Skip to main content
SpringerLink
Log in

Disentangling Clinical Depression from Diabetes-Specific Distress: Making Sense of the Mess We’ve Made

  • Chapter
  • First Online:
Screening for Depression and Other Psychological Problems in Diabetes

Abstract

This chapter examines conceptual and applied issues regarding the screening of depression and diabetes-specific distress in adults with diabetes. We explore the conceptualization of depression as a frequently comorbid condition of diabetes and the importance of diabetes-specific distress and subthreshold depressive symptoms in regard to the emotional, behavioral, and health outcomes of living with diabetes. Overviews of the constructs of major depressive disorder (MDD) and diabetes-specific distress and challenges to an operational approach to negative emotion in the context of chronic illness are also presented in light of the meaningful overlap between diagnostic criteria of MDD and symptoms of diabetes and distress related to the burden of living with diabetes. Assessment of both depression and diabetes-specific distress are considered, including methodological issues and the strengths and weakness of leading self-report and semi-structured interview tools. Finally, suggestions for valid and clinically meaningful assessment of depressive symptoms and diabetes-specific distress in medical settings are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Anderson R, Freedland K, Clouse R, Lustman P. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24:1069–78.

    Article  PubMed  CAS  Google Scholar 

  2. 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  PubMed  CAS  Google Scholar 

  3. Gonzalez J, Peyrot M, McCarl L, Collins E, Serpa L, Mimiaga M, Safren S. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care. 2008;31:2398–403.

    Article  PubMed  Google Scholar 

  4. Lustman PJ, Griffith LS, Freedland KE, Clouse RE. Fluoxetine for depression in diabetes. Diabetes Care. 2000;23:618–23.

    Article  PubMed  CAS  Google Scholar 

  5. de Groot M, Anderson R, Freedland K, Clouse R, Lustman P. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63:619–30.

    PubMed  Google Scholar 

  6. Black S, Markides K, Ray L. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care. 2003;26:2822–8.

    Article  PubMed  Google Scholar 

  7. Lin EHB, 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 

  8. Gonzalez JS, Esbitt SA. Depression and treatment nonadherence in type 2 diabetes: assessment issues and an integrative treatment approach. Epidemiol Psichiatr Soc. 2010;19(2):110–5.

    PubMed  Google Scholar 

  9. Egede L. Effect of depression on self-management behaviors and health outcomes in adults with type 2 diabetes. Curr Diabetes Rev. 2005;1(3):235–43.

    Article  PubMed  Google Scholar 

  10. Katon WJ, Fan MY, Unützer J, Taylor J, Pincus H, Schoenbaum M. Depression and diabetes: a potentially lethal combination. J Gen Intern Med. 2008;23:1571–5.

    Article  PubMed  Google Scholar 

  11. Katon WJ, Ciechanowski P. The impact of major depression on chronic medical illness. J Psychosom Res. 2002;53:859–63.

    Article  PubMed  Google Scholar 

  12. Moscicki EK. Epidemiology of completed and attempted suicide: towards a framework for prevention. Clin Neurosci Res. 2001;1:310–23.

    Article  Google Scholar 

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

    Google Scholar 

  14. World Health Organization. ICD-10 classifications of mental and behavioural disorder: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 2010.

    Google Scholar 

  15. Horowitz AV, Wakefield JC. The loss of sadness: how psychiatry transformed normal sorrow into depressive disorder. New York: Oxford University Press; 2007.

    Google Scholar 

  16. Freud S. Mourning and melancholia. In: Strachey J, editor. The standard edition of the complete works of Sigmund Freud, vol. 14. London: Hogarth Press; 1917/1957. p. 152–70.

    Google Scholar 

  17. Diefendorf AR, Kraepelin E. Clinical psychiatry: abstracted and adapted from the seventh German edition of Kraepelin’s “Lehrbuch der Psychiatrie”. New York: Macmillan; 1907/1915.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  20. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychological Association; 1994.

    Google Scholar 

  21. Kihlstrom JF. To honor Kraepelin: from symptoms to pathology in the diagnosis of mental illness. In: Beutler LE, Malik ML, editors. Rethinking the DSM: a psychological perspective. Washington, DC: American Psychological Association; 2002.

    Google Scholar 

  22. Kendler K, Myers J, Zisook S. Does bereavement-related major depression differ from major depression associated with other stressful life events? Am J Psychiatry. 2008;165:1449–55.

    Article  PubMed  Google Scholar 

  23. Kim NS, Paulus DJ, Gonzalez JS, Khalife D. Proportionate responses to life events influence clinicians’ judgments of psychological abnormality. Psychol Assess. doi:10.1037/a0026416.

  24. Roy T, Lloyd CE, Pouwer F, Holt RIG, 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.

    Google Scholar 

  25. Coyne JC. Self-reported distress: analog or ersatz depression? Psychol Bull. 1994;116:29–45.

    Article  PubMed  CAS  Google Scholar 

  26. Thombs BD, de Jonge P, Coyne JC, Whooley MA, Frasure-Smith N, Mitchell AJ, et al. Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA. 2008;300:2161–71.

    Article  PubMed  CAS  Google Scholar 

  27. Sheehan DV, Lecrubier Y, Sheehan KH, et al. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(20):22–33.

    PubMed  Google Scholar 

  28. Wittchen HU. Reliability and validity studies of the WHO–composite international diagnostic interview (CIDI): a critical review. J Psychiatr Res. 1994;28(1):57–84.

    Article  PubMed  CAS  Google Scholar 

  29. First MB, Frances A, Pincxus HA. DSM-IV handbook of differential diagnosis. Washington, DC: American Psychiatric Press; 1995.

    Google Scholar 

  30. Fisher L, Skaff M, Mullan J, Arean P, Mohr D, Masharani U, et al. Clinical depression versus distress among patients with type 2 diabetes: not just a question of semantics. Diabetes Care. 2007;30:542–8.

    Article  PubMed  Google Scholar 

  31. Fisher L, Skaff M, Mullan J, Arean P, Glasgow R, Masharani U. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes. Diabet Med. 2008;25:1096–101.

    Article  PubMed  CAS  Google Scholar 

  32. Katon WJ, Rutter C, Simon G, Lin E, Ludman E, Ciechanowski P, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28(11): 2668–72.

    Google Scholar 

  33. Gonzalez J, Safren S, Cagliero E, Wexler D, Delahanty L, Wittenberg E, Blais M, Meigs J, Grant R. Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diabetes Care. 2007;30:2222–7.

    Article  PubMed  Google Scholar 

  34. Pouwer F, Beekman ATF, Nijpels G, et al. Rates and risks for co-morbid depression in patients with type 2 diabetes mellitus: results of a community-based study. Diabetologia. 2003;46:892–8.

    Article  PubMed  CAS  Google Scholar 

  35. Goldney RD, Phillips PJ, Fisher LJ, Wilson DH. Diabetes, depression, and quality of life: a population study. Diabetes Care. 2004;27(5):1066–70.

    Article  PubMed  Google Scholar 

  36. Egede L. Effects of depression on work loss and disability bed days in individuals with diabetes. Diabetes Care. 2004;27:1751–3.

    Article  PubMed  Google Scholar 

  37. Gayman MD, Turner RJ, Cui M. Physical limitations and depressive symptoms: exploring the nature of the association. J Gerontol B Psychol Sci Soc Sci. 2008;63:S219–28.

    Article  PubMed  Google Scholar 

  38. Vileikyte L, Peyrot M, Gonzalez J, Rubin R, Garrow A, Stickings D, et al. Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study. Diabetologia. 2009;52:1265–73.

    Article  PubMed  CAS  Google Scholar 

  39. Kessler RC, Birnbaum H, Bromet E, Hwang I, Sampson N, Shahly V. Age differences in major depression: results from the national comorbidity survey replication (NCS-R). Psychol Med. 2010;40:225–37.

    Article  PubMed  CAS  Google Scholar 

  40. Schnittker J. Chronic illness and depressive symptoms in late life. Soc Sci Med. 2005;60:13–23.

    Article  PubMed  Google Scholar 

  41. Polonsky WH, Anderson BJ, Lohrer PA, Welch G, Jacobson AM, Aponte JE, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18:754–60.

    Article  PubMed  CAS  Google Scholar 

  42. Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan J, et al. Assessing psychosocial stress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005;28:626–31.

    Article  PubMed  Google Scholar 

  43. Gask L, Macdonald W, Bower P. What is the relationship between diabetes and depression? A qualitative meta-synthesis of patient experience of co-morbidity. Chron Illn. 2011;7:239–52.

    Article  Google Scholar 

  44. Fisher L, Mullan J, Arean P, Glasgow R, Hessler D, Masharani U. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care. 2010;33:23–8.

    Article  PubMed  Google Scholar 

  45. Gonzalez J, Delahanty L, Safren S, Meigs J, Grant R. Differentiating symptoms of depression from diabetes-specific distress: relationships with self-care in type 2 diabetes. Diabetologia. 2008;51:1822–5.

    Article  PubMed  CAS  Google Scholar 

  46. Lloyd CE, Pambianco G, Orchard TJ. Does diabetes-related distress explain the presence of depressive symptoms and/or poor self-care in individuals with type 1 diabetes? Diabet Med. 2010;27(2):234–7.

    Article  PubMed  CAS  Google Scholar 

  47. Tanenbaum ML, Gonzalez JS. The influence of diabetes distress on a clinician-rated assessment of depression in adults with type 1 diabetes. (In Press).

    Google Scholar 

  48. Dunn SM, Smartt H, Beeney L, Turtle J. Measurement of emotional adjustment in diabetic patients: validity and reliability of ATT39. Diabetes Care. 1986;9:480–9.

    Article  PubMed  CAS  Google Scholar 

  49. Herschbach P, Duran G, Waadt S, Zettler A, Amm C, Marten-Mittag B. Psychometric properties of the questionnaire on stress in patients with diabetes-revised (QSD-R). Health Psychol. 1997;16:171–4.

    Article  PubMed  CAS  Google Scholar 

  50. Duran G, Herschbach P, Waadt S, Strain F, Zettler A. Assessing daily problems with diabetes: a subject-oriented approach to compliance. Psychol Rep. 1995;76:515–21.

    Article  PubMed  CAS  Google Scholar 

  51. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised illness perception questionnaire (IPQ-R). Psychiatry Health. 2002;17(1):1–16.

    Article  Google Scholar 

  52. Ishii H, Welch GW, Jacobson A, Goto M, Okazaki K, Yamamoto T, Tsujii S. The Japanese version of the problem areas in diabetes scale: a clinical and research tool for the assessment of emotional functioning among diabetic patients. Diabetes. 1999;48:A319.

    Google Scholar 

  53. Lerman-Garber I, Barron-Uribe C, Calzada-Leon R, Mercado-Atri M, Vidal-Tarnayo R, Quintana S, Hernandez ME, Ruiz-Reyes MdlR, Tamez-Gutierrez LE, Nishimura-Meguro E, Villa AR. Emotional dysfunction associated with diabetes in Mexican adolescents and young adults with type-1 diabetes. Salud Publica Mex. 2003;45:13–8.

    Article  PubMed  Google Scholar 

  54. Snoek FJ, Pouwer F, Welch GW, Polonsky WH. Diabetes-related emotional distress in Dutch and U.S. diabetic patients: cross-cultural validity of the problem areas in diabetes scale. Diabetes Care. 2000;23:1305–9.

    Article  PubMed  CAS  Google Scholar 

  55. Hermanns N, Kulzer B, Krichbaum M, Kubiak T, Haak T. How to screen for depression and emotional problems in patients with diabetes: comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment. Diabetologia. 2006;49:469–77.

    Article  PubMed  CAS  Google Scholar 

  56. van Bastelaar KMP, Pouwer F, Geelhoed-Duijvestijn PHLM, Tack CJ, Bazelmans E, Beekman AT, Heine RJ, Snoek FJ. Diabetes-specific emotional distress mediates the association between depressive symptoms and glycaemic control in type 1 and type 2 diabetes. Diabet Med. 2011;27(7):798–803.

    Article  Google Scholar 

  57. Huang M, Courtney M, Edwards H, McDowell J. Validation of the Chinese version of the problem areas in diabetes (PAID-C) scale. Diabetes Care. 2010;33:38–40.

    Article  PubMed  Google Scholar 

  58. Graue M, Haugstvedt A, Wentzel-Larsen T, Iversen MM, Karlsen B, Rokne B. Diabetes-related emotional distress in adults: reliability and validity of the Norwegian versions of the problem areas in diabetes scale (PAID) and the diabetes distress scale (DDS). Int J Nurs Stud. 2012;49(2):174–82.

    Google Scholar 

  59. Huis In ‘T Veld EMJ, Makine C, Nouwen A, Karsidag C, Kadioglu P, Karsidag K, Pouwer F. Validation of the Turkish version of the problem areas in diabetes scale. Cardio Psych Neurol. 2011, p. 6. Article ID 315068. doi: 10.1155/2011/315068.

  60. Miller SA, Elasy TA. Psychometric evaluation of the problem areas in diabetes (PAID) survey in Southern, rural African American women with type 2 diabetes. BMC Public Health. 2008;8(70):1–6.

    Google Scholar 

  61. Weinger K, Jacobson AM. Psychosocial and quality of life correlates of glycemic control during intensive treatment of type 1 diabetes. Patient Educ Couns. 2001;42:123–31.

    Article  PubMed  CAS  Google Scholar 

  62. Welch GW, Jacobson AM, Polonsky WH. The problem areas in diabetes scale: an evaluation of its clinical utility. Diabetes Care. 1997;20:760–6.

    Article  PubMed  CAS  Google Scholar 

  63. Welch G, Weinger K, Anderson B, Polonsky WH. Responsiveness of the problem areas in diabetes (PAID) questionnaire. Diabet Med. 2003;20:69–72.

    Article  PubMed  CAS  Google Scholar 

  64. Delahanty LM, Grant RW, Wittenberg E, Bosch JL, Wexler DJ, Cagliero E, Meigs JB. Association of diabetes-related emotional distress with diabetes treatment in primary care patients with type 2 diabetes. Diabet Med. 2007;24(1):48–54.

    Article  PubMed  CAS  Google Scholar 

  65. McGuire B, Morrison T, Hermanns N, Skovlund S, Eldrup E, Gagliardino J, et al. Short-form measures of diabetes-related emotional distress: the problem areas in diabetes scale (PAID)-5 and PAID-1. Diabetologia. 2010;53(1):66–9.

    Article  PubMed  CAS  Google Scholar 

  66. Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress meaningful? Establishing cut points for the diabetes distress scale. Diabetes Care. 2012;35(2):259–64.

    Google Scholar 

  67. Fisher L, Glasgow R, Mullan JT, Skaff MM, Polonsky WH. Development of a brief diabetes distress screening instrument. Ann Fam Med. 2008;6(3):246–52.

    Article  PubMed  Google Scholar 

  68. American Diabetes Association. Standards of medical care in diabetes – 2011. Diabetes Care. 2011;34:S11–61.

    Article  Google Scholar 

  69. International Diabetes Federation. Clinical guidelines task force, global guidelines for type 2 diabetes. Brussels: International Diabetes Federation; 2005.

    Google Scholar 

  70. Pouwer F, Beekman AT, Lubach C, Snoek FJ. Nurses’ recognition and registration of depression, anxiety and diabetes-specific emotional problems in outpatients with diabetes mellitus. Patient Educ Couns. 2006;60:235–40.

    Article  PubMed  Google Scholar 

  71. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303:47–53.

    Article  PubMed  CAS  Google Scholar 

  72. Bhui K, Bhugra D. Transcultural psychiatry: some social and epidemiological research issues. Int J Soc Psychiatry. 2001;47:1–9.

    Article  PubMed  CAS  Google Scholar 

  73. Gonzalez J, Fisher L, Polonsky W. Depression in diabetes: have we been missing something important? Diabetes Care. 2011;34(1):236–9.

    Article  PubMed  Google Scholar 

  74. Glasgow RE, Strycker LA. Level of preventive practices for diabetes management: patient, physician, and office correlates in two primary care samples. Am J Prev Med. 2000;19:9–14.

    Article  PubMed  CAS  Google Scholar 

  75. Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy to effectiveness transition. Am J Public Health. 2003;93:1261–7.

    Article  PubMed  Google Scholar 

  76. Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin Psychol Rev. 2008;28:1426–46.

    Article  PubMed  Google Scholar 

  77. Glasgow RE, Goldstein MG, Ockene J, Pronk NP. Translating what we have learned into practice: principles and hypotheses for addressing multiple behaviors in primary care. Am J Prev Med. 2004;27:88–110.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA

    Sabrina A. Esbitt M.A., Molly L. Tanenbaum M.A. & Jeffrey S. Gonzalez Ph.D.

  2. Einstein Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Jeffrey S. Gonzalez Ph.D.

Authors
  1. Sabrina A. Esbitt M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Molly L. Tanenbaum M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey S. Gonzalez Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey S. Gonzalez Ph.D. .

Editor information

Editors and Affiliations

  1. , Faculty of Health & Social Care, Open University, Milton Keynes, MK7 6AA, United Kingdom

    Cathy E. Lloyd

  2. Tilburg University, Tilburg, 5000 LE, Netherlands

    Frans Pouwer

  3. Wuerzburg, Germany

    Norbert Hermanns

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Esbitt, S.A., Tanenbaum, M.L., Gonzalez, J.S. (2013). Disentangling Clinical Depression from Diabetes-Specific Distress: Making Sense of the Mess We’ve Made. 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_2

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-751-8_2

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-750-1

  • Online ISBN: 978-0-85729-751-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation