OBJECTIVE: This study examines clinical predictors of symptom deterioration (relapse/recurrence) at the completion of a clinical intervention trial of depressed, low-income, predominantly Hispanic diabetes patients who were randomized to socio-culturally adapted collaborative depression treatment or usual care and who no longer met clinically significant depression criteria at 12 months post-trial baseline. METHODS: A sub-cohort of 193 diabetes patients with major depression symptoms at baseline, who were randomized to a 12-month collaborative care intervention (INT) (problem-solving therapy and/or pharmacotherapy, telephone symptom monitoring/relapse prevention, behavioral activation and patient navigation support) or enhanced usual care (EUC), and who did not meet major depression criteria at 12 months were subsequently observed over 18 to 24 months. RESULTS: Post-trial depression symptom deterioration was similar between INT (35.2%) and EUC (35.3%) groups. Among the combined groups, significant predictors of symptom deterioration were baseline history of previous depression and/or dysthymia (odds ratio [OR] = 2.66), 12-month PHQ-9 score (OR = 1.22), antidepressant treatment receipt during the initial 12-months (OR = 2.38), 12-month diabetes symptoms (OR = 2.27), and new ICD-9 medical diagnoses in the initial 12 months (OR = 1.11) (R2 = 27%; max-rescaled R2 = 37%; likelihood ratio test, χ2 = 59.79, df = 5, P < 0.0001). CONCLUSIONS: Among predominantly Hispanic diabetes patients in community safety net primary care clinics whose depression had improved over 1 year, more than one-third experienced symptom deterioration over the following year. A primary care management depression care protocol that includes ongoing depression symptom monitoring, antidepressant adherence, and diabetes and co-morbid illness monitoring plus depression medication adjustment and behavioral activation may reduce and/or effectively treat depression symptom deterioration.
RCT Entities:
OBJECTIVE: This study examines clinical predictors of symptom deterioration (relapse/recurrence) at the completion of a clinical intervention trial of depressed, low-income, predominantly Hispanic diabetespatients who were randomized to socio-culturally adapted collaborative depression treatment or usual care and who no longer met clinically significant depression criteria at 12 months post-trial baseline. METHODS: A sub-cohort of 193 diabetespatients with major depression symptoms at baseline, who were randomized to a 12-month collaborative care intervention (INT) (problem-solving therapy and/or pharmacotherapy, telephone symptom monitoring/relapse prevention, behavioral activation and patient navigation support) or enhanced usual care (EUC), and who did not meet major depression criteria at 12 months were subsequently observed over 18 to 24 months. RESULTS: Post-trial depression symptom deterioration was similar between INT (35.2%) and EUC (35.3%) groups. Among the combined groups, significant predictors of symptom deterioration were baseline history of previous depression and/or dysthymia (odds ratio [OR] = 2.66), 12-month PHQ-9 score (OR = 1.22), antidepressant treatment receipt during the initial 12-months (OR = 2.38), 12-month diabetes symptoms (OR = 2.27), and new ICD-9 medical diagnoses in the initial 12 months (OR = 1.11) (R2 = 27%; max-rescaled R2 = 37%; likelihood ratio test, χ2 = 59.79, df = 5, P < 0.0001). CONCLUSIONS: Among predominantly Hispanic diabetespatients in community safety net primary care clinics whose depression had improved over 1 year, more than one-third experienced symptom deterioration over the following year. A primary care management depression care protocol that includes ongoing depression symptom monitoring, antidepressant adherence, and diabetes and co-morbid illness monitoring plus depression medication adjustment and behavioral activation may reduce and/or effectively treat depression symptom deterioration.
Authors: Loes C Lanting; Inez M A Joung; Johan P Mackenbach; Steven W J Lamberts; Aart H Bootsma Journal: Diabetes Care Date: 2005-09 Impact factor: 19.112
Authors: Raz Gross; Mark Olfson; Marc J Gameroff; Olveen Carasquillo; Steven Shea; Adriana Feder; Rafael Lantigua; Milton Fuentes; Myrna M Weissman Journal: J Gen Intern Med Date: 2005-05 Impact factor: 5.128
Authors: Maria E Garcia; Lisa Ochoa-Frongia; Nathalie Moise; Adrian Aguilera; Alicia Fernandez Journal: J Gen Intern Med Date: 2017-12-18 Impact factor: 5.128
Authors: Jessica L McCurley; Angela P Gutierrez; Julia I Bravin; Neil Schneiderman; Samantha A Reina; Tasneem Khambaty; Sheila F Castañeda; Sylvia Smoller; Martha L Daviglus; Matthew J O'Brien; Mercedes R Carnethon; Carmen R Isasi; Krista M Perreira; Greg A Talavera; Mingan Yang; Linda C Gallo Journal: Ann Behav Med Date: 2019-10-07