Christopher G Kemp1, Leslie C M Johnson2, Rajesh Sagar3, Subramani Poongothai4, Nikhil Tandon5, Ranjit Mohan Anjana6, Sosale Aravind7, Gumpeny R Sridhar8, Shivani A Patel9, Karl Emmert-Fees10, Deepa Rao11, K M V Narayan9, Viswanathan Mohan6, Mohammed K Ali12, Lydia A Chwastiak13. 1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. 2. Department of Family and Preventive Medicine, School of Medicine, Emory University, 1518 Clifton Rd, Atlanta 30322, USA. 3. Department of Psychiatry, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India. 4. Department of Clinical Trials, Madras Diabetes Research Foundation, No 4, Conran Smith Road, Gopalapuram, Chennai 600086, India. 5. Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029, India. 6. Department of Diabetology, Madras Diabetes Research Foundation, No 4, Conran Smith Road, Gopalapuram, Chennai 600086, India. 7. Diabetes Care and Research Center, Diacon Hospital, 359 - 360, 19th Main Rd, 1st Block, Rajajinagar, Bangalore, Karnataka 560010, India. 8. Endocrine and Diabetes Centre, 15-12-16, Krishna Nagar Visakhapatnam, Visakhapatnam 530002, Andhra Pradesh, India. 9. Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta 30322, USA. 10. Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Department of Sport and Health Sciences, Technical University of Munich, Connollystraße 32, 80809 Munich, Germany. 11. Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA 98195, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA 98104, USA. 12. Department of Family and Preventive Medicine, School of Medicine, Emory University, 1518 Clifton Rd, Atlanta 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta 30322, USA. 13. Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA 98104, USA. Electronic address: lchwast@uw.edu.
Abstract
OBJECTIVE: We assessed the impact of a collaborative care intervention on anxiety symptoms among participants in India with comorbid depression, poorly controlled diabetes, and moderate to severe anxiety symptoms. METHOD: We analyzed data from a randomized controlled trial conducted at four diabetes clinics in India. Participants received either collaborative care or usual care. We included only participants who scored ⩾10 on the Generalized Anxiety Disorder-7 (GAD-7) at baseline. We estimated the effect of the intervention on clinically significant reduction in anxiety symptoms; we considered several potential baseline moderators and mediation by anti-depressant use. RESULTS: One hundred and seventy-two participants scored 10 or above on the GAD-7 at baseline. Collaborative care participants were more likely than control participants to achieve a clinically significant reduction in anxiety symptoms at 6 and 12 months (65.7% vs. 41.4% at 12 months, p = 0.002); these differences were not sustained at 18 or 24 months. There was little evidence of moderation by participant characteristics at baseline, and effects were not mediated by anti-depressant use. CONCLUSIONS: Collaborative care for the treatment of depression and type 2 diabetes can lead to clinically significant reductions in anxiety symptoms among patients with anxiety. Effects were notable during the active intervention period but not over the year post-intervention.
OBJECTIVE: We assessed the impact of a collaborative care intervention on anxiety symptoms among participants in India with comorbid depression, poorly controlled diabetes, and moderate to severe anxiety symptoms. METHOD: We analyzed data from a randomized controlled trial conducted at four diabetes clinics in India. Participants received either collaborative care or usual care. We included only participants who scored ⩾10 on the Generalized Anxiety Disorder-7 (GAD-7) at baseline. We estimated the effect of the intervention on clinically significant reduction in anxiety symptoms; we considered several potential baseline moderators and mediation by anti-depressant use. RESULTS: One hundred and seventy-two participants scored 10 or above on the GAD-7 at baseline. Collaborative care participants were more likely than control participants to achieve a clinically significant reduction in anxiety symptoms at 6 and 12 months (65.7% vs. 41.4% at 12 months, p = 0.002); these differences were not sustained at 18 or 24 months. There was little evidence of moderation by participant characteristics at baseline, and effects were not mediated by anti-depressant use. CONCLUSIONS: Collaborative care for the treatment of depression and type 2 diabetes can lead to clinically significant reductions in anxiety symptoms among patients with anxiety. Effects were notable during the active intervention period but not over the year post-intervention.
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