TY - JOUR
KW - Adult
KW - Antidepressive Agents/therapeutic use
KW - Depressive Disorder, Major/drug therapy
KW - Diabetes Mellitus/psychology
KW - Female
KW - Hispanic Americans
KW - Humans
KW - Income
KW - Male
KW - Middle Aged
KW - Young Adult
AU - K. Ell
AU - W. Katon
AU - B. Xie
AU - P. J. Lee
AU - S. Kapetanovic
AU - J. Guterman
AU - C. P. Chou
A1 - 
AB - 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 (> or =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.
BT - Diabetes care
C5 - Healthcare Disparities
CP - 4
CY - United States
DO - 10.2337/dc09-1711
IS - 4
JF - Diabetes care
N2 - 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 (> or =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.
PP - United States
PY - 2010
SN - 1935-5548; 0149-5992
SP - 706
EP - 713
EP - 
T1 - Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial
T2 - Diabetes care
TI - Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial
U1 - Healthcare Disparities
U2 - 20097780
U3 - 10.2337/dc09-1711
VL - 33
VO - 1935-5548; 0149-5992
Y1 - 2010
ER -