title: 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.
  
  
  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.
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, California, USA. ell@usc.edu
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ell
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Bin
authors.initials: B
authors.lastname: Xie
authors.forename: Pey-Jiuan
authors.initials: PJ
authors.lastname: Lee
authors.forename: Suad
authors.initials: S
authors.lastname: Kapetanovic
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Guterman
authors.forename: Chih-Ping
authors.initials: CP
authors.lastname: Chou
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents