Collaborative Care Management of Major Depression Among Low-Income, Predominantly Hispanic Subjects With Diabetes: A randomized controlled trial

• Published in: Diabetes care Vol. 33; no. 4; pp. 706 - 713
• Main Authors: Ell, Kathleen, Katon, Wayne, Xie, Bin, Lee, Pey-Jiuan, Kapetanovic, Suad, Guterman, Jeffrey, Chou, Chih-Ping
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.04.2010
• Subjects: Adult; Algorithms; Antidepressants; Antidepressive Agents; Antidepressive Agents - therapeutic use; anxiety; Biological and medical sciences; body mass index; Depression, Mental; Depressive Disorder, Major; Depressive Disorder, Major - drug therapy; Diabetes; Diabetes Mellitus; Diabetes Mellitus - psychology; Diabetes therapy; Diabetes. Impaired glucose tolerance; drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Evidence-based medicine; Female; Health care; Hispanic or Latino; Hispanics; Humans; Income; linear models; Male; Medical sciences; Metabolic diseases; Middle Aged; Miscellaneous; odds ratio; Original Research; patients; problem solving; psychology; Public health. Hygiene; Public health. Hygiene-occupational medicine; randomized clinical trials; regression analysis; relapse; Studies; surveys; therapeutic use; Young Adult; Endocrinopathy; Mood disorder; Human; Poverty; Socioeconomic status; Diabetes mellitus; Personal income; Income; Depression; Metabolic diseases; Latinamerican; Care; Randomization; Clinical management; Treatment; Randomised controlled trial; Clinical trial; Severe; Hispanic; Endocrinology; Public health
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc09-1711

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.