Co-morbid diabetes and depression among low-income Latinos: A study of culturally appropriate treatment in a primary care setting

Depression is a common co-morbidity among persons with diabetes. The scope of this problem increases as the diabetes epidemic impacts more and more individuals. Among Latinos, the problem is exacerbated by both the prevalence of diabetes, which is 2 to 3 times that of Whites, and disparities in identifying and treating depression.

Project Dulce is a diabetes care program that has operated in San Diego's community health centers for over 10 years, and has published its outcomes in peer reviewed journals. Since the program's inception, Project Dulce's nurses and peer educators have identified depression as a major barrier to positive behavior change and improvement in health outcomes among their patients.

The evidence-based IMPACT model, (Improving Mood-Promoting Access to Collaborative Treatment), which has shown to be effective among seniors, was adapted to address with the complex needs of Project Dulce's patients. A 12-month pilot study demonstrated the effectiveness of the approach in reducing symptoms of depression, improving self-management skills, and improving quality of life.

This session will discuss the outcomes of the study of 500 Latinos with diabetes. Efforts made to adapt the model to address the cultural and socio-economic influences on depression and its treatment will be discussed. The impact of using peer educators and a multidisciplinary team, including a social worker, in screening for and treating depression will be examined. Current efforts to sustain the integration of depression and diabetes care in San Diego's primary care safety net clinics will be reviewed.