Depression Screening in Diabetes Care to Improve Outcomes

Abstract

Depression screening rates among individuals with diabetes and no history of MDD were remarkably low. Patients with diabetes but no MDD diagnosis who sought health care at a FQHC clinic had more depressive symptoms than those with a history of MDD at both sites. Individuals with diabetes and who have a MDD diagnosis are much more likely to receive regular depression screening than those without MDD, which leaves a substantial proportion of patients with undetected depression. Depression screening must be enhanced for all individuals with diabetes, particularly for low-income individuals and those without a previous diagnosis of MDD.

Missed Opportunities for Depression Screening and Treatment in the United States

“…This is consistent with prior research. 7,8 We found that people who score lower on measures of depressive symptoms (Ͻ3 on the PHQ2) have nearly 60 percent lower odds of being assessed (i.e. screened and/or treated) than people with higher PHQ scores (Ն3) scores.…”

“…7 A retrospective observational study of diabetic patients found that only 11% of patients with no history of depression (but who had depressive symptoms) were screened. 8 Another question is the extent to which depression screening is being implemented equitably, that is, if some populations are more likely to receive screening than others. Adherence to clinical practice guidelines can be an important tool for reducing health inequities, while unequal implementation of preventive services can exacerbate existing disparities in health outcomes.…”

The Importance of Addressing Depression and Diabetes Distress in Adults with Type 2 Diabetes

“…If a practice does not have access to mental health specialists, mental health screening tools, or a reminder system to alert providers to screen for mental health conditions on a routine basis, depression and diabetes distress may go undetected. 14,28…”

“…24 At the practice level, adding prompts to electronic health records can promote screening for depression and diabetes distress, re-evaluations, treatment, and referrals. 14,25…”

“…12,13 Yet, in systems without universal screening, these mental health conditions often go unrecognized or undertreated in people with type 2 diabetes. 14 For optimal disease management, as well as the prevention of life-threatening complications, the American Diabetes Association emphasizes the recognition, treatment, and management of depression and diabetes distress in people with type 2 diabetes. 15,16 Early recognition, routine screening, and the use of evidence-based treatment approaches for depression and diabetes distress can improve control of HbA1c, blood pressure, and cholesterol, as well as overall health, and results in medical cost savings.…”