Résumé :
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[BDSP. Notice produite par INIST-CNRS R0xUXOiU. Diffusion soumise à autorisation]. Context Impoverished minority women experience a higher burden from depression than do white women because they are less likely to receive appropriate care. Little is known about the effectiveness of guideline-based care for depression with impoverished minority women, most of whom do not seek care. Objective To determine the impact of an intervention to deliver guideline-based care for depression compared with referral to community care with low-income and minority women. Design, Setting, and Participants A randomized controlled trial conducted in the Washington, DC, suburban area from March 1997 through May 2002 of 267 women with current major depression, who attended county-run Women, Infants, and Children food subsidy programs and Title X family planning clinics. Outcomes Hamilton Depression Rating Scale measured monthly from baseline through 6 months ; instrumental role functioning (Social Adjustment Scale) and social functioning (Short Form 36-Item Health Survey) measured at baseline and 3 and 6 months. Interventions Participants were randomly assigned to an antidepressant medication intervention (trial of paroxetine switched to buproprion, if lack of response) (n=88), a psychotherapy intervention (8 weeks of manual-guided cognitive behavior therapy) (n=90), or referral to community mental health services (n=89). Results Both the medication intervention (P<. and the psychotherapy intervention reduced depressive symptoms more than community referral did. medication also resulted in improved instrumental role social functioning. functioning women randomly assigned to receive medications were twice as likely ratio confidence interval p="057)" achieve a hamilton depression rating scale score of or less by month those referred care. conclusions guideline-concordant care for major is effective these ethnically diverse impoverished patients. engaged sufficient duration treatment with compared outcome gains extensive robust medications.>
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