Screening tools used for measuring depression among people with Type 1 and Type 2 diabetes: a systematic review

Roy, Tapash; Lloyd, Cathy E.; Pouwer, Frans; Holt, Richard; Sartorius, Norman

doi:10.1111/j.1464-5491.2011.03401.x

Cited by 140 publications

(101 citation statements)

References 83 publications

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“…If scores do reflect the diabetes, not depression, this would lead to an overestimation of depression in this sample. In a recent review of depression screening tools, Roy et al (31) raise the concern that these tools have a high rate of false positives, although they conclude that the PHQ-9 is valid and reliable with high sensitivity and specificity for major depression. Twist et al (20) report similarly high falsepositive rates for patients with type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Depression in Adults in the T1D Exchange Clinic Registry

et al. 2014

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OBJECTIVELittle is known about the frequency of depression in adults with type 1 diabetes (T1D) or its relationship to diabetes outcomes. The T1D Exchange clinic registry allowed us to explore depression in a large, heterogeneous sample. RESEARCH DESIGN AND METHODSParticipants ‡18 years old (N = 6,172; median age 34 years; median diabetes duration 16 years; 55% female; and 89% non-Hispanic white) completed the eight-item Patient Health Questionnaire (PHQ-8), a validated, reliable measure of current depression. Probable major depression was defined in four ways: PHQ-8 ‡10, PHQ-8 ‡12, per diagnostic algorithm, and as a continuous variable. Characteristics and clinical outcomes of those with and without depression were compared using logistic and linear regression models. RESULTSA total of 4.6-10.3% of participants were classified as probable major depression depending on how defined. Participants classified as depressed were more likely female, nonwhite race/ethnicity, to have a lower household income and lower education level, to exercise less often, to miss insulin doses, and to have one or more complications (neuropathy, nephropathy, treatment for retinopathy, or cardiovascular/cerebrovascular disease) (all P < 0.01). HbA 1c was higher in the depressed versus not depressed groups (8.4 6 1.7% [68 6 8.6 mmol/mol] vs. 7.8 6 1.4% [62 6 15.3 mmol/mol]; P < 0.001). Occurrence of one or more diabetic ketoacidosis events (11 vs. 4%; P < 0.001) and one or more severe hypoglycemic events (18 vs. 9%; P < 0.001) in the past 3 months was higher among depressed participants. CONCLUSIONSIn the T1D Exchange clinic registry, adults with probable major depression have worse clinical outcomes than those not depressed. Whether identification and treatment of depression improves diabetes outcomes requires study. Depression is common in T1D, and better identification and treatment of this comorbid condition is needed.The prevalence of depression is almost two times higher in persons with diabetes than it is in the general population (1-3). Not only do persons with diabetes have an increased risk of developing depression (4), but persons with depression have an increased risk of developing diabetes (5), which may relate to their use of antidepressants (6) or other biological or psychosocial factors associated with diabetes. Depression in diabetes is a particular concern because it is associated with poorer glycemic control (7) and regimen adherence (8), greater morbidity and mortality

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Section: Discussionmentioning

confidence: 99%

Depression in Adults in the T1D Exchange Clinic Registry

et al. 2014

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“…This could be due to an undiagnosed or inadequately treated depressive disorder. Future suggestions for managing patients with unacceptable high levels of HbA1c are to test them for depression (30) and alexithymia (31,32). If test results are positive, clinical exploration and decisions regarding treatment should be made.…”

Section: Discussionmentioning

confidence: 99%

“…Hospital Anxiety and Depression Scale Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS) (11,28,29,30). HADS consists of two subscales with seven items reflecting depression (HADS-D) and seven items reflecting anxiety (HADS-A).…”

Section: Self-report Psychological Instrumentsmentioning

confidence: 99%

Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes

Melin

Thunander

Svensson³

et al. 2013

European Journal of Endocrinology

129

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Objective: The aim of this study was to explore the associations between inadequate glycemic control of diabetes and psychological, anthropometric, and lifestyle variables in a population-based cohort of type 1 diabetes patients. Design: Cross-sectional study. Methods: In this study, 292 patients with type 1 diabetes, aged 18-59 years, participated. Psychological data were assessed by self-report instruments: Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale-20. Anthropometrics, blood analyses, data from medical records, and data from the Swedish National Diabetes Registry were collected. Results: Self-reported depression (adjusted odds ratio (AOR) 4.8), obesity (AOR 4.3), and smoking (AOR 3.0) were independently associated with inadequate glycemic control of diabetes (HbA1cO8.6%). Gender-stratified analyses showed that self-reported depression (AOR 19.8) and obesity (AOR 7.0) in women and smoking in men (AOR 4.2) were associated with HbA1cO8.6%. Alexithymia, antidepressant medication, and physical inactivity were associated with HbA1cO8.6% only in bivariate analyses. Alexithymia, self-rated anxiety, physical inactivity, and absence of abdominal obesity were associated with self-reported depression. Conclusions: Depression was the only psychological factor independently associated with HbA1cO 8.6%. The association was of comparable importance as obesity and smoking, well-known risk factors for inadequate glycemic control and diabetes complications. The association between depression and HbA1cO8.6% was particularly strong for women. Alexithymia, which is a relatively stable personality trait, was associated with depression. In the future care of patients with diabetes, psychological aspects should be considered alongside anthropometrics and lifestyle factors in order to achieve the goals for HbA1c.

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“…A recent systematic review provides a comprehensive listing of instruments used for screening of depression in type 1 and type 2 diabetes. 32 The decision of which tool is most appropriate for a clinic should be guided by local resources. In our study, clear recommendations including talking points and indication for referral for further evaluation based upon the output of the assessment tool gave providers a platform to discuss mental health topics in a medical setting.…”

Section: Discussionmentioning

confidence: 99%

Improving Depression Screening for Adolescents With Type 1 Diabetes

et al. 2013

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OBJECTIVE: Depression is common among adolescents, but rates increase significantly in the presence of chronic health conditions. Outpatient screening for depression is recommended but rarely formally conducted due to barriers of implementation. METHODS:To provide a model for depression screening of youth with chronic health conditions, a standard process using a selfadministered electronic version of the Children' s Depression Inventory (CDI) was developed. Quality improvement methodology and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients 13 to 17 years of age with type 1 diabetes. RESULTS:Of the 528 eligible adolescents, 509 (96%) received at least 1 depression screen during the first year. The process was tested and refined in over 1200 patient encounters, which resulted in an increase in depression screening rates from ,5% to a median of 85% over the initial 12 months. Both patients and staff reported acceptance of screening on qualitative surveys. Elevated CDI scores ($16) were found in 8% of the sample; moderate scores (10-15) in 12% of the sample. Low risk scores were found in 80% of the sample. Higher CDI scores correlated with lower blood glucose monitoring frequency and higher hemoglobin A1c, confirming the link between more depression symptoms and poorer diabetes management and control. Suicidal ideation was endorsed in 7% of the population.CONCLUSIONS: Systematic depression screening in adolescents with type 1 diabetes can be reliably implemented with clinically significant results. A systematic approach, such as described in this study, can serve as a model for other chronic health conditions. Pediatrics

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Screening tools used for measuring depression among people with Type 1 and Type 2 diabetes: a systematic review

Cited by 140 publications

References 83 publications

Depression in Adults in the T1D Exchange Clinic Registry

Depression in Adults in the T1D Exchange Clinic Registry

Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes

Improving Depression Screening for Adolescents With Type 1 Diabetes

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