Engagement among Minority Patients in Collaborative Care Management for Depression

Research Article

Chronic Dis Int. 2015;2(1): 1014.

Engagement among Minority Patients in Collaborative Care Management for Depression

DeJesus RS1*, Njeru J1 and Angstman K2

1Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, USA

2Department of Family Medicine, Mayo Clinic, USA

*Corresponding author: DeJesus, R, Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

Received: February 12, 2015; Accepted: April 16, 2015; Published: April 17, 2015


The Collaborative Care Management (CCM) is an effective model for depression care and has been shown to mitigate disparity in treatment outcomes among minority. Engagement pattern among this group is less known. This retrospective study evaluated both enrollment and drop-out rates among minority patients in CCM at primary care sites of a Midwestern academic institution from March 2008 to December 2011 using the registry. Of the 765 eligible minority patients who were offered CCM, 49.9% enrolled; acceptance rate was not statistically significant when compared to non-minority patients (Caucasians). At six month, the drop-out rate among minority, defined as absence of care manager’s contact with patient for 2 months, was significantly higher than in Caucasians (p value=0.002). Both minority race and initial PHQ-9 scores were independent predictors to increased odds of dropping out from CCM. Hence, while CCM appear to mitigate disparity in outcomes and access to depression treatment among minority, treatment engagement in this population group remains a challenge as reflected by sub-optimal enrollment to the program and higher dropout rate.

Keywords: Depression; Collaborative care; Minority; Drop-out


Major depressive disorder is a prevalent illness affecting 5-13% of all adults but it is often under diagnosed and untreated [1,2]. The impact of depression is even greater among the minority population where there remains a disparity in access, management and treatment outcomes [3-5]. The Collaborative Care Management (CCM) in primary care has been shown to effectively achieve and sustain significant improvement in depression treatment outcomes across various population groups [6,7]; it may also mitigate depression care disparity among minority groups [2,8]. A recent analysis of CCM’s impact on minority population done by Angstman et al showed resolution of disparity in remission outcomes between minority and non-minority groups treated under this model [9].

Treatment adherence and engagement has continued to be a challenge in chronic disease management; as many as 60% of persons with chronic illness are poorly adherent to treatment [10]. Depression is no exception with low treatment engagement among patients being a persistent concern of primary care providers who usually initiate therapy. This is particularly challenging in underserved and minority populations who are more likely to miss clinic appointments and prematurely discontinue depression treatment [11]. Adherence to treatment has been correlated to improved outcomes [12]; in depression, this translates to remission. A review by Interian et al. on interventions that can potentially improve mental health treatment engagement among underserved racial-ethnic minority populations reported the collaborative care model to be most efficacious [13]. This retrospective study’s aims were (1) to evaluate enrollment rate to CCM among minority patients and (2) to determine and compare drop-out rates between minority and non-minority groups within CCM. We hypothesized that among those patients with depression who were

enrolled to CCM, there is no significant difference in the drop-out rates between minority and non-minority participants. CCM was adopted among primary care sites at an academic institution in Midwestern United States on March 2008.


Using the registry, records of patients eligible for CCM from March 2008 until December 2011 were reviewed. Details of the model had been described previously [14]; adults 18 years and older with a Patient Health Questionnaire-9 (PHQ-9) score of 10 or higher and a DSM-IV diagnosis of major depression (initial or recurrent) or dysthymia, were eligible for enrollment. Those with a diagnosis of bipolar disorder were excluded. For the purpose of this study, only patients who chose to self-identify their racial or ethnic status and who gave consent to participate in research were included. Enrollment rate to CCM among minority patients was tracked. Six month drop-out rates, defined as absence of care manager’s contact with patient for 2 months, were compared between Caucasian and minority (non-Caucasian) patients who were followed under CCM.

Data were analyzed using Chi-Square testing with Yates correction; Mann-Whitney test was used for age and PHQ-9 score as sample distribution did not follow the normal curve. Logistic regression modeling for six month odd of dropping out was performed while retaining all independent variables studied. Calculations were performed on MedCalc software (www.medcalc.org, version 12.7.7). The study was reviewed and approved by the institutional review board.


Of the 765 minority patients who met eligibility for enrollment to CCM, 49.9% (N=382) enrolled; the rest (N=383) stayed in UC. Majority of enrolled minority (69.6%) was female and mean age was 38.9 years. Enrollment rate to CCM among Caucasians was 47.7% (N=2967). The difference in enrollment rates between the two groups was not statistically significant (p value=0.07). However, the mean baseline PHQ-9 score in minority patients was significantly higher than Caucasians (Table 1).

Citation: DeJesus RS, Njeru J and Angstman K. Engagement among Minority Patients in Collaborative Care Management for Depression. Chronic Dis Int. 2015;2(1): 1014.