Depression and Diabetes among Low-Income Hispanics: Design Elements of a Socio-Culturally Adapted Collaborative Care Model Randomized Controlled Trial

Abstract

Objective This article describes design elements of the Multifaceted Depression and Diabetes Program (MDDP) randomized clinical trial. The MDDP trial hypothesizes that a socioculturally adapted collaborative care depression management intervention will reduce depressive symptoms and improve patient adherence to diabetes self-care regimens, glycemic control, and quality-of-life. In addition, baseline data of 387 low-income, 96% Hispanic, enrolled patients with major depression and diabetes are examined to identify study population characteristics consistent with trial design adaptations. Methods The PHQ-9 depression scale was used to identify patients meeting criteria for major depressive disorder (1 cardinal depression symptom + a PHQ-9 score of ≥ 10) from two community safety net clinics. Design elements included sociocultural adaptations in recruitment and efforts to reduce attrition and collaborative depression care management. Results Of 1,803 diabetes patients screened, 30.2% met criteria for major depressive disorder. Of 387 patients enrolled in the clinical trial, 98% had Type 2 diabetes, and 83% had glycated hemoglobin (HbA1c) levels ≥ 7%. Study recruitment rates and baseline data analyses identified socioeconomic and clinical factors that support trial design and intervention adaptations. Depression severity was significantly associated with diabetes complications, medical comorbidity, greater anxiety, dysthymia, financial worries, social stress, and poorer quality-of-life. Conclusion Low-income Hispanic patients with diabetes experience high prevalence of depressive disorder and depression severity is associated with socioeconomic stressors and clinical severity. Improving depression care management among Hispanic patients in public sector clinics should include intervention components that address self-care of diabetes and socioeconomic stressors.

Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study

“…Although minority and low income patients may be at higher risk for depression, other studies have reported that these patient groups are significantly less likely to be screened and treated for depression [20,21,48]. Effective depression treatments are available [22,24,25,49,50], and the continuity of health care to optimally manage diabetes presents an opportunity to detect and treat depression in populations at risk.…”

Demographic, clinical and psychosocial factors identify a high-risk group for depression screening among predominantly Hispanic patients with Type 2 diabetes in safety net care

“…Relative to White Americans, Black and Hispanic Americans are more likely to experience persistent depressive symptom trajectories [6][7][8]. Thus, there is a need for ongoing enhanced socioenvironmental resources that support diabetes self-management, emotional well-being and glycemic control in this safety net population [9][10][11].…”

Collaborative Depression Care Among Latino Patients in Diabetes Disease Management, Los Angeles, 2011–2013

“…Specifically, decreasing the prevalence of depression in cancer patients significantly improves quality of life and cancer outcomes (10,12). Expanding methods to improve quality of life and clinical outcomes for patients with diabetes, which affects more than 285 million adults worldwide (26), is an additional step to preventing chronic disease progression.…”