This project will be an intervention study among Latinos with both depressive symptoms and diabetes and will build upon existing expertise among our EXPORT Center faculty. Recently, Dr. Mangione (Co Principal Investigator of this project) demonstrated that a self-care intervention improves diabetes outcomes for older Latinos. However, 30% of these older Latinos were depressed, and the intervention did not result in improved diabetes outcomes for this subset of depressed diabetics. Dr. Miranda (Co-Principal Investigator of this project) has demonstrated that Cognitive Behavioral Therapy is highly effective for treating depression in low-income Latinos and has recently modified this depression intervention so that it can be given by nonmental health 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 San Fernando Valley and Hubert Humphrey Comprehensive Health Centers. We hypothesize that the intervention group, which will receive both interventions, will display significant improvement in both diabetes and depression outcomes compared to the control group will receive the self-management intervention alone. This project will also serve as a training opportunity for several EXPORT junior investigators with interest and expertise in diabetes and depression, allowing them to build upon initial work they have performed in these fields under the mentorship or Drs. Mangione, Miranda and other participating senior faculty.
The Specific Aims of this project are:
Specific Aim 1 : To evaluate the impact of a 12-week mood treatment enhanced self-care diabetes intervention 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 as compared 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 depressive symptoms 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 for diabetes 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 community through our ongoing participation in the Community Core with the Witness for Wellness and Building Bridges to Optimum Health-Diabetes Throughout the Lifespan community dissemination projects.
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