title: Improving depression care in patients with diabetes and multiple complications.
abstract: BACKGROUND
  Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications.
  
  
  OBJECTIVE
  To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who had 2 or more complications as in patients with diabetes who had fewer complications.
  
  
  METHODS
  The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications.
  
  
  METHODS
  Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan.
  
  
  METHODS
  Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist. Diabetes complications were determined from automated patient records.
  
  
  RESULTS
  The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced similar reductions in depressive symptoms in both intervention and usual care.
  
  
  CONCLUSIONS
  Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems.
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98101, USA. lskinder@stanfordalumni.org
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Kinder
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.forename: Greg
authors.initials: G
authors.lastname: Simon
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales