TY - JOUR
T1 - Treating Depression in Predominantly Low-Income Young Minority Women
T2 - A Randomized Controlled Trial
AU - Miranda, Jeanne
AU - Chung, Joyce Y.
AU - Green, Bonnie L.
AU - Krupnick, Janice
AU - Siddique, Juned
AU - Revicki, Dennis A.
AU - Belin, Tom
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2003/7/2
Y1 - 2003/7/2
N2 - Context: Impoverished minority women experience a higher burden from depression than do white women because they are less likely to receive appropriate care. Little is known about the effectiveness of guideline-based care for depression with impoverished minority women, most of whom do not seek care. Objective: To determine the impact of an intervention to deliver guideline-based care for depression compared with referral to community care with low-income and minority women. Design, Setting, and Participants: A randomized controlled trial conducted in the Washington, DC, suburban area from March 1997 through May 2002 of 267 women with current major depression, who attended county-run Women, Infants, and Children food subsidy programs and Title X family planning clinics. Outcomes: Hamilton Depression Rating Scale measured monthly from baseline through 6 months; instrumental role functioning (Social Adjustment Scale) and social functioning (Short Form 36-Item Health Survey) measured at baseline and 3 and 6 months. Interventions: Participants were randomly assigned to an antidepressant medication intervention (trial of paroxetine switched to buproprion, if lack of response) (n = 88), a psychotherapy intervention (8 weeks of manual-guided cognitive behavior therapy) (n=90), or referral to community mental health services (n=89). Results: Both the medication intervention (P<.001) and the psychotherapy intervention (P=.006) reduced depressive symptoms more than the community referral did. The medication intervention also resulted in improved instrumental role (P=.006) and social (P=.001) functioning. The psychotherapy intervention resulted in improved social functioning (P=.02). Women randomly assigned to receive medications were twice as likely (odds ratio, 2.04; 95% confidence interval, 0.98-4.27; P=.057) to achieve a Hamilton Depression Rating Scale score of 7 or less by month 6 as were those referred to community care. Conclusions: Guideline-concordant care for major depression is effective for these ethnically diverse and impoverished patients. More women engaged in a sufficient duration of treatment with medications compared with psychotherapy, and outcome gains were more extensive and robust for medications.
AB - Context: Impoverished minority women experience a higher burden from depression than do white women because they are less likely to receive appropriate care. Little is known about the effectiveness of guideline-based care for depression with impoverished minority women, most of whom do not seek care. Objective: To determine the impact of an intervention to deliver guideline-based care for depression compared with referral to community care with low-income and minority women. Design, Setting, and Participants: A randomized controlled trial conducted in the Washington, DC, suburban area from March 1997 through May 2002 of 267 women with current major depression, who attended county-run Women, Infants, and Children food subsidy programs and Title X family planning clinics. Outcomes: Hamilton Depression Rating Scale measured monthly from baseline through 6 months; instrumental role functioning (Social Adjustment Scale) and social functioning (Short Form 36-Item Health Survey) measured at baseline and 3 and 6 months. Interventions: Participants were randomly assigned to an antidepressant medication intervention (trial of paroxetine switched to buproprion, if lack of response) (n = 88), a psychotherapy intervention (8 weeks of manual-guided cognitive behavior therapy) (n=90), or referral to community mental health services (n=89). Results: Both the medication intervention (P<.001) and the psychotherapy intervention (P=.006) reduced depressive symptoms more than the community referral did. The medication intervention also resulted in improved instrumental role (P=.006) and social (P=.001) functioning. The psychotherapy intervention resulted in improved social functioning (P=.02). Women randomly assigned to receive medications were twice as likely (odds ratio, 2.04; 95% confidence interval, 0.98-4.27; P=.057) to achieve a Hamilton Depression Rating Scale score of 7 or less by month 6 as were those referred to community care. Conclusions: Guideline-concordant care for major depression is effective for these ethnically diverse and impoverished patients. More women engaged in a sufficient duration of treatment with medications compared with psychotherapy, and outcome gains were more extensive and robust for medications.
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U2 - 10.1001/jama.290.1.57
DO - 10.1001/jama.290.1.57
M3 - Article
C2 - 12837712
AN - SCOPUS:0038504054
VL - 290
SP - 57
EP - 65
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
SN - 0098-7484
IS - 1
ER -