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

Kathleen Ell, Wayne Katon, Bin Xie, Pey-Jiuan Lee, Suad Kapetanovic, Jeffrey Guterman, Chih-Ping Chou, Kathleen Ell, Wayne Katon, Bin Xie, Pey-Jiuan Lee, Suad Kapetanovic, Jeffrey Guterman, Chih-Ping Chou

Abstract

Objective: The aim of this study was to determine sustained effectiveness in reducing depression symptoms and improving depression care 1 year following intervention completion.

Method: Of 387 low-income, predominantly Hispanic diabetes patients with major depression symptoms randomized to 12-month socioculturally adapted collaborative care (psychotherapy and/or antidepressants, telephone symptom monitoring/relapse prevention) or enhanced usual care, 264 patients completed 2-year follow-up. Depression symptoms (Symptom Checklist-20 [SCL-20], Patient Health Questionnaire-9 [PHQ-9]), treatment receipt, diabetes symptoms and quality of life were assessed 24 months postenrollment using intent-to-treat analyses.

Results: At 24 months, more intervention patients received ongoing antidepressant treatment (38% vs. 25%, χ(2)=5.11, df=1, P=.02); sustained depression symptom improvement [SCL-20 <0.5 (adjusted odds ratio=2.06, 95% confidence interval=1.09-3.90, P=.03), SCL-20 score (adjusted mean difference -0.22, P=.001) and PHQ-9 ≥50% reduction (adjusted odds ratio=1.87, 95% confidence interval =1.05-3.32, P=.03)]. Over 2 years, improved effects were found in significant study group by time interaction for Short Form-12 mental health, Sheehan Disability Scale (SDS) functional impairment, diabetes symptoms, anxiety and socioeconomic stressors (P=.02 for SDS; P<.0001 for all others); however, group differences narrowed over time and were no longer significant at 24 months.

Conclusions: Socioculturally 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.

Trial registration: ClinicalTrials.gov NCT00709150.

Conflict of interest statement

Disclosures: No potential conflicts of interest relevant to this article were reported.

Copyright © 2011 Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
MDDP CONSORT Diagram
Figure 2
Figure 2
Intervention vs control differences in mean depression scores Mean depression scores from SCL-20 (range, 0–4) and PHQ-9 (range, 0–27) adjusted for study site, birth place, language, years in US, and baseline SCL-20 score, dysthymia, and number of stressors. Error bars indicate standard errors. Significant group difference in mean SCL-20 was observed at all follow-up points (P≤.001), as well as significant group difference in mean PHQ-9 at 6, 12, and 18 months (P≤.001).

References

    1. Lanting LC, Joung I, Mackenbach JP, Lamberts SW, Boostma AH. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients. Diabetes Care. 2005;28:2280–2288.
    1. Li C, Ford ES, Strine TW, Mokdad AH. Prevalence of depression among U.S. adults with diabetes: findings from the 2006 behavioral risk factor surveillance system. Diabetes Care. 2008;31:105–107.
    1. Gross R, Olfson M, Gameroff MJ, et al. Depression and glycemic control in Hispanic primary care patients with diabetes. J Gen Intern Med. 2005;20:460–466.
    1. Burcusa SL, Iacono WG. Risk for recurrence in depression. Clin Psychol Rev. 2007;27:959–985.
    1. Lustman P, Griffith LS, Freedland KE, Clouse RE. The course of major depression in diabetes. Gen Hosp Psychiatry. 1997;19:138–143.
    1. Cabassa LJ, Hansen MC, Palinkas LA, Ell K. Azúcar y nervios: explanatory models and treatment experiences of Hispanics with diabetes and depression. Soc Sci Med. 2008;66:2413–2424.
    1. Vega WA, Rodriguez MA, Ang A. Addressing stigma of depression in Latino primary care patients. Gen Hosp Psychiatry. 2010;32:182–191.
    1. Fernandez Y, Garcia E, Franks P, Jerant A, Bell RA, Kravitz RL. Depression treatment preferences of Hispanic individuals: exploring the influence of ethnicity, language, and explanatory models. J Am Board Fam Med. 2011;24:39–50.
    1. Givens JL, Houston TK, Van Voorhees BW, Ford DE, Cooper LA. Ethnicity and preferences for depression treatment. Gen Hosp Psychiatry. 2007;29:182–191.
    1. Ell K, Sanchez K, Vourlekis B, et al. Depression, correlates of depression and receipt of depression care among low-income women with breast or gynecological cancer. J Clin Oncol. 2005;23:3052–3060.
    1. Karasz A, Watking L. Conceptual models of treatment in depressed Hispanic patients. Ann Fam Med. 2006;4:527–533.
    1. Ell K, Katon W, Cabassa LJ, et al. Depression and diabetes among low-income Hispanics: design elements of a socio-culturally adapted collaborative care model randomized controlled trial. Int J Psychiatry Med. 2009;39:113–132.
    1. Ell K, Katon W, Xie B, et al. Collaborative care management of major depression among low-income predominantly Hispanics with diabetes: a randomized controlled trial. Diabetes Care. 2010;33:706–713.
    1. Ell K, Xie B, Quon B, Quinn DI, Dwight-Johnson M, Lee PJ. Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. J Clin Oncol. 2008;26:4488–4496.
    1. Ell K, Xie B, Kapetanovic S, et al. One-year follow-up of collaborative depression care for low-income, predominantly Hispanic patients with cancer. Psychiatr Serv. 2011;62:162–170.
    1. Palinkas L, Ell K, Hansen M, Cabassa L, Wells A. Sustainability of collaborative care interventions in primary care settings. J Soc Work. 2011;11:99–117.
    1. Dwight-Johnson M, Lagomasino IT, Hay J, et al. Effectiveness of collaborative care in addressing depression treatment preferences among low-income Latinos. Psychiatr Services. 2010;61:1112–1118.
    1. Ware J, Kosinski M, Keller S. How to score the SF-12 physical and mental health summary scales. Boston: New England Medical Center, The Health Institute. 1995
    1. Whitty P, Steen N, Eccles M, et al. A new self-completion outcome measure for diabetes: is it responsive to change? Qual Life Res. 1997;6:407–413.
    1. Toobert DJ, Hampson SE, Russell E. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–950.
    1. Horton NJ, Lipsitz SR. Review of software to fit generalized estimating equation regression models. Am Statistician. 1999;53:160–169.
    1. Liang KY, Beaty TH, Cohen BH. Application of odds ratio regression models for assessing familial aggregation from case-control studies. Am J Epidemiol. 1986;124:678–683.
    1. Zeger SL, Liang KY. An overview of methods for the analysis of longitudinal data. Stat Med. 1992;11:1825–1839.
    1. Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. New Jersey: John Wiley and Sons; 2004.
    1. Little RJ. Regression with missing X's: a review. J Am Stat Assoc. 1992;87:1227–1237.
    1. Rubin DB. Multiple imputation for nonresponse in surveys. New York: John Wiley and Sons; 1987.
    1. SOLAS software. Saugus, MA: Statistical Solution Ltd.; 2001. Retrieved from .
    1. Hunkeler EM, Katon W, Tang L, et al. Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ. 2006;332:259–263.
    1. Katon WJ, Von Korff M, Lin EH, et al. The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatr. 2004;61:1042–1049.
    1. Heckbert S, Rutter CM, Oliver M, et al. Depression in relation to long-term control of glycemia, blood pressure, and lipids in patients with diabetes. J Gen Intern Med. 2010;25:524–529.
    1. Markowitz S, Gonzalez JS, Wilkinson JL, Safren SA. Treating depression in diabetes: emerging findings. Psychosomatics. 2011;52:1–8.
    1. van der Feltz-Cornelis CM, Nuyen J, Stoop C, et al. Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2010;32:389–395.
    1. Katon WJ, Russo JE, Von Korff M, et al. Long-term effects on medical costs of improving depression outcomes in patients with depression and diabetes. Diabetes Care. 2008;31:1155–1159.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe