Collaborative Depression Care Management in Treating Depressed Low-income Hispanics With Diabetes
Collaborative Depression Care Management in Treating Depressed Low-income Hispanics With Diabetes
This study will evaluate the effectiveness of culturally adapted depression treatment for
 reducing depressive symptoms and improving adherence to diabetes self-care regimens in
 Hispanics with depression and diabetes.
Diabetes, a disease in which the body does not properly produce or use insulin, is the fifth
 leading cause of death among Hispanics in the United States. The risk of comorbid depression
 among diabetics is twice as high as that of the general population, with depression rates
 among diabetic Hispanics as high as 33%. Symptoms of depression include feelings of sadness,
 anxiety, and guilt; lack of energy; changes in appetite; and lack of pleasure in previously
 enjoyed activities. These symptoms can make maintaining good diabetic management and
 self-care regimens difficult. Fortunately, depression is treatable with forms of
 psychotherapy and antidepressant medications. However, depression treatment adherence and
 response rates among the Hispanic population, especially among Hispanics of low
 socio-economic status, are lower than those of the general population. Depression treatment
 that is specifically adapted for the Hispanic culture may be best at helping diabetic
 Hispanics stick to their treatment and self-care plans. This study will evaluate the
 effectiveness of culturally adapted depression treatment for reducing depressive symptoms and
 improving adherence to diabetes self-care regimens in low-income Hispanics with depression
 and diabetes.

 Participation in this study will last 18 months. All participants will first undergo baseline
 assessments that will include a 40-minute interview about personal health and feelings.
 Eligible participants will then be assigned randomly to receive either collaborative
 depression care management or enhanced usual care.

 Participants assigned to receive collaborative depression care management 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 participants receiving
 collaborative depression care management will also receive supportive patient navigation
 services and maintenance/relapse telephone monitoring.

 Participants assigned to enhanced usual care will receive an educational pamphlet on
 depression and a list of mental health resources in the community. Participants' primary care
 doctors will be free to prescribe antidepressant medication or provide other usual care. All
 participants will undergo follow-up phone interviews about their status at Months 6, 12, and
 18.
Inclusion Criteria:

 -  Meets criteria for major depression based on a score of greater than 2 for five or
 more symptoms, including one of the two cardinal depression symptoms and a nine-item
 depression scale of the Patient Health Questionnaire (PHQ-9) score of greater than 10

 -  Patient with diabetes

 -  Has attended two community safety net clinics

 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