• Leslie S Kinder, Wayne J Katon, Evette Ludman, Joan Russo, Greg Simon, Elizabeth H B Lin, Paul Ciechanowski, Von KorffMichaelM, and Bessie Young.
• Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98101, USA. lskinder@stanfordalumni.org
• J Gen Intern Med. 2006 Oct 1; 21 (10): 103610411036-41.

BackgroundDepression 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.ObjectiveTo 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.DesignThe 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.PatientsThree hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan.MeasurementsDepression 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.ResultsThe 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.ConclusionPatients 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.

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