Depression and Diabetes Impact of Depressive Symptoms on Adherence, Function, and Costs

Box 356560, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 12/2000; 160(21):3278-85. DOI: 10.1001/archinte.160.21.3278
Source: PubMed


Depression is common among patients with chronic medical illness. We explored the impact of depressive symptoms in primary care patients with diabetes on diabetes self-care, adherence to medication regimens, functioning, and health care costs.
We administered a questionnaire to 367 patients with types 1 and 2 diabetes from 2 health maintenance organization primary care clinics to obtain data on demographics, depressive symptoms, diabetes knowledge, functioning, and diabetes self-care. On the basis of automated data, we measured medical comorbidity, health care costs, glycosylated hemoglobin (HbA(1c)) levels, and oral hypoglycemic prescription refills. Using depressive symptom severity tertiles (low, medium, or high), we performed regression analyses to determine the impact of depressive symptoms on adherence to diabetes self-care and oral hypoglycemic regimens, HbA(1c) levels, functional impairment, and health care costs.
Compared with patients in the low-severity depression symptom tertile, those in the medium- and high-severity tertiles were significantly less adherent to dietary recommendations. Patients in the high-severity tertile were significantly distinct from those in the low-severity tertile by having a higher percentage of days in nonadherence to oral hypoglycemic regimens (15% vs 7%); poorer physical and mental functioning; greater probability of having any emergency department, primary care, specialty care, medical inpatient, and mental health costs; and among users of health care within categories, higher primary (51% higher), ambulatory (75% higher), and total health care costs (86% higher).
Depressive symptom severity is associated with poorer diet and medication regimen adherence, functional impairment, and higher health care costs in primary care diabetic patients. Further studies testing the effectiveness and cost-effectiveness of enhanced models of care of diabetic patients with depression are needed. Arch Intern Med. 2000;160:3278-3285.

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    • "The yearly prevalence of major depression is comparable in DM2 patients and patients with CHD and adds up to about 10–20%, which is considerably high compared to the prevalence of 5% in the general Dutch population (Anderson et al., 2001; Backenstrass et al., 2006; Bot et al., 2010; de Graaf et al., 2012; Harter et al., 2007; Kroenke et al., 2001; Rodriguez et al., 2012; Rudisch and Nemeroff, 2003; Thombs et al., 2006). Major depression among DM2 and/or CHD patients is associated with lower quality of life, an increased risk of mortality, poor medication adherence and increased health care costs (Ciechanowski et al., 2000; Haddad et al., 2013; Lamers et al., 2008; Lin et al., 2009; Rodriguez et al., 2012; Simon, 1992; Stafford et al., 2007). Moreover, once patients are diagnosed with major depression, only roughly one third of the associated disease burden can be averted, even when optimal Contents lists available at ScienceDirect journal homepage: "
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    ABSTRACT: Background Depression is common among type 2 diabetes mellitus (DM2)/coronary heart disease (CHD) patients and is associated with adverse health effects. A promising strategy to reduce burden of disease is to identify patients at risk for depression in order to offer indicated prevention. This study aims to assess the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) to be used as a tool to identify high risk patients. Methods In this cross-sectional study, 586 consecutive DM2/CHD patients aged >18 were recruited through 23 general practices. PHQ-9 outcomes were compared to the Mini International Neuropsychiatric Interview (MINI), which was considered the reference standard. Diagnostic accuracy was evaluated for minor and major depression, comparing both sum- and algorithm based PHQ-9 scores. Results For minor depression, the optimal cut-off score was 8 (sensitivity 71%, specificity 71% and an AUC of 0.74). For major depression, the optimal cut-off score was 10 resulting in a sensitivity of 84%, a specificity of 82%, and an AUC of 0.88. The positive predictive value of the PHQ-9 algorithm for diagnosing minor and major depression was 25% and 33%, respectively. Limitations Two main limitations apply. MINI Interviewers were not blinded for PHQ-9 scores and less than 10% of all invited patients could be included in the analyses. This could have resulted in biased outcomes. Conclusions The PHQ-9 sum score performs well in identifying patients at high risk of minor and major depression. However, the PHQ-9 showed suboptimal results for diagnostic purposes. Therefore, it is recommended to combine the use of the PHQ-9 with further diagnostics to identify depression.
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    • "Based on the results of the meta-analysis, the aggregate estimate of the prevalence of depression was 21% for patients with type 1 diabetes, and 27% for patients with T2DM (Anderson et al., 2001). The clinical relevance of this finding is emphasized by results which indicate that patients with depressive symptoms have poorer diet and medication adherence, functional impairment and higher healthcare costs (Ciechanowski, Katon, & Russo, 2000). Moreover, depressive symptoms are significantly associated with a variety of diabetes complications including retinopathy, nephropathy, neuropathy, macrovascular complications and sexual dysfunction (de Groot, Anderson, Freedland, et al., 2001). "
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    ABSTRACT: To determine the relationship between ABC goal attainment, depression, and health-related quality of life (HRQoL) among a national sample of patients with type 2 diabetes (T2DM). A retrospective, cross-sectional analysis was performed examining 808 non-pregnant patients ≥20years old with T2DM from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. ABC goals were defined as HbA1c<7%, BP<130/80mm Hg, and LDL-C<100mg/dL. Patient characteristics associated with ABC goal attainment were examined. Overall, 23.7% of participants achieved simultaneous ABC goals. Severe depression was significantly associated with lower rates of ABC goal attainment compared to those with no depression (5.0% vs. 25.4%, p=0.048). ABC goal attainment rates were lower among females, Hispanic and non-Hispanic black minority groups, and patients with a duration of diabetes over five years, while increased visits with health care professionals were significantly associated with meeting all three ABC goals for patients with T2DM. The relationship between simultaneous ABC goal attainment, depression and HRQoL is complex. Patients with T2DM unable to meet ABC goals may benefit from increased contact with health care professionals. Copyright © 2015. Published by Elsevier Inc.
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