Collaborative Care Management of Major Depression among Low-Income, Predominantly His
 

Objective-To determine whether evidence-based socio-culturally adapted collaborative depression care improves receipt depression care, receipt, and depression and diabetes outcomes in low-income Hispanics.
Research design and methods -A randomized controlled trial of 387 diabetes patients (96.5% Hispanic) with clinically significant depression, recruited from two public safety net clinics August 2005 to July 2007 and followed over 18 months. Intervention (INT) included: Problem Solving Therapy and/or antidepressant medication based on a stepped care algorithm, first-line treatment choice, telephone treatment response/adherence/and relapse prevention follow-up over 12 months, plus systems navigation assistance. Enhanced usual care (EUC) included standard clinic care plus patient receipt of depression educational pamphlets and a community resource list.
Results -
Intervention patients had significantly greater depression improvement (≥50% reduction in SCL-20 depression score from baseline) (57%, 62%, 62% versus EUC 36%, 42%, 44% at 6, 12, 18 months, respectively; OR 2.46-2.57; P