CONTEXT: Impoverished minority women experience a higher burden from depression than do white women because they are less likely to receive appropriate care. Little is known about the effectiveness of guideline-based care for depression with impoverished minority women, most of whom do not seek care. OBJECTIVE: To determine the impact of an intervention to deliver guideline-based carefor depression compared with referral to community care with low-income and minority women. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial conducted in the Washington, DC, suburban area from March 1997 through May 2002 of 267 women with current major depression, who attended county-run Women, Infants, and Children food subsidy programs and Title X family planning clinics. Outcomes Hamilton Depression Rating Scale measured monthly from baseline through 6 months; instrumental role functioning (Social Adjustment Scale) and social functioning (Short Form 36-Item Health Survey) measured at baseline and 3 and 6 months. INTERVENTIONS: Participants were randomly assigned to an antidepressant medication intervention (trial of paroxetine switched to buproprion, if lack of response) (n = 88), a psychotherapy intervention (8 weeks of manual-guided cognitive behavior therapy) (n = 90), or referral to community mental health services (n = 89). RESULTS: Both the medication intervention (P<.001) and the psychotherapy intervention (P =.006) reduced depressive symptoms more than the community referral did. The medication intervention also resulted in improved instrumental role (P =.006) and social (P =.001) functioning. The psychotherapy intervention resulted in improved social functioning (P =.02). Women randomly assigned to receive medications were twice as likely (odds ratio, 2.04; 95% confidence interval, 0.98-4.27; P =.057) to achieve a Hamilton Depression Rating Scale score of 7 or less by month 6 as were those referred to community care. CONCLUSIONS: Guideline-concordant care for major depression is effective for these ethnically diverse and impoverished patients. More women engaged in a sufficient duration of treatment with medications compared with psychotherapy, and outcome gains were more extensive and robust for medications.
RCT Entities:
CONTEXT: Impoverished minority women experience a higher burden from depression than do white women because they are less likely to receive appropriate care. Little is known about the effectiveness of guideline-based care for depression with impoverished minority women, most of whom do not seek care. OBJECTIVE: To determine the impact of an intervention to deliver guideline-based care for depression compared with referral to community care with low-income and minority women. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial conducted in the Washington, DC, suburban area from March 1997 through May 2002 of 267 women with current major depression, who attended county-run Women, Infants, and Children food subsidy programs and Title X family planning clinics. Outcomes Hamilton Depression Rating Scale measured monthly from baseline through 6 months; instrumental role functioning (Social Adjustment Scale) and social functioning (Short Form 36-Item Health Survey) measured at baseline and 3 and 6 months. INTERVENTIONS:Participants were randomly assigned to an antidepressant medication intervention (trial of paroxetine switched to buproprion, if lack of response) (n = 88), a psychotherapy intervention (8 weeks of manual-guided cognitive behavior therapy) (n = 90), or referral to community mental health services (n = 89). RESULTS: Both the medication intervention (P<.001) and the psychotherapy intervention (P =.006) reduced depressive symptoms more than the community referral did. The medication intervention also resulted in improved instrumental role (P =.006) and social (P =.001) functioning. The psychotherapy intervention resulted in improved social functioning (P =.02). Women randomly assigned to receive medications were twice as likely (odds ratio, 2.04; 95% confidence interval, 0.98-4.27; P =.057) to achieve a Hamilton Depression Rating Scale score of 7 or less by month 6 as were those referred to community care. CONCLUSIONS: Guideline-concordant care for major depression is effective for these ethnically diverse and impoverished patients. More women engaged in a sufficient duration of treatment with medications compared with psychotherapy, and outcome gains were more extensive and robust for medications.
Authors: Nancy K Grote; Jeffrey A Bridge; Amelia R Gavin; Jennifer L Melville; Satish Iyengar; Wayne J Katon Journal: Arch Gen Psychiatry Date: 2010-10
Authors: Donna J Keyser; Ellen Burke Beckjord; Ray Firth; Sarah Frith; Susan L Lovejoy; Sanjith Pillai; Dana Schultz; Harold Alan Pincus Journal: Rand Health Q Date: 2011-03-01
Authors: Wayne Katon; Joan Russo; Susan D Reed; Carmen A Croicu; Evette Ludman; Anna LaRocco; Jennifer L Melville Journal: Am J Psychiatry Date: 2014-10-31 Impact factor: 18.112
Authors: Lynn Boschloo; Ella Bekhuis; Erica S Weitz; Mirjam Reijnders; Robert J DeRubeis; Sona Dimidjian; David L Dunner; Boadie W Dunlop; Ulrich Hegerl; Steven D Hollon; Robin B Jarrett; Sidney H Kennedy; Jeanne Miranda; David C Mohr; Anne D Simons; Gordon Parker; Frank Petrak; Stephan Herpertz; Lena C Quilty; A John Rush; Zindel V Segal; Jeffrey R Vittengl; Robert A Schoevers; Pim Cuijpers Journal: World Psychiatry Date: 2019-06 Impact factor: 49.548