Hosted by Ray Shields, MD

Mental and Emotional Health: Screening for Depression in Patients with Diabetes  

Depression in patients with diabetes has a significant impact on the individual, as well as the health care system.  A previous diagnosis of depression doubles the risk for developing diabetes.   Adults with diabetes are more likely to experience depression than those without diabetes.  Approximately 15-20% of patients with diabetes suffer from depression compared to 2-9% of the general population.  Specific information on depression in Native Americans with diabetes is limited; however in the Pima population the prevalence was documented at 16.3%.  Individuals with other chronic diseases in addition to diabetes have greater levels of depression.

In addition, depression is linked to poor glycemic control, poor diabetes self-care, diabetes complications, and higher health care costs. Research shows people with diabetes who struggle with depression have a significant overall greater risk of mortality than those without depression.

For the person with diabetes and depression, a multidisciplinary approach to care, which may include a behavioral health professional, is beneficial.  Timely diagnosis of depression with initiation of a treatment plan that has a follow-up mechanism (when indicated) is necessary for those with a positive screen for depression.

Depression Screening Recommendations

Use a screening tool that is simple to administer and assess, such as the Patient Health Questionnaire (PHQ) screening tool.  This assesses DSM-IV criteria and is designed for use in the primary care setting.  The PHQ-2 is a two question basic screening tool that asks the following two questions:

Over the last two weeks, have you been bothered by any of the following problems:

1. Little interest or pleasure in doing things? 
2. Feeling down, depressed or hopeless? 

If the patient responds "yes" to either question, administer the PHQ-9, which asks seven additional questions. Patients who screen positive should receive timely evaluation by a medical provider or behavioral health provider to determine whether the patient meets diagnostic criteria for depression and, if so, to initiate a treatment plan.  (See references for further information and a website where you can download the PHQ-9).