The Pathways study was a randomized controlled trail designed to determine if Problem Solving Therapy -Primary Care (PST-PC) would improve depression and diabetes outcomes. PST-PC is a short term stepped behavioral health intervention. The therapist were nurses specially trained in providing this type of therapy. The study did not involve the use of psychiatric nurse practitioners, psychologist, or psychiatrists. The average number of sessions with the nurse was only 5.06. The results with the 329 participants showed an improvement with depression but not with level of diabetes control in the intervention arm.
Katon et al (2004) methods and study design is well thought out. The study was designed to show if mental health treatment would improve depression alone or both depression and diabetes control. Unfortunately, I feel that the level of mental health intervention was not sufficient to result in major behavior changes that are needed to improve diabetes control. The usual care group also received diabetes education and the option of antidepressant medication. Of interest, the antidepressant medication adherence rate was much higher for the intervention group than the control group. Katon and associates continue to pursue through numerous studies the relationship of diabetes and depression. Their work is excellent and has added a large amount of medical knowledge to the relationship of diabetes and depression. Most of their studies have been completed on a middle class, white, insured population. What would the results be on a poor uninsured racially mixed population?
Katon, W., Von Korff, M., Lin, E., Simon, G., Ludman, E., Russo, J., et al. (2004). The pathways study: A randomized trial of collaborative care in patients with diabetes and depression. Archives of General Psychiatry 6, 1042-1049.
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