Improving treatment of depression among Latinos with diabetes using project Dulce and IMPACT

Abstract

Objective: To assess the feasibility and cost of integrating diabetes and depression care management in three community clinics serving a low-income and predominantly Spanish-speaking Latino population.

Research design and methods: We screened diabetes patients for depression, and for those with depressive symptoms, we provided depression care management. We assessed changes in depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), diabetes self-care activities (nutrition, exercise, and medication adherence), and costs.

Results: Thirty-three percent of patients with diabetes had symptoms of major depression. Among 99 patients completing the study, PHQ-9 scores declined by an average of 7.5 points from 14.8 to 7.3 (P < 0.001). Clients averaged 6.7 visits with the care manager during the study period. Costs of depression care management were estimated to be $512 per participant.

Conclusions: Adding a depression care manager to an existing diabetes management team was effective at reducing depressive symptoms at a reasonable cost.

Figures

Figure 1—

Box plot showing depressive symptoms at baseline and 6-month follow-up: median, horizontal line through box; inter-quartile range, box; highest and lowest PHQ-9 scores, whiskers; and outlier PHQ-9 scores, dots.