Search

Background: Depression is highly prevalent in patients with chronic physical illnesses. A promising intervention for this group of patients is the collaborative care treatment as developed in the us., Aim: To demonstrate the prevalence of depression and the risk factors of depression in diabetes patients, to describe how the screening for depression can be carried out and to assess whether the collaborative care treatment in the Netherlands is effective., Method: A questionnaire was completed every three months in order to determine whether there was an improvement in patients' depression and physical symptoms. The outcomes were analysed by means of the multilevel logistic regression analyses., Results: On the basis of the Patient Health Questionnaire, about 26% of the diabetes patients were found to have a depression. This questionnaire was validated for the measurement of depression in diabetes patients, the best results being found at a cut-off point of 12. In cases of fairly severe depression, collaborative care had no effect on depressive symptoms but did reduce severe physical complications. In cases of more severe depression, collaborative care only had an effect on depressive symptoms, but was not found to have any effect on physical complications., Conclusion: There is evidence that collaborative care can reduce depression and physical complications in chronically ill patients. However, more research is needed to find out whether collaborative care can become more effective if it is supplemented with digital methods and group therapy.

Background: For the treatment of depression in diabetes patients, it is important that depression is recognized at an early stage. A screening method for depression is the patient health questionnaire (PHQ-9). The aim of this study is to validate the 9-item Patient Health Questionnaire (PHQ-9) as a screening instrument for depression in diabetes patients in outpatient clinics., Methods: 197 diabetes patients from outpatient clinics in the Netherlands filled in the PHQ-9. Within 2 weeks they were approached for an interview with the Mini Neuropsychiatric Interview. DSM-IV diagnoses of Major Depressive Disorder (MDD) were the criterion for which the sensitivity, specificity, positive- and negative predictive values and Receiver Operator Curves (ROC) for the PHQ-9 were calculated., Results: The cut-off point of a summed score of 12 on the PHQ-9 resulted in a sensitivity of 75.7% and a specificity of 80.0%. Predictive values for negative and positive test results were respectively 93.4% and 46.7%. The ROC showed an area under the curve of 0.77., Conclusions: The PHQ-9 proved to be an efficient and well-received screening instrument for MDD in this sample of diabetes patients in a specialized outpatient clinic. The higher cut-off point of 12 that was needed and somewhat lower sensitivity than had been reported elsewhere may be due to the fact that the patients from a specialized diabetes clinic have more severe pathology and more complications, which could be recognized by the PHQ-9 as depression symptoms, while instead being diabetes symptoms.