title: One-year postcollaborative depression care trial outcomes among predominantly Hispanic diabetes safety net patients.
abstract: OBJECTIVE
  The aim of this study was to determine sustained effectiveness in reducing depression symptoms and improving depression care 1 year following intervention completion.
  
  
  METHODS
  Of 387 low-income, predominantly Hispanic diabetes patients with major depression symptoms randomized to 12-month socioculturally adapted collaborative care (psychotherapy and/or antidepressants, telephone symptom monitoring/relapse prevention) or enhanced usual care, 264 patients completed 2-year follow-up. Depression symptoms (Symptom Checklist-20 [SCL-20], Patient Health Questionnaire-9 [PHQ-9]), treatment receipt, diabetes symptoms and quality of life were assessed 24 months postenrollment using intent-to-treat analyses.
  
  
  RESULTS
  At 24 months, more intervention patients received ongoing antidepressant treatment (38% vs. 25%, χ(2)=5.11, df=1, P=.02); sustained depression symptom improvement [SCL-20 <0.5 (adjusted odds ratio=2.06, 95% confidence interval=1.09-3.90, P=.03), SCL-20 score (adjusted mean difference -0.22, P=.001) and PHQ-9 ≥50% reduction (adjusted odds ratio=1.87, 95% confidence interval =1.05-3.32, P=.03)]. Over 2 years, improved effects were found in significant study group by time interaction for Short Form-12 mental health, Sheehan Disability Scale (SDS) functional impairment, diabetes symptoms, anxiety and socioeconomic stressors (P=.02 for SDS; P<.0001 for all others); however, group differences narrowed over time and were no longer significant at 24 months.
  
  
  CONCLUSIONS
  Socioculturally tailored collaborative care that included maintenance antidepressant medication, ongoing symptom monitoring and behavioral activation relapse prevention was associated with depression improvement over 24 months for predominantly Hispanic patients in primary safety net care.
authors.affiliation: School of Social Work, MRF 102R (MC 0411), University of Southern California, Los Angeles, CA 90089-0411, 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; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003299:Cooperative Behavior; D003466:Cultural Characteristics; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D057194:Intention to Treat Analysis; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011203:Poverty; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents