Multifaceted Depression and Cardiovascular Program
Multifaceted Depression and Cardiovascular Program
1. Implement an evidence-based structured care approach that includes screening; acute
 treatment and relapse prevention follow-up tailored for public sector clinics and
 low-income and minority patients.

 2. Adapt an evidence-based collaborative care model for primary care, implement the adapted
 model, evaluate and further refine the model based on the pilot experience, and produce
 and disseminate a detailed manual for use in public sector clinics.

 3. Evaluate Multifaceted Depression and Cardiovascular Program (MDCP) in an open trial to
 determine: its acceptance by patients, medical providers, and organizational
 decision-makers; patient depression treatment adherence; its direct cost; and the size
 and variability of change from baseline in the primary outcome measures: depressive
 symptoms, functional status, quality of life, health service use, and cardiac status at
 6 and 12 month follow-up.
The pilot open trial was conducted to evaluate the effectiveness of a health services quality
 improvement intervention, Multifaceted Depression and Cardiovascular Program (MDCP), on
 reduction of major depressive disorder, adherence to recommended cardiac exercise and diet
 self-care regimens and appointment keeping, blood pressure and low density lipid levels,
 functional status, quality of life and use of health services among low-income, predominantly
 Hispanic adults with congestive heart failure (CHF) or other cardiac disease such as coronary
 artery disease (CAD) in public sector community-based primary care clinics. The study was
 based on key observations from recent studies: 1) Patients with cardiac conditions are more
 likely to experience clinically significant depressive symptoms than the general population,
 with depression being associated with poor cardiac outcomes; 2) depression rates are high
 among Hispanics with chronic illness; 3) Minority patients are less likely to receive care
 for depression, but benefit with culturally appropriate care enhancements; and 4) depression
 co-morbid with cardiac conditions is likely to be persistent. Low-income patient needs,
 depression illness characteristics, and public care system resources call for a multifaceted,
 collaborative chronic disease management model of depression care. MDCP is aimed at
 positively affecting depression and cardiac outcomes by reducing known patient, provider, and
 system barriers to care.

 Participation in this study will last 12 months. All participants will first undergo baseline
 assessments that will include a 40-minute interview about personal health and feelings. All
 study participants will receive collaborative depression care management. They will first be
 provided with information about depression treatment. Participants will then have the option
 of choosing between two depression treatments: counseling or antidepressant medications.
 Participants who choose to receive treatment with counseling will receive eight weekly
 45-minute counseling sessions, conducted either on the phone or at the clinic. During these
 sessions, participants will undergo structured problem solving therapy (PST) and will learn
 strategies to manage their depressive symptoms. Participants who choose to receive treatment
 with antidepressant medication will be prescribed medication by a study doctor and will be
 monitored for any side effects throughout treatment. Medication treatment may last up to 12
 months but will depend upon participants' severity of depression. After completing medication
 treatment, participants will be offered PST counseling. All study participants will also
 receive supportive patient navigation services and maintenance/relapse telephone monitoring.

 All participants will undergo follow-up phone interviews about their status at months 6 and
 12.
Inclusion Criteria:

 -  Meets criteria for clinically significant depression based on a score of ≥ 2 for one
 of the two cardinal depression symptoms (depressed mood or loss of interest) and a
 Patient Health Questionnaire-9 total score of ≥ 10

 -  Patient with heart disease

 -  Has attended Los Angeles County Department of Health Services Comprehensive Health
 Clinics or the Cardiology Clinic at Los Angeles County+University of Southern
 California Medical Center

 Exclusion Criteria:

 -  Current suicidal ideation

 -  Score of 8 or greater on the Alcohol Use Disorders Identification Test (AUDIT)

 -  Recent use of lithium or antipsychotic medication