style.
  
  
  CONCLUSIONS
  Among depressed patients with diabetes, the Pathways collaborative care intervention improved quality of care for depression compared with usual care in both relationship style groups but was associated with significantly better depressive outcomes and greater satisfaction with care compared with usual care in patients with independent but not interactive relationship style.
authors.affiliation: Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA. pavelcie@u.washington.edu
authors.forename: Paul S
authors.initials: PS
authors.lastname: Ciechanowski
authors.forename: Joan E
authors.initials: JE
authors.lastname: Russo
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Simon
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
mesh_terms: D000368:Aged; D003299:Cooperative Behavior; D003625:Data Collection; D003863:Depression / Q000628:therapy*; D003920:Diabetes Mellitus / Q000523:psychology*; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D014481:United States