Abstract

Objective- To determine whether evidence-based socio-culturally adapted collaborative depression care improves receipt depression care, receipt, and depression and diabetes outcomes in low-income Hispanics.

Research design and methods - A randomized controlled trial of 387 diabetes patients (96.5% Hispanic) with clinically significant depression, recruited from two public safety net clinics August 2005 to July 2007 and followed over 18 months. Intervention (INT) 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) included standard clinic care plus patient receipt of depression educational pamphlets and a community resource list.

Results - Intervention patients had significantly greater depression improvement (≥50% reduction in SCL-20 depression score from baseline) (57%, 62%, 62% versus EUC 36%, 42%, 44% at 6, 12, 18 months, respectively; OR 2.46-2.57; P<.001). Mixed-effects linear regression models showed a significant study group by time interaction over 18 months in diabetes symptoms, anxiety, 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, and P<.001 for all others), but no study group by time interaction in HbA_1c, 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.