Clinical Case Management and Cognitive-Behavioral Therapy: Integrated Psychosocial Services for Depressed Latino Primary Care Patients
While prevalence rates of maj or depression in the general population range from 2.1 to 3.5 percent, rates in primary care settings are now between 6 and 10 percent (Katon, 1982). Indeed, depression is now considered to be one of the most common problems seen in general medicine (Kamerow, 1989), and numerous guidelines for detecting and treating depression in primary care are currently being disseminated by national professional organizations such as the Agency for Health Care Policy and Research (AHCPR) (Depression Guideline Panel, 1993a, 1993b) and the American Psychiatric Association (APA, 1993). These guidelines are a welcomed response to the traditionally low detection and treatment of depression in medical settings (Katon, 1987) and to emerging evidence that depression may be more debilitating than many chronic medical conditions. For example, Wells et al. (1989) found that the impaired social functioning associated with depressive symptoms was generally worse than impaired functioning associated with eight major chronic medical conditions such as hypertension, diabetes, and ar-
thritis. In fact, the only medical condition that proved comparable to depression in terms of functional impairment was heart disease.