Background: Recent, large randomized controlled trials focusing on depression treatment alone among persons with diabetes and heart disease have failed to show improved cardiovascular or diabetes outcomes. Benefits for depression outcomes have been variable in these trials, as cardiovascular disease and diabetes are also correlated with less favorable depression prognosis. An integrated approach may be needed to improve both depression and medical outcomes. Research goal: We propose to test a Chronic Disease-Focused Depression Treatment model enhancing both major depression and co-morbid chronic disease management in patients with poor disease control. We will test this intervention in a complex and difficult to treat patient population: depressed patients with poorly controlled diabetes and/or coronary heart disease (CHD). If we find that disease-focused depression treatment improves depression, chronic disease, and disability outcomes, it will accelerate adoption of evidence-based depression care for patients in general medical settings. Theoretical framework: This research will test Piette's conceptual framework for managing depression and comorbid chronic disease, emphasizing reciprocal effects of depression and chronic disease. Study design: Disease-Focused Depression Treatment will be assessed through a randomized controlled trial in which 300 persons with poorly controlled diabetes or CHD and major depression/dysthymia are assigned to either: 1) a depression treatment program that addresses management of comorbid disease;or 2) care as usual. We will screen 6400 persons with poorly controlled diabetes and/or CHD (blood pressure, glycemic, lipid dyscontrol) for depression and enroll 300 of these patients in the trial. Primary and secondary outcomes: We will evaluate the effectiveness over a 2-year period of Chronic Disease-Focused Depression Treatment for patients with depression and co-morbid diabetes and/or CHD who are poorly controlled. The primary measures of effectiveness of Disease-Focused Depression Treatment, relative to a usual care, will be effects on depressive symptoms and the percentage of patients with successful management of all three disease control measures (glycemic, blood pressure and lipid control). Secondary process and outcome measures will include functional disability, adherence to prescribed medications and disease self-management behaviors (i.e. physical activity and nutrition).

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH041739-22
Application #
7898568
Study Section
Services Research Review Committee (SRV)
Program Officer
Azrin, Susan
Project Start
1987-07-01
Project End
2012-07-31
Budget Start
2010-08-01
Budget End
2012-07-31
Support Year
22
Fiscal Year
2010
Total Cost
$472,256
Indirect Cost
Name
University of Washington
Department
Psychiatry
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
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Yu, Margaret K; Katon, Wayne; Young, Bessie A (2013) Diabetes self-care, major depression, and chronic kidney disease in an outpatient diabetic population. Nephron Clin Pract 124:106-12
Yu, Margaret K; Lyles, Courtney Rees; Bent-Shaw, Luis A et al. (2012) Risk factor, age and sex differences in chronic kidney disease prevalence in a diabetic cohort: the pathways study. Am J Nephrol 36:245-51
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Lin, Elizabeth H B; Von Korff, Michael; Ciechanowski, Paul et al. (2012) Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial. Ann Fam Med 10:6-14
McGregor, Mary; Lin, Elizabeth H B; Katon, Wayne J (2011) TEAMcare: an integrated multicondition collaborative care program for chronic illnesses and depression. J Ambul Care Manage 34:152-62

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