had slightly worse control of their diabetes and weight at base line compared to the composite score on diabetes self management between baseline and …
REPORT FOR CLINICIANS: RESULTS OF THE AHRQ PBRN STUDY-
INVESTIGATING THE CORRELATES AND OUTCOMES OF DEPRESSION IN ADULT DIABETICS
Carole Upshur, EdD Mary Lindholm, MD
University of Massachusetts Medical School-Department of Family Medicine
and Community Health
October 2007
The goals of this project were to: 1 investigate the prevalence and
correlates of major depressive disorder MDD and depressive symptoms in
adult Type II diabetics who receive their health care in three community
health centers in the New England Clinicians Forum Practice-Based Research
Network; 2 to assess the interaction of MDD with diabetes control
indicators and self-reported diabetes self-management activities; and 3
initiate a pilot intervention-outcome study to provide depression treatment
for patients with high levels of depression symptoms, and longitudinally
assess at three and six months both depression and diabetes outcomes and
self-reported adherence to diabetes control activities
Methods: Patients were recruited from a randomly selected list of 175
patients from each health centers diabetes registry
220 patients were
enrolled, 85 from Holyoke, 56 from Fair Haven, and 79 from Neponset
Of those enrolled, 327 were male and their mean age was 589 years
146 were Black, 455 Hispanic, and 391 White This compares to the
patients who refused enrollment both passively or by active refusal of
participation Data collection was completed on July 7, 2007
Baseline Descriptors: Our enrolled group had slightly worse control of
their diabetes and weight at base line compared to the randomly selected
list from the registries Average hemoglobin A1C was 743 and BMI was 352
in the enrolled group as compared to an A1C of 729 and a BMI of 325 in
the refused enrollment group Blood pressure and LDL measurements were
similar between groups with BP averaging 1266/744 in the enrolled vs
733/1279, and LDL 1010 vs 1039
Depression symptom rates and correlates: Over 305 of enrolled patients
had either a PHQ-9 score of 10 or above or at least one SF8 emotional item
marked as at least somewhat bothersome or interfering with daily activity
545 of these patients were already receiving treatment for depression and
187 of patents who did not screen in for depression reported being
treated for depression
Combining these 2 groups resulted in 43 of the
enrolled sample having some indication of depressive symptoms
Those with depression were more often Hispanic, Spanish speaking, and had
slightly lower systolic blood pressures They were more likely to be
Medicaid insured, report poorer overall health, less energy, more bodily
pain and consistently more limitations on work and social activities than
those without depression They reported smoking more, but using less
alcohol and having poorer diets significantly less fruit and vegetable
consumption and a trend to a higher fat diet
Depression symptoms along with baseline A1C values, Medicaid insurance,
systolic blood pressure and Spanish language were significantly associated
with self management Those with higher A1cs , higher blood pressure,
preferring to communicate in Spanish, and having Medicaid insurance were
all associated with better self-reported self-management Patients with
depression, controlling for ethnicity and insurance status, had poorer
overall self-management scores
Outcomes for patients referred to PCPs for high depression scores:
39 patients were referred to their PCPs for evaluation of their
depression
treatment 36 were reevaluated at 3 months and 22 at six months Initial
average PHQ-9 was 1943 followed by 1405 at 3 months and 1261 at six
months p001 This group also reported improved overall health, more
energy and less interference with activities due to emotional problems
They self-reported increases in rates of treatment for depression, from 54
to 68 including both medication and counseling There were no significant
changes in A1C, LDL or BP There was near significant improvement in the
composite score on diabetes self management between baseline and 6 months
It rose from 285 to 325 p076
:
Conclusions
We found very high rates of depression in our sample, with a possible rate
of 43 combining those with current symptoms with those reporting current
depression treatments This rate exceeds the highest rate cited in the
prior literature that suggests diabetics may have rates of depression of up
to 40 Consistent with other studies, however, teasing out the effects of
depression on diabetic status and on diabetic self-management was
difficult Similar to some other studies, we did not find an association
of depression/emotional problems and A1C, but we found some
evidence that
depression affected diabetes self-management activities
What were most striking were the significant self-reported poorer health,
levels of pain, and levels of interference with work, daily activities and
social activities among those with depression We also found some evidence
that with depression treatment organized in primary care for diabetic
patients, and identification of the patients to their PCP, more patients
received treatment and showed improvements in depressive symptoms
Simultaneously we found some evidence that diabetic self-management in
areas such as diet, exercise and foot checks also improved among those
patients referred back to their PCP for depression management Thus we have
generated pilot date for further study among a highly diverse,
disadvantaged population of diabetic patients using community health
centers for primary care A follow up study should be considered using the
patients who enrolled in this study to assess both those with and without
depression prospectively
If you have additional questions about this study, or would like a copy of
the full 20-page AHRQ Final Report, please feel free to contact: Jennifer
Granger,
jgranger@ctpcaorg, Carole Upshur or Mary Lindholm at University
of Massachusetts Medical School; caroleupshur@umassmededu or 508-334-
7267; Lindholm@ummhcorg
Source:anmc.org
