title: Collaborative health literate depression care among predominantly Hispanic patients with coronary heart disease in safety net care.
abstract: OBJECTIVE
  To determine whether evidence-based socioculturally health literate-adapted collaborative depression care improves depression care, depressive symptoms, and quality of life among predominantly Hispanic patients with coronary heart disease.
  
  
  METHODS
  The 12-month trial included 97 patients with coronary heart disease (79% of eligible patients) who met the depression criteria assessed by the Patient Health Questionnaire-9. Patients were recruited from 3 safety net clinics and offered depression team care by a bilingual clinical social worker and community patient navigator, a consulting psychiatrist, and a primary care physician. The team provided problem-solving therapy (PST) or pharmacotherapy or both, telephone symptom monitoring and behavioral activation, and patient resource navigation support. Recruited patients were given patient and family member health literacy-adapted educational and community resource materials in Spanish or English.
  
  
  RESULTS
  Overall, depression treatment was 74% (PST, 55%; PST plus antidepressant medications, 18%; and antidepressant medications alone, 2%). Nearly half of the patients showed a 50% reduction of the Symptom Checklist-20 (49% at 6 mo and 48% at 12 mo) and of Patient Health Questionnaire-9 score with 47% of patients at 6 months and 43% at 12 months. The 50% improvement in Patient Health Questionnaire and Symptom Checklist-20 score reduction did not vary significantly between patients who received PST or antidepressant only or those who received PST plus antidepressant. The quality of life Short-Form Health Survey SF-12, the Minnesota Living with Heart Failure questionnaire, and the Sheehan Disability Scale outcomes also improved significantly.
  
  
  CONCLUSIONS
  Socioculturally literacy-adapted collaborative depression care was accepted by patients with coronary heart disease and improved depression care and symptoms, quality of life, and functional outcomes among predominantly Hispanic patients with heart disease.
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL). Electronic address: ell@usc.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ell
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL).
authors.forename: Hyunsung
authors.initials: H
authors.lastname: Oh
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL).
authors.forename: Pey-Jiuan
authors.initials: PJ
authors.lastname: Lee
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Services, Los Angeles County, Los Angeles, CA (JG).
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Guterman
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D001521:Behavior Therapy; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000150:complications / Q000208:ethnology* / Q000523:psychology; D065246:Culturally Competent Care / Q000379:methods; D003863:Depression / Q000150:complications / Q000208:ethnology* / Q000628:therapy; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011569:Psychiatric Status Rating Scales; D064876:Safety-net Providers / Q000706:statistics & numerical data*
chemical_list: D000928:Antidepressive Agents