title: Participation in and impact of a depression care management program targeting low-income minority patients in an urban community-based clinic.
abstract: BACKGROUND
  African American people experience disproportionately higher rates of chronic depression, and among those affected, the condition is less likely to be detected and treated than in non-Hispanic white people.
  
  
  OBJECTIVE
  To address this disparity in our primary care clinic, we introduced a validated framework for detecting and managing depression.
  
  
  METHODS
  Over a 5-year period, there were 146 patients diagnosed as having depression and enrolled in a depression care management program. We evaluated the feasibility and effectiveness of that program using baseline and follow-up screening data from the Patient Health Questionnaire-9.
  
  
  RESULTS
  The mean baseline severity score of 20.60 was reduced to 15.89 at 6 months (P < 0.001) and to 16.62 at 12 months. Patients achieved their best score, a mean of 12.93, 10.14 months after baseline (P < 0.001). The last mean severity score, after 15.47 months, was 14.60, a significant difference compared with baseline (P < 0.001). Although baseline severity scores for both groups were similar (P = 0.534), patients who remained engaged with the program demonstrated better scores and achieved greater severity score reductions from baseline to the last measure (P < 0.001). This study did not find any differences between the sexes when comparing PHQ-9 scores at baseline (P = 0.074), 6 months (P = 0.303), and 12 months (P = 0.429) and best (P = 0.875) and last (P = 0.640) scores.
  
  
  CONCLUSIONS
  Most of the improvement was witnessed in the first 10 months of treatment. Patients with more medical comorbidities participated longer in the study than patients with fewer comorbidities. Further research could elicit the relationship between improvement in mental health and medical conditions.
authors.affiliation: Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: John G
authors.initials: JG
authors.lastname: Ryan
authors.affiliation: Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Ushimbra
authors.initials: U
authors.lastname: Buford
authors.affiliation: Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Erika
authors.initials: E
authors.lastname: Arias
authors.affiliation: Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, Florida. Electronic address: IVittoria@miami.med.edu.
authors.forename: Isabel
authors.initials: I
authors.lastname: Alfonsin-Vittoria
authors.affiliation: Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Mark
authors.initials: M
authors.lastname: Fedders
authors.affiliation: Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Terri
authors.initials: T
authors.lastname: Jennings
authors.affiliation: Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: William
authors.initials: W
authors.lastname: Grubb
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D010358:Patient Participation / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000458:organization & administration / Q000592:standards*
keywords: African American; care management; depression; minority; primary care; psychiatry