Behavioral Activation Therapy for Rural Veterans With Diabetes and Depression
Diabetes Mellitus, Depression
About this trial
This is an interventional health services research trial for Diabetes Mellitus focused on measuring Diabetes Mellitus, Depression, Affective Symptoms, Self Care, Telemedicine, Psychotherapy
Eligibility Criteria
Inclusion Criteria:
- Veterans with comorbid diabetes and depressive symptoms receiving primary care services at VA CBOCs throughout Southeast Texas
- as well as MEDVAMC patients living >20 miles from the hospital who face similar distance related treatment barriers
Participants must have:
- a diagnosis of diabetes mellitus
- an average HbA1c level >7.5% in the prior 6 months
- clinically significant symptoms of depression
- Verification of diabetes mellitus diagnoses will be based on data collected from the VA data warehouse.
- To verify that participants meet the depression criteria, the investigators will use participant self-report of clinically significant depressive symptoms according to the PHQ-9, where a score of greater than/equal to 10 on the PHQ-9 will signify a clinically meaningful symptom burden.
Exclusion Criteria:
- The investigators will exclude potential participants only for clinical factors that would render a telephone-based behavioral activation intervention inappropriate.
Specific exclusion criteria are:
- lack of regular access to a telephone
- significant cognitive impairment (three or more errors) on an established six-item screening exam
- meeting criteria for bipolar, psychotic, or substance-abuse disorders
- presence of uncorrected hearing or vision impairment
- their medical chart recommends not titrating therapy due to prior history of significant hypoglycemic events
- they live within 20 miles of the MEDVAMC.
- Patients will be secondarily excluded if their HbA1C level falls below 7.5% at baseline assessment, or if they report suicidal ideation on the PHQ-9 at baseline assessment.
- Patients receiving mental health services at the time of study recruitment will not be excluded.
- All mental health treatments and health service-use characteristics will be included in study analyses as covariates.
Sites / Locations
- Michael E. DeBakey VA Medical Center, Houston, TX
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Arm 1: HOPE
Arm 2: EUC
The Healthy Outcomes through Patient Empowerment (HOPE) intervention group is the intervention arm which will employ behavioral health coaching telephone sessions. Tele-coaching is a theoretically grounded, structured processes guided by intervention manuals.
The Enhanced Usual Care (EUC) group will serve as a concurrent control group to compare to the intervention arm of the study. Participants are screened for diabetes self-management behaviors and control and for active depressive and anxiety symptoms. Primary care providers are alerted of the patients' status and given decision support to enhance care for these uncontrolled conditions.