Improving treatment of depression among Latinos with diabetes using project Dulce and IMPACT

To assess the feasibility and cost of integrating diabetes and depression care management in three community clinics serving a low-income and predominantly Spanish-speaking Latino population.

We screened diabetes patients for depression, and for those with depressive symptoms, we provided depression care management. We assessed changes in depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), diabetes self-care activities (nutrition, exercise, and medication adherence), and costs.

Thirty-three percent of patients with diabetes had symptoms of major depression. Among 99 patients completing the study, PHQ-9 scores declined by an average of 7.5 points from 14.8 to 7.3 (P < 0.001). Clients averaged 6.7 visits with the care manager during the study period. Costs of depression care management were estimated to be $512 per participant.

Adding a depression care manager to an existing diabetes management team was effective at reducing depressive symptoms at a reasonable cost.