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.
- 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
- Current suicidal ideation
- Score of 8 or greater on the Alcohol Use Disorders Identification Test (AUDIT)
- Recent use of lithium or antipsychotic medication