This project will be an intervention study among Latinos with both depressive symptoms and diabetes andwill build upon existing expertise among our EXPORT Center faculty. Recently, Dr. Mangione (Co PrincipalInvestigator of this project) demonstrated that a self-care intervention improves diabetes outcomes for olderLatinos. However, 30% of these older Latinos were depressed, and the intervention did not result inimproved diabetes outcomes for this subset of depressed diabetics. Dr. Miranda (Co-Principal Investigator ofthis project) has demonstrated that Cognitive Behavioral Therapy is highly effective for treating depression inlow-income Latinos and has recently modified this depression intervention so that it can be given by nonmentalhealth professionals. Thus, our Center is uniquely positioned to examine this combined intervention,which will be studied using a randomized design in 340 Latino subjects recruited at the Northeast SanFernando Valley and Hubert Humphrey Comprehensive Health Centers. We hypothesize that theintervention group, which will receive both interventions, will display significant improvement in both diabetesand depression outcomes compared to the control group will receive the self-management interventionalone. This project will also serve as a training opportunity for several EXPORT junior investigators withinterest and expertise in diabetes and depression, allowing them to build upon initial work they haveperformed in these fields under the mentorship or Drs. Mangione, Miranda and other participating seniorfaculty.
The Specific Aims of this project are:
Specific Aim 1 : To evaluate the impact of a 12-week mood treatment enhanced self-care diabetesintervention as compared with a self-care diabetes intervention alone for older depressed Latino diabetics:1.a. To determine if the combined mood/self-care intervention results in lowered hemoglobin A1c ascompared with a self-care intervention alone, at 3 and 6 months.1.b. To determine if the combined mood/self-care intervention results in lowered depressivesymptoms as compared with a self-care intervention alone, at 3 and 6 months.1 .c. To determine if the combined mood/self-care intervention results in improved self-care fordiabetes as compared with a self-care intervention alone, at 3 and 6 months.
Specific Aim 2. To support dissemination of positive findings from our intervention to the communitythrough our ongoing participation in the Community Core with the Witness for Wellness and Building Bridgesto Optimum Health-Diabetes Throughout the Lifespan community dissemination projects.
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