Depression improves with team-based care

Wednesday, 26 August 2020

People with chronic conditions like diabetes, are more likely to experience depression and have poorer health outcomes when depression occurs.

However, a recent study has found that team-based care improved outcomes for both depression and diabetes.

Researchers from Emory University, University of Washington School of Medicine, and their colleagues in India compared a collaborative care model in 404 patients with diabetes who also showed moderate-to-severe depressive symptoms.

What they found was that more than 70 percent receiving integrated team-based care showed improvements in both their diabetes and depression.

Stigma attached to mental health

“Too often, mental health is overlooked due to fragmented care, stigma of psychiatric illnesses, and shortages of mental health professions,” said Mohammed Ali, from Emory University.

“Our study showed that as depression worsens people were less likely to manage their diabetes well. Poorly controlled diabetes can result in a range of high risk health complications and greater mortality,” he said.

Globally, there is a shortage of psychiatrists to address the mental health needs of people living with diabetes. Although there are effective treatments for depression, between 76% and 85% of people in low- and middle-income countries receive no treatment for their mental health, said researchers.

The model used in the study was adapted from a collaborative care model developed by the late Dr. Wayne Katon, from the University of Washington, School of Medicine.

Dr Katon was influential in developing an understanding of the effects of depression on physical health.

This was the first time the model was implemented outside of the United States, said Lydia Chwastiak, one of three principal investigators on the study.

How the team-based care model works

Chwastiak led training of 10 nutritionists who worked in four diabetes clinics to be patient-care managers.

The care managers worked with patients, their family members, doctor and a consulting psychiatrist on an individualized treatment plans.

The patient care manager advocated for the patient and supported them to manage their illness more effectively.

“The relationship with the patient care manager was so powerful,” said Chwastiak. “The patients were very attached to them.”

Dr. Viswanathan Mohan, Director of Madras Diabetes Research Foundation in India, called the findings impressive.

“This was the first study reporting on whether a one-year integrated, collaborative care model has sustainable effects at two years,” said Mohan. “This low-cost model produced impressive results both in improving depression as well as in several metabolic parameters and can be useful in other settings and countries.”

The study was recently published in JAMA.

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