title: Depressive symptom deterioration among predominantly Hispanic diabetes patients in safety net care.
abstract: OBJECTIVE
  This study examines clinical predictors of symptom deterioration (relapse/recurrence) at the completion of a clinical intervention trial of depressed, low-income, predominantly Hispanic diabetes patients who were randomized to socio-culturally adapted collaborative depression treatment or usual care and who no longer met clinically significant depression criteria at 12 months post-trial baseline.
  
  
  METHODS
  A sub-cohort of 193 diabetes patients with major depression symptoms at baseline, who were randomized to a 12-month collaborative care intervention (INT) (problem-solving therapy and/or pharmacotherapy, telephone symptom monitoring/relapse prevention, behavioral activation and patient navigation support) or enhanced usual care (EUC), and who did not meet major depression criteria at 12 months were subsequently observed over 18 to 24 months.
  
  
  RESULTS
  Post-trial depression symptom deterioration was similar between INT (35.2%) and EUC (35.3%) groups. Among the combined groups, significant predictors of symptom deterioration were baseline history of previous depression and/or dysthymia (odds ratio [OR] = 2.66), 12-month PHQ-9 score (OR = 1.22), antidepressant treatment receipt during the initial 12-months (OR = 2.38), 12-month diabetes symptoms (OR = 2.27), and new ICD-9 medical diagnoses in the initial 12 months (OR = 1.11) (R2 = 27%; max-rescaled R2 = 37%; likelihood ratio test, χ2 = 59.79, df = 5, P < 0.0001).
  
  
  CONCLUSIONS
  Among predominantly Hispanic diabetes patients in community safety net primary care clinics whose depression had improved over 1 year, more than one-third experienced symptom deterioration over the following year. A primary care management depression care protocol that includes ongoing depression symptom monitoring, antidepressant adherence, and diabetes and co-morbid illness monitoring plus depression medication adjustment and behavioral activation may reduce and/or effectively treat depression symptom deterioration.
authors.affiliation: School of Social Work, University of Southern California, Los Angeles 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: 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: Bin
authors.initials: B
authors.lastname: Xie
authors.forename: Chih-Ping
authors.initials: CP
authors.lastname: Chou
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003153:Community Health Services / Q000458:organization & administration*; D015897:Comorbidity; D003299:Cooperative Behavior; D003863:Depression / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D003865:Major Depressive Disorder / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006304:Health Status; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group; D011788:Quality of Life; D012008:Recurrence; D012648:Self Care; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents