• Score on the Symptom Checklist-20 (SCL-20) depression scale [ Time Frame: Measured at Months 6, 12, 18, and 24 ] [ Designated as safety issue: No ]
  
• Percentage on disease control indices [ Time Frame: Measured at Months 6, 12, 18, and 24 ] [ Designated as safety issue: No ]
  

• Functional impairment [ Time Frame: Measured at Months 6, 12, 18, and 24 ] [ Designated as safety issue: No ]
  
• Adherence to prescribed medications [ Time Frame: Measured at Months 6, 12, 18, and 24 ] [ Designated as safety issue: No ]
  
• Health care costs [ Time Frame: Measured at Months 6, 12, 18, and 24 ] [ Designated as safety issue: No ]
  

Depression is a serious medical illness that has been associated with increased risk for heart disease and diabetes. Depression may negatively impact aspects of self-care that are required to effectively manage such long-term diseases. In depressed people who have heart disease and/or diabetes, treatment for depression appears to result in only limited improvements in depression symptoms and no improvements in heart disease and diabetes symptoms. An integrated treatment approach may be more effective in improving all three conditions. This study will evaluate the effectiveness of a nurse-led case management intervention in improving disease control and depression symptoms in adults with diabetes and/or heart disease who are also depressed.

Participants in this single-blind study will be randomly assigned to take part in the case management intervention or receive usual care. All participants will attend 10 study visits and receive 4 follow-up phone calls over 24 months. At 5 of the study visits, measurements of height, weight, waist size, and blood pressure will be taken. At the other 5 study visits, blood and urine samples will be taken. Participants will be asked not to eat for 8 hours before providing blood samples at 3 of the visits. During follow-up phone calls participants will answer various questions.

The case management intervention will entail two to eight additional visits with a trained nurse at the clinic or by telephone. Participants in this group will receive educational materials about how to manage diabetes and/or heart disease and stress or depression. Nurses will also provide guidance and support in managing medications, phone calls to check participants' progress, and assistance in setting personal goals and in managing physical health problems and symptoms of depression or stress. Outcomes will be measured at Months 6, 12, 18, and 24.

Inclusion Criteria:

• Diagnosis of diabetes and/or heart disease
• Poor disease control (defined as an HbA1c level of at least 8.5%, blood pressure greater than 140/90 mm Hg, LDL cholesterol greater than 130 mg/dL)
• Diagnosis of major depressive disorder

Exclusion Criteria:

• History of psychosis
• At high risk for suicide
• Cognitive impairment
• Current alcohol or substance abuse disorder
• Does not own a telephone
• Currently seeking psychiatric care
• Pregnant or breastfeeding
• Currently enrolled in a Group Health Cooperative disease management program
• Terminal illness
• Plans to leave Group Health Cooperative in less than a year
• Does not speak English