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

OBJECTIVE — To 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 METHODS — This 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. Inter-vention (INT group) included problem-solving therapy and/or antidepressant medication based on a stepped-care algorithm; first-line treatment choice; telephone treatment response, adher-ence, 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 depres-sion educational pamphlets and a community resource list. RESULTS — INT 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 i