Collaborative Health Literate Depression Care Among Predominantly Hispanic Patients With Coronary Heart Disease in Safety Net Care

Objective: To determine whether evidence-based socio-culturally health literate adapted collaborative depression care improves depression care, depressive symptoms, and quality of life among predominantly Hispanic patients' with coronary heart disease. Methods: The 12-month trial included 97 patients with coronary heart disease (79% of eligible patients) who met the depression criteria assessed by the Patient Health Questionnaire-9. Patients were recruited from 3 safety net clinics and offered depression team care by a bilingual clinical social worker and community patient navigator, a consulting psychiatrist, and a primary care physician The team provided problem-solving therapy (PST) or pharmacotherapy or both, telephone symptom monitoring and behavioral activation, and patient resource navigation support. Recruited patients were given patient and family member health literacy adapted educational and community resource materials in Spanish or English. Results: Overall, depression treatment was 74% (PST, 55%; PST plus antidepressant medications, 18%; and antidepressant medications alone, 2%). Nearly half of the patients showed a 50% reduction of the Symptom Checklist-20 (490, at 6 mo and 48% at 12 mo) and of Patient Health Questionnaire-9 score with 470 L, of patients at 6 months and 43% at 12 months. The 500 improvement in Patient Health Questionnaire and Symptom Checklist-20 score reduction (lid not vary significantly between patients who received PST or antidepressant only or those who received PST plus antidepressant. The quality of life Short-Form Health Survey SF-12, the Minnesota Living with Heart Failure questionnaire, and the Sheehan Disability Scale outcomes also improved significantly. Conclusions: Socio-culturally literacy-adapted collaborative depression care was accepted by patients with coronary heart disease and improved depression care and symptoms, quality of life, and functional outcomes an tong predominantly Hispanic patients with heart disease.