Table of Contents - Academy of Psychosomatic Medicine

medical and behavioral health expenditures and increased
satisfaction.
13. Impact of Collaborative Care for
Depression in Public Sector, Primary Care
Clinics
Presenting Author: Isabel Lagomasino, MD, MSHS
Co-Authors: Megan Dwight-Johnson, MD, MPH, Naihua
Duan, PhD, Jennifer Green, MSW, Lily Zhang, MS, Lingqi
Tang, PhD, Jeanne Miranda, PhD
Purpose: To examine the effectiveness of a collaborative
care intervention tailored to the preferences and constraints
of low-income, ethnic minority patients and their providers in
public sector primary clinics.
Methods: 402 primary care patients from 3 public sector,
Los Angeles clinics were recruited through waiting room
screening or provider referral and randomized to a 4-month
collaborative care intervention vs. wait list control. Adults
were eligible if they spoke English or Spanish and had a depressive
disorder, using the Patient Health Questionnaire-9
(PHQ-9) and PRIME-MD. Bilingual, entry-level social workers
provided psycho education and offered a choice of shortterm
cognitive-behavioral therapy, antidepressant medication,
or both. Primary care providers provided prescriptions;
a psychiatrist supervised social workers’ caseloads and
therapy.
Results: Of 1637 patients screened, 627 (38%) had depressive
disorder. After exclusions, 402 enrolled. Subjects’ mean
age was 49.5; they were 84% women, 85% Latino (86%
Spanish-speaking), 48% with < 6 years education, 64%
unemployed, 56% uninsured. The mean PHQ-9 score was
17.3; 37% of subjects had thoughts of death/suicide; 62%
had likely comorbid anxiety disorder; 77% reported fair/poor
health; the mean number of chronic illnesses conditions was
3.4. Among intervention subjects, 83% received some treatment;
most chose therapy (55% received therapy plus medication,
38% only therapy, 7% only medication). At 4-months,
intervention subjects had significantly improved depression
outcomes (mean PHQ-9 score 8.6 v. 13.3, p