Treating depression in predominantly low-income young minority women: a randomized controlled trial

JAMA. 2003 Jul 2;290(1):57-65. doi: 10.1001/jama.290.1.57.


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<.001) and the psychotherapy intervention (P =.006) reduced depressive symptoms more than the community referral did. The medication intervention also resulted in improved instrumental role (P =.006) and social (P =.001) functioning. The psychotherapy intervention resulted in improved social functioning (P =.02). Women randomly assigned to receive medications were twice as likely (odds ratio, 2.04; 95% confidence interval, 0.98-4.27; P =.057) to achieve a Hamilton Depression Rating Scale score of 7 or less by month 6 as were those referred to community care.

Conclusions: Guideline-concordant care for major depression is effective for these ethnically diverse and impoverished patients. More women engaged in a sufficient duration of treatment with medications compared with psychotherapy, and outcome gains were more extensive and robust for medications.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Analysis of Variance
  • Antidepressive Agents / therapeutic use*
  • Cognitive Behavioral Therapy*
  • Community Mental Health Services*
  • Depressive Disorder / economics
  • Depressive Disorder / ethnology*
  • Depressive Disorder / therapy*
  • Female
  • Humans
  • Minority Groups
  • Poverty*
  • Practice Guidelines as Topic
  • Referral and Consultation
  • Treatment Outcome


  • Antidepressive Agents