Depression and diabetes among low-income Hispanics: design elements of a socioculturally adapted collaborative care model randomized controlled trial.
Depression and diabetes among low-income Hispanics: design elements of a socioculturally adapted collaborative care model randomized controlled trial.
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DOI：
10.2190/pm.39.2.a
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发表时间：
2009
影响因子：
2
通讯作者：
Guterman J
中科院分区：
文献类型：
--
作者：
Ell K;Katon W;Cabassa LJ;Xie B;Lee PJ;Kapetanovic S;Guterman J
本文介绍了多方面抑郁症和糖尿病计划（MDDP）随机临床试验的设计要素。MDDP试验假设，社会文化适应的协作护理抑郁症管理干预将减少抑郁症状，改善患者对糖尿病自我护理方案的依从性，血糖控制和生活质量。此外，对387例低收入、96%为西班牙裔、入选的重度抑郁症和糖尿病患者的基线数据进行了检查，以确定与试验设计适应性一致的研究人群特征。使用PHQ-9抑郁量表从两个社区安全网诊所中识别符合重度抑郁障碍标准（1项主要抑郁症状+PHQ-9评分≥ 10）的患者。设计要素包括社会文化适应招聘和努力减少减员和协作抑郁症护理管理。在接受筛查的1,803名糖尿病患者中，30.2%符合重度抑郁症的标准。在387例入组临床试验的患者中，98%患有2型糖尿病，83%的糖化血红蛋白（HbA 1c）水平≥ 7%。研究招募率和基线数据分析确定了支持试验设计和干预调整的社会经济和临床因素。抑郁的严重程度与糖尿病并发症、医疗并发症、更大的焦虑、心境恶劣、经济担忧、社会压力和更差的生活质量显著相关。低收入西班牙裔糖尿病患者抑郁症患病率高，抑郁症的严重程度与社会经济压力和临床严重程度相关。改善公共部门诊所西班牙裔患者的抑郁症护理管理应包括干预措施，以解决糖尿病和社会经济压力的自我护理。
This article describes design elements of the Multifaceted Depression and Diabetes Program (MDDP) randomized clinical trial. The MDDP trial hypothesizes that a socioculturally adapted collaborative care depression management intervention will reduce depressive symptoms and improve patient adherence to diabetes self-care regimens, glycemic control, and quality-of-life. In addition, baseline data of 387 low-income, 96% Hispanic, enrolled patients with major depression and diabetes are examined to identify study population characteristics consistent with trial design adaptations. The PHQ-9 depression scale was used to identify patients meeting criteria for major depressive disorder (1 cardinal depression symptom + a PHQ-9 score of ≥ 10) from two community safety net clinics. Design elements included sociocultural adaptations in recruitment and efforts to reduce attrition and collaborative depression care management. Of 1,803 diabetes patients screened, 30.2% met criteria for major depressive disorder. Of 387 patients enrolled in the clinical trial, 98% had Type 2 diabetes, and 83% had glycated hemoglobin (HbA1c) levels ≥ 7%. Study recruitment rates and baseline data analyses identified socioeconomic and clinical factors that support trial design and intervention adaptations. Depression severity was significantly associated with diabetes complications, medical comorbidity, greater anxiety, dysthymia, financial worries, social stress, and poorer quality-of-life. Low-income Hispanic patients with diabetes experience high prevalence of depressive disorder and depression severity is associated with socioeconomic stressors and clinical severity. Improving depression care management among Hispanic patients in public sector clinics should include intervention components that address self-care of diabetes and socioeconomic stressors.