USC Study Finds Better Ways Of Treating Hispanics With Depression

A recent clinical trial finds that providing culturally sensitive care can have a marked effect on reducing depression among low-income, predominantly Hispanic diabetes patients.

The study’s results are important, given that Hispanics in the United States have the highest lifetime risk for diabetes—with instances in females of 52.5 percent and 45.4 percent in males. Further, diabetes sufferers are at a two-fold higher risk of clinical depression than the general population.

The study is featured in the April 2010 issue of Diabetes Care, published by the American Diabetes Association.

“We believe this trial got the attention of such a high-impact journal because this is such a disadvantaged and underserved population,” said principal investigator Kathleen Ell, the Ernest P. Larson Professor of Poverty, Ethnicity and Health at the University of Southern California School of Social Work. “They face a lot of barriers to receiving appropriate treatment—everything from language and cultural barriers to getting time off work.”

The research team—which included faculty from the University of Washington, the Keck School of Medicine of USC and the USC School of Pharmacy, as well as the medical director of the Los Angeles County Department of Health Services Clinical Resource Management program—recruited 387 diabetes patients suffering from depression to participate in the trial. The patients, recruited from two Los Angeles public safety-net clinics between August 2005 and July 2007, were randomized to either modestly enhanced usual care or collaborative stepped care and then followed over 18 months.

The more successful depression-care model tested was attentive to socio-culturally driven patient treatment preferences, including psycho-education to dispel treatment misconceptions, reduce stigma and enhance therapeutic alliance. Bilingual social workers, with psychiatrist supervision, worked directly with primary care physicians, providing patients with problem-solving skill training to enhance diabetes and depression self-management and cope with socioeconomic stress, as well as patient navigation assistance to facilitate patient-doctor communication and to help them access needed financial and social resources. The model also featured relapse-prevention and behavioral activation to encourage treatment adherence over 12 months.

Almost all patients in the intervention group preferred psychotherapy instead of medication to treat their depression. If they did not respond to therapy alone, they became more open to antidepressant medication after building a relationship with the social worker, Ell says. Having a social worker to talk with also helped ensure patients adhered to their medication regimen.

“Side effects are very common in antidepressants,” explains Ell. “But a patient may have no side effects by switching to a different medication. Guided by an evidence-based stepped care algorithm, we set it up so the social worker consulted the study psychiatrist via telephone and then communicated directly with the prescribing primary care physician if the medication needed to be adjusted.”

The above intervention program was compared with a model of modestly enhanced usual care, which included standard clinic care, along with patient receipt of depression educational pamphlets and a community resource list. The study found that the intervention patients had significantly greater depression and quality of life improvement over those who only received enhanced usual care.

The study concluded that providing collaborative, culturally sensitive acute and maintenance care that includes facilitating access to socioeconomic resources and is organizationally integrated within safety-net care systems is likely to have a noticeable effect on decreasing disparities in depression care among low-income Hispanic patients with diabetes. In response to the study, the Los Angeles County Department ofHealth Services already has hired social workers to provide such intervention on an ongoing basis. The study team is now conducting comparative cost analyses of the two care models.

About the USC School of Social Work
The University of Southern California’s School of Social Work ranks among the nation’s top 10 social work graduate programs and maintains the oldest social work master’s and PhD programs in the West. With its reputation for educational excellence, cultural diversity and research funding, the school prepares students for leadership roles in public and private organizations that serve individuals, families and communities in need. The USC School of Social Work was the first to endow a center for interdisciplinary social work research—the Hamovitch Center for Science in the Human Services—and remains a pioneer in translational research, experiential learning and academic innovation.