title: Telephone-based cognitive-behavioral therapy for Latino patients living in rural areas: a randomized pilot study.
abstract: OBJECTIVE
  This pilot study tested the effectiveness of culturally tailored, telephone-based cognitive-behavioral therapy (CBT) for improving depression outcomes among Latino primary care patients living in rural settings.
  
  
  METHODS
  A total of 101 Latino patients at a rural family medical center who met criteria for probable major depression were randomly assigned to enhanced usual care or eight sessions of CBT delivered by phone by trained bilingual therapists from the community. Blinded study assistants assessed depression symptom severity, using the Hopkins Symptom Checklist (SCL) depression items and the Patient Health Questionnaire-9, and patient satisfaction after six weeks, three months, and six months. Mixed-effects models were used to estimate intervention effects over time. For cross-sectional analyses, attrition weights were used to account for missing data.
  
  
  RESULTS
  In intent-to-treat analyses, patients who received CBT by phone were more likely to experience improvement in depression scores over the six-month follow-up period compared with patients who received enhanced usual care (β=-.41, t=-2.36, df=219, p=.018, for the SCL; and β=-3.51, t=-2.49, df=221, p=.013, for the PHQ-9). A greater proportion of patients in the CBT group than in the group that received enhanced usual care achieved treatment response at three months (p=.017), as indicated by a 50% improvement in SCL depression score or a score <.75, and reported high satisfaction with treatment (p=.013).
  
  
  CONCLUSIONS
  Although limited by small sample size, pilot results suggest culturally tailored, telephone-based CBT has the potential to enhance access to psychotherapy in an underserved Latino population with little access to mental health services.
authors.affiliation: Department of Behavioral Sciences, RAND Corporation, 1776 Main St., Santa Monica, CA 90401, USA. meganj@rand.org
authors.forename: Megan
authors.initials: M
authors.lastname: Dwight-Johnson
authors.forename: Eugene
authors.initials: E
authors.lastname: Aisenberg
authors.forename: Daniela
authors.initials: D
authors.lastname: Golinelli
authors.forename: Seunghye
authors.initials: S
authors.lastname: Hong
authors.forename: Mary
authors.initials: M
authors.lastname: O'Brien
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D017060:Patient Satisfaction; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012424:Rural Population; D017216:Telemedicine / Q000379:methods; D013689:Telephone; D016896:Treatment Outcome; D014861:Washington