Treating Depression in Predominantly Low-Income Young Minority Women: A Randomized Controlled Trial | Depressive Disorders | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Original Contribution
July 2, 2003

Treating Depression in Predominantly Low-Income Young Minority Women: A Randomized Controlled Trial

Author Affiliations

Author Affiliations: Health Services Research Center, University of California at Los Angeles Neuropsychiatric Institute (Drs Miranda and Belin, and Mr Siddique); Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Drs Chung, Green, Krupnick, and Revicki); Center for Health Outcomes Research, MEDTAP International, Bethesda, Md (Dr Revicki); and Department of Biostatistics, University of California at Los Angeles School of Public Health (Dr Belin).

JAMA. 2003;290(1):57-65. doi:10.1001/jama.290.1.57

Context  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.

Objective  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.

Outcomes  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.

Interventions  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).

Results  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.

Conclusions  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.