This study compares the efficacy, in disadvantaged medical patients, of two treatments for major depression, a disorder that is highly prevalent and debilitating. Because disadvantaged medical patients experience chronic stressors associated with medical illness and poverty, case management treatments that directly modify the patients' coping skills and enhance access to environmental resources may be necessary to adequately treat depression and prevent relapse in this patient population. This study compares the relative efficacy of a well-established treatment for depression, group cognitive-behavioral therapy (CBT), versus cognitive-behavioral group therapy plus short-term case management (CBT+CM) with disadvantaged English- and Spanish-speaking public care patients. The group CBT will be standardized and adhere to a treatment manual. The case management will involve standardized assessment, individualized treatment plans, and rigorous supervision to insure adherence to the plan. Patients who meet DSM-III-R criteria for major depression will be randomly assigned to 16 weeks of group CBT or 16 weeks of group CBT plus 6 months of case management. A total of 200 patients will complete treatment. Evaluations will occur at intake, 16 weeks, 6 months and 1 year. The investigators hypothesize that case management augmentation of group therapy will decrease stress and increase overall compliance with the group therapy, psychosocial adjustment, coping skills, and life functioning in comparison with patients not receiving the case management. In addition, it is predicted that the case management augmentation of therapy will significantly increase appropriate use of social, medical, and psychiatric services as compared with patients treated by CBT alone.
|Miranda, Jeanne; Azocar, Francisca; Organista, Kurt C et al. (2003) Treatment of depression among impoverished primary care patients from ethnic minority groups. Psychiatr Serv 54:219-25|