Depression screening in diabetes improves outcomes

Teen suicide prompts an investigation
Teen suicide prompts an investigation

Las Vegas -- Instituting routine annual depression screening for patients with diabetes may help improve overall health outcomes, including physical and mental functioning, productivity and adherence to medical treatments, study results suggest.

“Providers can utilize routine depression screening to improve health outcomes of patients with chronic illness and concurrent depression,” Rebecca Russo Hill, DNP, MSN, RN, FNP-C, of Massachusetts General Hospital in Boston, reported during a poster presentation at the American Association of Nurse Practitioners 2013 National Conference.

Diabetes and depression are recognized among the top 10 most expensive health conditions, according to the Agency for Healthcare Research and Quality.

Previous research has indicated that patients with chronic conditions are 2.6 times more likely to have depression than healthy individuals, and are three times more likely to be nonadherent to depression treatment than those who have the condition without comorbidities.

As a result the National Guidelines Clearinghouse recommends annual depression screening for patients with diabetes. To analyze the effects of guideline implementation at a family health clinic and to identify barriers to depression screening and management among diabetes patients, Hill and colleagues administered the Patient Health Questionnaire-9 (PHQ-9) to 115 adult patients who visited their clinic from February 2012 to June 2012.

They then performed retrospective chart reviews to determine A1c lab values and insulin use. A total of 30 participants had diabetes and 85 did not.

At baseline, six patients without diabetes had preexisting depression, whereas only three patients in the diabetes group reported preexisting depression.

Eight new cases of depression were identified during the study period. Six of those newly diagnosed had diabetes, representing a statistically significant difference of new depression diagnoses for this patient group after PHQ-9 screening was implemented.

“A depression screening tool is cost and time effective and has been shown to make a positive impact on the management of DM in the outpatient setting,” Hill reported.

Among the eight patients with newly diagnosed depression, six refused treatment for the condition and gave the following reasons:

  • Belief that he or she could handle depression on his or her own without behavioral or pharmacological intervention
  • Not wanting to add an additional medication to his or her regimen
  • Not wanting to gain weight from antidepressant medication
  • Belief that the depression would resolve by itself
  • Belief that depression symptoms were a result of older age

“Providers can utilize this data and a routine depression screening to improve health outcomes of patients with chronic illness and concurrent depression,” she concluded.

References

  1. Hill RR. Poster #107. “Screening for Depression in Patients with Diabetes Mellitus: A Vital Practice Improvement.” Presented at: American Association of Nurse Practitioners 2013 National Conference. June 19-23, 2013; Las Vegas.
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