title: Collaborative depression care management and disparities in depression treatment and outcomes.
abstract: BACKGROUND
  Collaborative depression care management (DCM), by addressing barriers disproportionately affecting patients of racial/ethnic minority and low education, may reduce disparities in depression treatment and outcomes.
  
  
  OBJECTIVE
  To examine the effects of DCM on treatment disparities by education and race/ethnicity in older depressed primary care patients.
  
  
  METHODS
  Analysis of data from the randomized controlled trial Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT).
  
  
  METHODS
  Twenty primary care practices.
  
  
  METHODS
  A total of 396 individuals 60 years or older with major depression. We conducted model-based analysis to estimate potentially differential intervention effects by education, independent of those by race/ethnicity (and vice versa).
  
  
  METHODS
  Algorithm-based recommendations to physicians and care management by care managers.
  
  
  METHODS
  Antidepressant use, depressive symptoms, and intensity of DCM over 2 years.
  
  
  RESULTS
  The PROSPECT intervention had a larger and more lasting effect in less-educated patients. At month 12, the intervention increased the rate of adequate antidepressant use by 14.2 percentage points (pps) (95% confidence interval [CI], 1.7 to 26.4 pps) in the no-college group compared with a null effect in the college-educated group (-9.2 pps [95% CI, -25.0 to 2.7 pps]); at month 24, the intervention reduced depressive symptoms by 2.6 pps on the Hamilton Depression Rating Scale (95% CI, -4.6 to -0.4 pps) in no-college patients, 3.8 pps (95% CI, -6.8 to -0.4) more than in the college group. The intervention benefitted non-Hispanic white patients more than minority patients. Intensity of DCM received by minorities was 60% to 70% of that received by white patients after the initial phase but did not differ by education.
  
  
  CONCLUSIONS
  The PROSPECT intervention substantially reduced disparities by patient education but did not mitigate racial/ethnic disparities in depression treatment and outcomes. Incorporation of culturally tailored strategies in DCM models may be needed to extend their benefits to minorities.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier for
  
  
  CONCLUSIONS
  NCT00279682.
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY 10065, USA. yub2003@med.cornell.edu
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Bao
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ten Have
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
authors.forename: Edward P
authors.initials: EP
authors.lastname: Post
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003299:Cooperative Behavior; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000208:ethnology / Q000628:therapy*; D004522:Educational Status; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents