Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial.
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.
Ell
Kathleen
K
School of Social Work, University of Southern California, Los Angeles, California, USA. ell@usc.edu
Katon
Wayne
W
Xie
Bin
B
Lee
Pey-Jiuan
PJ
Kapetanovic
Suad
S
Guterman
Jeffrey
J
Chou
Chih-Ping
CP
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
D000928:Antidepressive Agents