Clinical trial NCT00260169: Determining Depression Treatment Preferences of Low-Income Latinos in Primary Care Settings
Official title: Patient-Centered Depression Care in the Public Sector
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Depression
Keywords: Treatment Preferences
Public sector
Latino
Lead sponsor: University of Southern California
Sponsor class: OTHER
Collaborators: name: National Institute of Mental Health (NIMH)
First posted: 2005-12-01
Enrollment: 432
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study will determine ways to make depression care more responsive to the needs of consumers in primary care clinics serving low-income Latinos.

Detailed description: Depression is a serious illness that is difficult to diagnose and treat, especially in populations that underutilize mental health services. The Latino population is one such group. Accommodating patient preferences for care, provider capacities, and administrator priorities is essential to the development of effective depression care interventions that are sustainable in public sector systems. However, little is understood regarding the depression treatment preferences of low-income Latinos who have not received quality depression care and who may not feel that they can voice their opinions about their health care. In addition, little is known about the preferences, capabilities, and priorities of providers and administrators in primary care clinics. This study will determine ways to make depression care more responsive to the needs of consumers in primary care clinics serving low-income Latinos. The study will also evaluate the effectiveness of various treatments in reducing depression.

Following baseline assessments of depression treatment preferences and resources, participants in this open label study will be randomly assigned to receive collaborative care either immediately or after a waiting period. Individuals assigned to receive immediate care will undergo treatment for 12 weeks. Other participants will receive treatment at a later time. All participants will have the option to receive one of the following treatments: (1) medication management from the Depression Care Specialist (DCS) and antidepressant medication from their primary care provider (PCP); (2) cognitive-behavioral therapy from the DCS; or (3) a combination of both treatments. Depression treatment outcomes and preferences will be measured post-intervention. Provider and administrator preferences will also be measured post-intervention and potential strategies for implementing patient-centered depression care programs will be identified.

Eligibility criteria: Inclusion Criteria:

For Participating Patients:

* Attending one of the study clinics for primary care
* English or Spanish-speaking
* Screens positive for major depressive disorder or dysthymia

For Providers:

* All primary care providers providing at least one day of services at one of the study clinics

For Administrators:

* Administrative, medical, and nursing directors from each study site and directors of affiliated local mental health clinics

Exclusion Criteria:

For Participating Patients:

* Acutely suicidal
* Screens positive for bipolar disorder, psychotic disorder, or cognitive impairment

Primary outcomes:
measure: Depression treatment preferences as measured by a conjoint analysis survey and qualitative interviews
timeFrame: Measured at Week 16
Secondary outcomes:
measure: Depression outcomes as measured by the Patient Health Questionnaire-9
timeFrame: Measured at Week 16
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: H. Claude Hudson Comprehensive Health Center
state: California
city: Los Angeles
country: United States
facility: USC Family Practice Center at California Hospital
state: California
city: Los Angeles
country: United States
facility: LAC+USC Outpatient Department
state: California
Study officials:
affiliation: University of Southern California
name: Isabel T. Lagomasino, MD, MSHS
role: PRINCIPAL_INVESTIGATOR
affiliation: VA Medical Center-West Los Angeles
name: Megan Dwight-Johnson, MD, MPH
role: PRINCIPAL_INVESTIGATOR
References:
citation: Dwight-Johnson M, Lagomasino IT, Hay J, Zhang L, Tang L, Green JM, Duan N. Effectiveness of collaborative care in addressing depression treatment preferences among low-income Latinos. Psychiatr Serv. 2010 Nov;61(11):1112-8. doi: 10.1176/ps.2010.61.11.1112.