BACKGROUND: Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical
demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes
who have multiple complications.
OBJECTIVE: To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who
had 2 or more complications as in patients with diabetes who had fewer complications.
DESIGN: The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary
care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications.
PATIENTS: Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics
of a large prepaid health plan.
MEASUREMENTS: Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist.
Diabetes complications were determined from automated patient records.
RESULTS: The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual
primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced
similar reductions in depressive symptoms in both intervention and usual care.
CONCLUSION: Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression.
These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes
who have the highest severity of medical problems.
Key words depression - diabetes mellitus - primary care
Supported by NIH grants MH4-1739, MH01643, and MH073686.