Four RCTs (seven articles) were included in the review (n approximately 3,536, of whom about 750 were Latinos). Mean quality score was 14 out of 17 possible points (range 13 to 17). All studies reported details of patient characteristics and methodology, used valid outcomes measures, described drop-out rates and used suitable statistical procedures. Mean follow-up rate was 80% (range 73 to 83%).
Cognitive-behavioural therapy (CBT) and medication versus usual care: CBT and medication were both superior to usual care in improvements to depression-related clinical outcomes in study populations that included 31% to 51% Latinos (two RCTs). In both RCTs improved outcomes in the treatment groups (CBT or medication) persisted at 12 months compared with usual care.
CBT with or without case management among Latinos: One RCT reported that Spanish-speaking patients (n=77) who received CBT with case management had significantly less depressive symptoms and improved functioning at four and six months compared with those who received CBT alone (this result was not replicated among English-speakers).
Collaborative care and quality improvement in Latinos and African Americans: At 12 months, the collaborative care intervention was associated with significantly improved depression outcomes and higher response and remission rates than usual care (one RCT). Similarly, the quality improvement intervention was associated with significantly lower rates of probable depression than usual care, although employment rates did not improve significantly (one RCT). Among Latinos, those who received quality improvement were significantly more likely to receive appropriate depression care than controls (39% versus 26%, one RCT) and those who received collaborative care had a higher likelihood of using antidepressants and psychotherapy than controls (one RCT). At 57 months, the quality improvement intervention was associated with ongoing improvement in health outcomes and significantly lower rates of depression and unmet needs among Latinos and African Americans (a finding not replicated among non-Latino whites).