Modernized Collaborative Care for Depression: Impact on Psychological Risk and Protective Factors for Diabetes and Intervention Outcomes Among Diverse Sociodemographic Groups

Abstract

Objective: We examined the effect of a modernized collaborative care intervention for depression on multiple psychological risk and protective factors for diabetes and characterized intervention process outcomes using data from the eIMPACT-DM trial. Methods: Forty-six primary care patients with depression and elevated diabetes risk from a safety net healthcare system (Mage = 50 years, 78% women, 72% Black, Meducation = 13 years, 33% with income <$10,000/year) were randomized to 6 months of the eIMPACT-DM intervention (our modernized collaborative care intervention for depression involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants; n=24) or active control (depression education, depressive symptom monitoring, and usual primary care for depression; n=22). Depressive symptoms (Patient Health Questionnaire-9 [PHQ-9], anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]), trait positive affect (Positive and Negative Affect Schedule- Positive Affect Subscale [PANAS-PA]), life satisfaction (Satisfaction With Life Scale [SWLS]), and intervention process outcomes were measured across the treatment period. Results: Effect size metrics (standardized regression coefficients; bY) indicated that, compared to active control, the intervention group demonstrated clinically meaningful medium-to-large improvements in depressive symptoms (PHQ-9 bY = -0.69), anxiety symptoms (GAD-7 bY = - 0.76), and trait positive affect (PANAS-PA bY = 0.61) as well as small-to-medium improvements in life satisfaction (bY = 0.43). Although only 27% of participants assigned to iCBT had good engagement and 60% had good iCBT comprehension, the intervention group reported high skills implementation and treatment satisfaction. Conclusion: These findings demonstrate the potential of a modernized collaborative care intervention to improve multiple psychological risk and protective factors for diabetes in a diverse primary care population. Such an intervention could ultimately serve to bolster future diabetes prevention in diverse groups, helping to reduce diabetes-related health disparities.