Patients with diabetes are two times more likely to experience depression than the general population, with depression being associated with poor diabetes outcomes and likely to be persistent. Prevalence of diabetes and its complications among Hispanics is twice that among non-Hispanic Whites, and they are less likely to receive care for depression. A randomized clinical trial will test the effectiveness of a health services quality improvement intervention, Multi-faceted Depression and Diabetes Program (MDDP), on improvement in depressive symptoms over time, patient adherence to diabetes self-care regimens, glycemic control, functional status, and quality of life among low-income Hispanic adults with diabetes. MDDP is aimed at positively affecting depression and diabetes outcomes by reducing socio-cultural patient/family, health care provider, and system barriers to patient access and adherence to guideline depression treatment. MDDP is designed for public sector primary care systems. Intervention enhancements include: depression care management based on a stepped care depression treatment algorithm; extension of the primary care management team with a master's degreed social worker, who acts as Diabetes Depression Clinical Specialist (DDCS) in collaboration with primary care physicians (PMDs) and a Case Manager; a psychiatric consultant to provide supervision of the DDCS and consultation to the PMD; DDCS treatment adherence and outcome monitoring and feedback to primary care providers; and PMD education on depression management. Cultural sensitivity and competency enhancements include: patient choice of first line treatment (medication/Problem Solving Treatment and degree of family participation in their depression care; PST tailored for Hispanic patients with diabetes; bilingual, bicultural DDCS; Spanish educational materials; and systems navigation services. Usual Care (UC) patients will receive the care and clinic services routinely provided to all patients with diabetes plus an educational pamphlet on depression. The study will be conducted in two large public urban community-based clinics serving low-income, predominantly Hispanic patients. Following a depression screen, 350 adult Hispanic patients with diabetes who meet diagnostic criteria for major depression or dysthymia will be randomized to MDDP or UC. Outcomes will be examined at 6, 12, and18 mo. Relationships between socio-cultural, clinical, clinic organizational factors and depression treatment adherence and outcomes will be examined, cost-effectiveness analysis will be conducted and patient and provider qualitative studies will address post-trial sustainability. Study Hypotheses: MDDP will result in: a) greater reduction of depressive symptoms; b) significant improvement in diabetic self-care regimens (i.e., diet, exercise, checking blood glucose, and taking diabetic medication), decreased HbA1c levels and diabetes symptoms; and c) will improve function and satisfaction with diabetic and depression care vs. UC.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
Project #
Application #
Study Section
Services Research Review Committee (SRV)
Program Officer
Chambers, David A
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Southern California
Schools of Social Work
Los Angeles
United States
Zip Code
Oh, Hyunsung; Ell, Kathleen; Palinkas, Lawrence A (2017) Self-care behavior change and depression among low-income predominantly Hispanic patients in safety-net clinics. Soc Work Health Care 56:714-732
Oh, Hyunsung; Ell, Kathleen (2016) Depression remission, receipt of problem-solving therapy, and self-care behavior frequency among low-income, predominantly Hispanic diabetes patients. Gen Hosp Psychiatry 41:38-44
Jin, Haomiao; Wu, Shinyi; Di Capua, Paul (2015) Development of a Clinical Forecasting Model to Predict Comorbid Depression Among Diabetes Patients and an Application in Depression Screening Policy Making. Prev Chronic Dis 12:E142
Ell, Kathleen; Katon, Wayne; Lee, Pey-Jiuan et al. (2012) Depressive symptom deterioration among predominantly Hispanic diabetes patients in safety net care. Psychosomatics 53:347-55
Hay, Joel W; Katon, Wayne J; Ell, Kathleen et al. (2012) Cost-effectiveness analysis of collaborative care management of major depression among low-income, predominantly Hispanics with diabetes. Value Health 15:249-54
Ell, Kathleen; Katon, Wayne; Xie, Bin et al. (2011) One-year postcollaborative depression care trial outcomes among predominantly Hispanic diabetes safety net patients. Gen Hosp Psychiatry 33:436-42
Ell, Kathleen; Katon, Wayne; Xie, Bin et al. (2010) Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial. Diabetes Care 33:706-13
Ell, Kathleen; Aranda, MarĂ­a P; Xie, Bin et al. (2010) Collaborative depression treatment in older and younger adults with physical illness: pooled comparative analysis of three randomized clinical trials. Am J Geriatr Psychiatry 18:520-30
Ell, Kathleen; Katon, Wayne; Cabassa, Leopoldo J et al. (2009) Depression and diabetes among low-income Hispanics: design elements of a socioculturally adapted collaborative care model randomized controlled trial. Int J Psychiatry Med 39:113-32
Cabassa, Leopoldo J; Hansen, Marissa C; Palinkas, Lawrence A et al. (2008) Azucar y nervios: explanatory models and treatment experiences of Hispanics with diabetes and depression. Soc Sci Med 66:2413-24