Collaborative Care Management of Major Depression Among Low-Income, Predominantly Hispanic Subjects With Diabetes

A randomized controlled trial

  1. Chih-Ping Chou, PHD6
  1. 1School of Social Work, University of Southern California, Los Angeles, California;
  2. 2Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington;
  3. 3School of Community and Global Health, Claremont Graduate University, San Dimas, California;
  4. 4Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, California;
  5. 5David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles County Department of Health Services, Los Angeles, California;
  6. 6Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
  1. Corresponding author: Kathleen Ell, ell{at}usc.edu.

Abstract

OBJECTIVE To determine whether evidence-based socioculturally adapted collaborative depression care improves receipt of depression care and depression and diabetes outcomes in low-income Hispanic subjects.

RESEARCH DESIGN AND METHODS This was a randomized controlled trial of 387 diabetic patients (96.5% Hispanic) with clinically significant depression recruited from two public safety-net clinics from August 2005 to July 2007 and followed over 18 months. Intervention (INT group) included problem-solving therapy and/or antidepressant medication based on a stepped-care algorithm; first-line treatment choice; telephone treatment response, adherence, and relapse prevention follow-up over 12 months; plus systems navigation assistance. Enhanced usual care (EUC group) included standard clinic care plus patient receipt of depression educational pamphlets and a community resource list.

RESULTS INT patients had significantly greater depression improvement (≥50% reduction in Symptom Checklist-20 depression score from baseline; 57, 62, and 62% vs. the EUC group's 36, 42, and 44% at 6, 12, and 18 months, respectively; odds ratio 2.46–2.57; P < 0.001). Mixed-effects linear regression models showed a significant study group–by–time interaction over 18 months in diabetes symptoms; anxiety; Medical Outcomes Study Short-Form Health Survey (SF-12) emotional, physical, and pain-related functioning; Sheehan disability; financial situation; and number of social stressors (P = 0.04 for disability and SF-12 physical functioning, P < 0.001 for all others) but no study group–by–time interaction in A1C, diabetes complications, self-care management, or BMI.

CONCLUSIONS Socioculturally adapted collaborative depression care improved depression, functional outcomes, and receipt of depression treatment in predominantly Hispanic patients in safety-net clinics.

Footnotes

  • Clinical trial reg. no. NCT00709150, clinicaltrials.gov.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received September 14, 2009.
    • Accepted January 17, 2010.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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  1. Diabetes Care vol. 33 no. 4 706-713
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