One-year postcollaborative depression care trial outcomes among predominantly Hispanic diabetes safety net patients

Abstract

Objective To determine sustained effectiveness in reducing depression symptoms and improving depression care one year following intervention completion. Method Of 387 low-income, predominantly Hispanic diabetes patients with major depression symptoms randomized to 12-month socio-culturally adapted collaborative care (psychotherapy and/or antidepressants, telephone symptom monitoring/relapse prevention) or enhanced usual care, 264 patients completed two-year follow-up. Depression symptoms (SCL-20, PHQ-9), treatment receipt, diabetes symptoms, and quality of life were assessed 24 months post-enrollment using intent-to-treat analyses. Results At 24 months, more intervention patients received ongoing antidepressant treatment (38% v 25%, chi-square=5.11, df=1, P=0.02); sustained depression symptom improvement (SCL-20<0.5 (adjusted OR=2.06, 95%CI=1.09–3.90, P=0.03), SCL-20 score (adjusted mean difference −0.22, P=0.001), and PHQ-9 ≥50% reduction (adjusted OR=1.87, 95%CI=1.05–3.32, P=0.03). Over 2 years, improved effects were found in significant study group by time interaction for SF-12 mental health, SDS functional impairment, diabetes symptoms, anxiety, and socioeconomic stressors (P=0.02 for SDS, P<0.0001 for all others); however, group differences narrowed over time and were no longer significant at 24 months. Conclusions Socio-culturally tailored collaborative care that included maintenance antidepressant medication, ongoing symptom monitoring and behavioral activation relapse prevention was associated with depression improvement over 24 months for predominantly Hispanic patients in primary safety net care.

Type 2 diabetes, depressive symptoms and disability over a 15-year follow-up period in older Mexican Americans living in the southwestern United States

“…Patients with long-term type 2 diabetes should be screened routinely for depression during annual exams (Ell et al, 2011; Abrams et al, 2015). However, evidence still suggests that depression is often undiagnosed or unrecognized among Hispanics due to cultural and linguistic barriers between health professionals and patients, despite its high prevalence (Dilsaver and Akiskal, 2005).…”

“…The Center for Epidemiologic Studies-Depression (CES-D) has high reliability at detecting high depressive symptoms among Hispanics with chronic diseases, including type 2 diabetes (Ell et al, 2015; Glassy et al, 2010; Ell et al, 2011). Using established cutpoints (Black et al, 2003), we created three categories representing no depressive symptoms (0 CES-D score), minor depressive symptoms (1-15 CES-D score) or significant depressive symptomology (16+ CES-D score).…”

Serious Psychological Distress and Diabetes: A Review of the Literature

“…African Americans with diabetes have been shown to be much less likely to report taking antidepressant medication than whites [32]. Among Hispanics, long-term antidepressant treatment did not have an association with diabetes outcomes [33]. However, in a randomized controlled trial, a socially and culturally adapted problem-solving and medication therapy intervention was associated with better medical, emotional, physical, and pain-related functioning [34].…”

“…Ell et al [33] (2011) Socio-culturally tailored collaborative care, including maintenance antidepressant medication, symptom monitoring, and behavioral activation relapse prevention, was associated with depression improvement over 24 months.…”

Improvement in Depressive Symptoms Among Hispanic/Latinos Receiving a Culturally Tailored IMPACT and Problem-Solving Intervention in a Community Health Center

“…Depressive symptoms were measured over a 6 month-period where participants took part in a culturally-tailored IMPACT model delivered by trained paraprofessional mental health workers that were defined as Depression Care Specialists (DCS). Given that culturally tailored supportive treatment has proven to improve symptoms of chronic diseases, such as diabetes, (Ell K; Ell et al, 2011), a culturally modified IMPACT model was used to meet the needs and characteristics of the patient population in the targeted community health center. Based on this rationale, we hypothesized that individuals receiving a culturally tailored IMPACT intervention delivered by a DCS would demonstrate a sustained improvement in their depressive symptoms over a 6 month period as measured by the PHQ-9.…”