engleski

The reach of screening for and treating of subsyndromal depression in type 2 diabetic patients

Background and aim: Elevated depressive symptoms, common in diabetic patients, have suboptimal recognition and treatment rates. This study aimed to assess the reach of depression screening followed by treatment programmes for subsyndromal depression in a large sample of type 2 diabetic patients, and to determine predictors of patients’ participation in treatment. Materials and methods: A sample of 4196 type 2 patients (44% female, aged 56±8 yrs, educated for 12±3 yrs, with diabetes duration of 10±7 yrs, BMI of 30±5 kg/m2 and HbA1C of 7.2%±1.4) was screened for depressive symptoms. They were sent the two-item Patient Health Questionnaire-Depression scale (PHQ-2) accompanied by an additional question inquiring into the need to receive professional help in mood-related issues. Disease-related data (BMI, diabetes duration, HbA1C, total cholesterol, LDL, HDL, triglycerides and creatinine) were extracted from the patients’ electronic files. Patients with positive screening results were phoned to collect sociodemographic and personal data (professional, economic and family status, and self-reported acute and chronic stress) and to assess the severity of depressive symptoms by administering a structured clinical interview (SCID-I). Patients classified as having subclinical depressive symptoms were invited to be randomized to a psychoeducational, physical exercise or diabetes re-education treatment group. The reach of the screening procedure was evaluated based on the total response rate, the proportion of positive depression screenings, and the proportion of eligible patients who entered the treatment programmes. Demographic and disease-related characteristics were explored in patients with elevated depressive symptoms vs. depression-free patients by using chi-square and t-tests. Multivariate logistic regression analysis was used to determine which demographic and disease-related factors differentiated between individuals who entered the treatment and those who declined to participate. Results: Of the 34% of patients who returned the questionnaire (n=1420), 40% reported elevated depressive symptoms and a need for professional help (n=581). One-half (48%, n=282) were considered eligible for treatments, with 191 (68%) entering the treatment programmes and 91 declining to do so. Responsiveness to screening, reporting depressive symptoms and expressing a need for help were comparable in female and male respondents (all p’s >0.05). Treatment participants in comparison with non-participants had lower BMI (29 kg/m2±4.3 vs. 31 kg/m2±4.9, p=0.02) and triglycerides (1.9 mmol/L±0.9 vs. 2.4mmol/L±2.9, p=0.02). Female gender reached borderline significance (chi-square=3.62, p=0.057), and no differences were detected in other personal and disease-related variables. In multivariate analysis, gender (Wald chi square=3.84, p=0.05), education (Wald chi square=3.81 p=0.05) and BMI (Wald chi square =5.96 p=0.01) were shown to predict participation in treatment. Conclusion: One-third (34%) of type 2 diabetic patients responded to postal screening for depression, and 40% of these respondents reported elevated symptoms and a need for professional help. Two-thirds (68%) of the eligible individuals were willing to enter the treatment programmes. Women, better-educated persons and those with lower BMI were more likely to χ2 agree to participate in treatment programmes for subsyndromal depression.

diabetes; depression; screening; depression treatment

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