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Miranda J, Chung JY, Green BL, et al. Treating Depression in Predominantly Low-Income Young Minority Women: A Randomized Controlled Trial. JAMA. 2003;290(1):57–65. doi:10.1001/jama.290.1.57
Impoverished minority women experience a higher burden from depression than do white women because they are less likely to receive appropriate care. Little is known about the effectiveness of guideline-based care for depression with impoverished minority women, most of whom do not seek care.
To determine the impact of an intervention to deliver guideline-based care for depression compared with referral to community care with low-income and minority women.
Design, Setting, and Participants
A randomized controlled trial conducted in the Washington, DC, suburban area from March 1997 through May 2002 of 267 women with current major depression, who attended county-run Women, Infants, and Children food subsidy programs and Title X family planning clinics.
Hamilton Depression Rating Scale measured monthly from baseline through 6 months; instrumental role functioning (Social Adjustment Scale) and social functioning (Short Form 36-Item Health Survey) measured at baseline and 3 and 6 months.
Participants were randomly assigned to an antidepressant medication intervention (trial of paroxetine switched to bupropion, if lack of response) (n = 88), a psychotherapy intervention (8 weeks of manual-guided cognitive behavior therapy) (n = 90), or referral to community mental health services (n = 89).
Both the medication intervention (P<.001) and the psychotherapy intervention (P = .006) reduced depressive symptoms more than the community referral did. The medication intervention also resulted in improved instrumental role (P = .006) and social (P = .001) functioning. The psychotherapy intervention resulted in improved social functioning (P = .02). Women randomly assigned to receive medications were twice as likely (odds ratio, 2.04; 95% confidence interval, 0.98-4.27; P = .057) to achieve a Hamilton Depression Rating Scale score of 7 or less by month 6 as were those referred to community care.
Guideline-concordant care for major depression is effective for these ethnically diverse and impoverished patients. More women engaged in a sufficient duration of treatment with medications compared with psychotherapy, and outcome gains were more extensive and robust for medications.
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