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

Abstract

OBJECTIVETo 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 METHODSThis 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.RESULTSINT 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.CONCLUSIONSSocioculturally adapted collaborative depression care improved depression, functional outcomes, and receipt of depression treatment in predominantly Hispanic patients in safety-net clinics.

Cognitive Behavioral Therapy Versus Sertraline in Patients With Depression and Poorly Controlled Diabetes: The Diabetes and Depression (DAD) Study

“…Previous trials in the research field of diabetes and depression to a large extent included primary care patients (e.g., [12,13]) and the rare positive effects on glycemic control were mainly seen in studies conducted in primary care patients (13,38,39). In contrast, we recruited participants exclusively from secondary care study sites.…”

“…These included the measurement of depression with SCID and HAMD interviews by trained clinical psychologists (instead of questionnaires, as in some important trials on this topic [12,13]), the video-controlled monitoring of adherence of psychologists to the CBT manual, the establishment of an independent scientific advisory board, the data management, and data validation with intense validation strategies. Finally, we limited bias due to center or investigator effects by including eight clinical psychologists and 70 trial sites across Germany.…”

“…The overall result for glycemic control is controversial, mostly due to severe methodological limitations and the heterogeneity of the examined populations and interventions (11). In addition, collaborative care studies with sound methodology (e.g., studies by Ell et al [12] and Katon et al [13]), tested the efficacy of this approach as a whole. However, these studies were not able to identify single effective components of compound treatments or evaluate the superiority of one single treatment over another because of a design that allowed a switch between pharmacological and psychological interventions.…”

Anxiety and diabetes: Innovative approaches to management in primary care

“…[82][83][84][85][86][87] These models involve routine depression screening among individuals with uncontrolled diabetes, on-site care managers providing between-visit phone calls to assess diabetes self-care adherence, and on-site behavioral health providing brief interventions and SMG during the clinic visit. CCMs of diabetes and depression yield improvements in depression-related outcomes, [87][88][89][90][91] increased adherence to diabetes and depression self-management, 92,93 and decreased rates of mortality, compared to usual care. 94 Limited quantitative data are available supporting the association of collaborative care with improvement in HbA1c; however, one study showed that the incorporation of health coaching into diabetes management was associated with accelerated HbA1c reduction and improved mood as measured by Hospital Anxiety and Depression Scale (HADS).…”

Understanding Barriers to Retention after a Clinical Treatment Trial Drop Out: Translating Qualitative Research and Theory to Practice

“…This study identifies many of the same barriers found in the literature that categorize Latino clinical trial retention barriers: familial relationships and issues [22], lack of transportation, employment interferences [23], economic stress [24] and financial costs [25], insufficient caregiving resources to meet demands [26], practical barriers [24,27], like interference with other top priorities of life such as work and family obligations [26], and systems barriers [28][29][30]. Andersen and Newman's [16] framework helps illuminate new and important Predisposing "Psychological Coping" Belief barriers specific to this co-morbid population, that are not specifically indicated in the literature (i.e., "feeling better;" "not interested;" "emotional stress;" grief over "loss;" untreated panic attacks; and anxiety over fertility issues).…”