To compare the effectiveness of standard and patient‐centered, culturally tailored collaborative care () interventions for African American patients with major depressive disorder () over 12 months of follow‐up.
Data Sources/Study Setting
Twenty‐seven primary care clinicians and 132 patients with in urban community‐based practices in Maryland and Delaware.
Cluster randomized trial with patient‐level, intent‐to‐treat analyses.
Data Collection/Extraction Methods
Patients completed screener and baseline, 6‐, 12‐, and 18‐month interviews to assess depression severity, mental health functioning, health service utilization, and patient ratings of care.
Patients in both interventions showed statistically significant improvements over 12 months. Compared with standard, patient‐centered patients had similar reductions in depression symptom levels (−2.41 points; 95 percent confidence interval (), −7.7, 2.9), improvement in mental health functioning scores (+3.0 points; 95 percent , −2.2, 8.3), and odds of rating their clinician as participatory (, 1.48, 95 percent , 0.53, 4.17). Treatment rates increased among standard ( = 1.8, 95 percent 1.0, 3.2), but not patient‐centered ( = 1.0, 95 percent 0.6, 1.8) patients. However, patient‐centered patients rated their care manager as more helpful at identifying their concerns (, 3.00; 95 percent , 1.23, 7.30) and helping them adhere to treatment (, 2.60; 95 percent , 1.11, 6.08).
Patient‐centered and standard approaches to depression care showed similar improvements in clinical outcomes for African Americans with depression; standard resulted in higher rates of treatment, and patient‐centered resulted in better ratings of care.
