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Measuring and Assessing Depression in People with Diabetes: Implications for Clinical Practice

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Screening for Depression and Other Psychological Problems in Diabetes

Abstract

Diabetes is an increasing global health and economic burden that is frequently associated with and worsened by clinically significant depression or anxiety. This chapter focuses on the history and evolution of the concept of depression and will also describe some of the uncertainties and controversy surrounding psychiatric nosology. Depression as a syndrome of pathological emotions should be diagnosed using operationalized criteria; however, at the same time, depression should not be reified as a discrete construct with absolute boundaries. Depression is often comorbid with anxiety and other mental disorders, which could be clinically important for diabetes. As with other medical syndromes, there is substantial heterogeneity between patients within psychiatric diagnostic groups. Clinically significant depression is defined using cutoff scores for self-rated symptoms using various psychometrics, which correlate reasonably well with operationalized diagnoses. Both methods classify persons into clinically significant dichotomies of depression for diabetes. This chapter considers the implications of these diagnoses for clinical practice and makes suggestions as to the way forward both in terms of the identification of people with comorbid depression and diabetes and for treatment and care. Computerized assessment, for example, with computerized adaptive testing (CAT), can facilitate time-efficient depression screening in busy clinic settings.

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References

  1. Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006;23(11):1165–73.

    Article  CAS  PubMed  Google Scholar 

  2. Barnard KD, Skinner TC, Peveler R. The prevalence of co-morbid depression in adults with type 1 diabetes: systematic literature review. Diabet Med. 2006;23(4):445–8.

    Article  CAS  PubMed  Google Scholar 

  3. Pouwer F, Geelhoed-Duijvestijn PH, Tack CJ, Bazelmans E, Beekman AJ, Heine RJ, et al. Prevalence of comorbid depression is high in out-patients with type 1 or type 2 diabetes mellitus. Results from three out-patient clinics in the Netherlands. Diabet Med. 2010;27:217–24.

    Article  CAS  PubMed  Google Scholar 

  4. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619–30.

    PubMed  Google Scholar 

  5. Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complications. 2005;19(2):113–22.

    PubMed  Google Scholar 

  6. Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care. 2008;31(12):2383–90.

    Article  PubMed  Google Scholar 

  7. Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K, et al. European depression in diabetes (EDID) research consortium. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010;53(12):2480–6.

    Article  CAS  PubMed  Google Scholar 

  8. American Diabetes Association. Economic costs of diabetes in the U.S. In 2007. Diabetes Care. 2008;31:596–615.

    Article  Google Scholar 

  9. Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ, et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care. 2008;31:2398–403.

    Article  PubMed  Google Scholar 

  10. Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000;23:934–42.

    Article  CAS  PubMed  Google Scholar 

  11. Atlantis E, Goldney RD, Eckert KA, Taylor AW, Phillips P. Trends in health-related quality of life and health service use associated with comorbid diabetes and major depression in South Australia, 1998–2008. Soc Psychiatry Psychiatr Epidemiol. 2012;47(6):871–7.

    Google Scholar 

  12. Hilliard ME, Herzer M, Dolan LM, Hood KK. Psychological screening in adolescents with type 1 diabetes predicts outcomes one year later. Diabetes Res Clin Pract. 2011;94(1):39–44.

    Article  PubMed  Google Scholar 

  13. Schram MT, Baan CA, Pouwer F. Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium. Curr Diabetes Rev. 2009;5(2):112–9.

    Article  PubMed  Google Scholar 

  14. Lin EH, Rutter CM, Katon W, Heckbert SR, Ciechanowski P, Oliver MM, et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care. 2010;33:264–9.

    Article  PubMed  Google Scholar 

  15. Atlantis E, Shi Z, Penninx BJ, Wittert GA, Taylor A, Almeida OP. Chronic medical conditions mediate the association between depression and cardiovascular disease mortality. Soc Psychiatry Psychiatr Epidemiol. 2012;47(4):615–25. doi:10.1007/s00127-011-0365-9. Epub 2011 Mar 8.

    Article  PubMed  Google Scholar 

  16. Davydow DS, Russo JE, Ludman E, Ciechanowski P, Lin EH, Von Korff M, et al. The association of comorbid depression with intensive care unit admission in patients with diabetes: a prospective cohort study. Psychosomatics. 2011;52:117–26.

    Article  PubMed  Google Scholar 

  17. Hutter N, Schnurr A, Baumeister H. Healthcare costs in patients with diabetes mellitus and comorbid mental disorders – a systematic review. Diabetologia. 2010;53: 2470–2479. International Diabetes Federation. IDF diabetes atlas. 5th ed. Brussels: International Diabetes Federation; 2011.

    Google Scholar 

  18. Stewart SM, Rao U, Emslie GJ, Klein D, White PC. Depressive symptoms predict hospitalization for adolescents with type 1 diabetes mellitus. Pediatrics. 2005;115:1315–9.

    Article  PubMed  Google Scholar 

  19. Weich S, McBride O, Hussey D, Exeter D, Brugha T, McManus S. Latent class analysis of co-morbidity in the adult psychiatric morbidity survey in England 2007: implications for DSM-5 and ICD-11. Psychol Med. 2011;41(10):2201–12.

    Article  CAS  PubMed  Google Scholar 

  20. Li C, Barker L, Ford ES, Zhang X, Strine TW, Mokdad AH. Diabetes and anxiety in US adults: findings from the 2006 behavioral risk factor surveillance system. Diabet Med. 2008;25(7):878–81.

    Article  CAS  PubMed  Google Scholar 

  21. Engum A. The role of depression and anxiety in onset of diabetes in a large population-based study. J Psychosom Res. 2007;62(1):31–8.

    Article  PubMed  Google Scholar 

  22. Eriksson AK, Ekbom A, Granath F, Hilding A, Efendic S, Ostenson CG. Psychological distress and risk of pre-diabetes and type 2 diabetes in a prospective study of Swedish middle-aged men and women. Diabet Med. 2008;25(7):834–42.

    Article  PubMed  Google Scholar 

  23. Hothersall D. Chapter 1: Psychology and the ancients. In: History of psychology. 4th ed. New York: Mc Graw-Hill; 2004. p. 15–32.

    Google Scholar 

  24. Clending L. Chapter 8: Aretaeus the Cappadocian. In: Source book of medical history. New York: Dover Publications; 1960. p. 52–7.

    Google Scholar 

  25. Adams F (trans). Chapter 5: Melancholy. In: The extant works of aretaeus, the cappadocian. Boston: Milford House Inc; 1972. p. 53–55.

    Google Scholar 

  26. American Psychiatric Association. Diagnostic and statistical manual: mental disorders. Washington: American Psychiatric Association; 1952.

    Google Scholar 

  27. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 2nd ed. Washington, DC: American Psychiatric Association; 1968.

    Google Scholar 

  28. Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry. 1972;26:57–63.

    Article  CAS  PubMed  Google Scholar 

  29. Spitzer RL, Robins E. Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry. 1978;35:773–82.

    Article  CAS  PubMed  Google Scholar 

  30. Kendler KS, Muñoz RA, Murphy G. The development of the feighner criteria: a historical perspective. Am J Psychiatry. 2010;167(2):134–42.

    Article  PubMed  Google Scholar 

  31. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980.

    Google Scholar 

  32. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000, text revisions.

    Google Scholar 

  33. Poole L, Dickens C, Steptoe A. The puzzle of depression and acute coronary syndrome: reviewing the role of acute inflammation. J Psychosom Res. 2011;71(2):61–8.

    Article  PubMed  Google Scholar 

  34. de Jonge P. Depression deconstruction lessons from psychosomatic research. J Psychosom Res. 2011;71(2):59–60.

    Article  PubMed  Google Scholar 

  35. Licht CM, Vreeburg SA, van Reedt Dortland AK, Giltay EJ, Hoogendijk WJ, DeRijk RH, Vogelzangs N, Zitman FG, de Geus EJ, Penninx BW. Increased sympathetic and decreased parasympathetic activity rather than changes in hypothalamic-pituitary-adrenal axis activity is associated with metabolic abnormalities. J Clin Endocrinol Metab. 2010;95(5):2458–66.

    Article  CAS  PubMed  Google Scholar 

  36. Luppino FS, van Reedt Dortland AK, Wardenaar KJ, Bouvy PF, Giltay EJ, Zitman FG, Penninx BW. Symptom dimensions of depression and anxiety and the metabolic syndrome. Psychosom Med. 2011;73(3):257–64.

    Article  CAS  PubMed  Google Scholar 

  37. Roy T, Lloyd CE, Pouwer F, Holt RI, Sartorius N. Screening tools used for measuring depression among people with type 1 and type 2 diabetes: a systematic review. Diabet Med. 2012;29(2):164–75.

    Article  CAS  PubMed  Google Scholar 

  38. IDF Clinical Guidelines Task Force. Global guideline for type 2 diabetes: recommendations for standard, comprehensive, and minimal care. Diabet Med. 2006;23(6):579–93.

    Article  Google Scholar 

  39. Valenstein M, Vijan S, Zeber JE, Boehm K, Buttar A. The cost-utility of screening for depression in primary care. Ann Intern Med. 2001;134(5):345–60.

    CAS  PubMed  Google Scholar 

  40. Pouwer F, Snoek FJ, van der Ploeg HM, Heine RJ, Brand AN. A comparison of the standard and the computerized versions of the well-being questionnaire (WBQ) and the diabetes treatment satisfaction questionnaire (DTSQ). Qual Life Res. 1998;7(1):33–8.

    Article  CAS  PubMed  Google Scholar 

  41. van Bastelaar KM, Pouwer F, Cuijpers P, Riper H, Snoek FJ. Web-based depression treatment for type 1 and type 2 diabetic patients: a randomized, controlled trial. Diabetes Care. 2011;34(2):320–5.

    Article  PubMed  Google Scholar 

  42. van Bastelaar KM, Pouwer F, Cuijpers P, Riper H, Twisk JW, Snoek FJ. Is a severe clinical profile an effect modifier in a web-based depression treatment for adults with type 1 or type 2 diabetes? Secondary analyses from a randomized controlled trial. J Med Internet Res. 2012;14(1):e2.

    Article  PubMed  Google Scholar 

  43. Gardner W, Shear K, Kelleher KJ, Pajer KA, Mammen O, Buysse D, Frank E. Computerized adaptive measurement of depression: a simulation study. BMC Psychiatry. 2004;4:13.

    Article  PubMed  Google Scholar 

  44. Pouwer F, Skinner TC, Pibernik-Okanovic M, Beekman AT, Cradock S, Szabo S, Metelko Z, Snoek FJ. Serious diabetes-specific emotional problems and depression in a Croatian-Dutch-English survey from the European depression in diabetes [EDID] research consortium. Diabetes Res Clin Pract. 2005;70(2):166–73.

    Article  PubMed  Google Scholar 

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Correspondence to Evan Atlantis Ph.D. .

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Pouwer, F., Atlantis, E. (2013). Measuring and Assessing Depression in People with Diabetes: Implications for Clinical Practice. In: Lloyd, C., Pouwer, F., Hermanns, N. (eds) Screening for Depression and Other Psychological Problems in Diabetes. Springer, London. https://doi.org/10.1007/978-0-85729-751-8_10

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  • DOI: https://doi.org/10.1007/978-0-85729-751-8_10

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