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Quality of Depression Care in a Population-Based Sample of Patients With Diabetes and Major Depression

Katon, Wayne J. MD*; Simon, Gregory MD, MPH; Russo, Joan PhD*; Von Korff, Michael ScD; Lin, Elizabeth H. B. MD, MPH; Ludman, Evette PhD; Ciechanowski, Paul MD, MPH*; Bush, Terry PhD

Original Article

Objectives: Major depression occurs in approximately 11% to 15% of patients with diabetes and is associated with poor glycemic control and adverse medical outcomes. This study examined the rates and predictors of recognition of depression among primary care patients with diabetes and comorbid major depression and the quality of depression care provided during a 12-month period.

Methods: This study used automated utilization, pharmacy, and laboratory data from a health maintenance organization to describe the rate of recognition of depression and quality of care provided for patients with major depression and diabetes in the 12-month period before diagnosis. Major depression was diagnosed based on the Patient Health Questionnaire (PHQ-9) that was included in a mail survey sent to 9063 patients on the Group Health diabetes registry from 9 primary care clinics.

Results: Approximately 51% of patients with major depression and diabetes were recognized as depressed by the health care system. Women were more likely to be recognized (odds ratio [OR] 1.58, 95% confidence interval [CI 1.26–1.97]), as were those with dysthymia (OR 3.44, 95% CI 2.08–5.72), panic attacks (OR 1.55, 95% CI 1.19–2.19), patients with more than 7 primary care visits (OR 1.42, 95% CI 1.06–1.91) and patients reporting poor health (OR 1.62, 95% CI 1.04–2.53). Of the 51% of patients with major depression who were recognized, 43% received 1 or more antidepressant prescriptions but only 6.7% received 4 or more psychotherapy sessions during a 12-month period.

Discussion: There were large gaps in both recognition and quality of depression care provided to patients with major depression and diabetes within a health maintenance organization system.

From the *Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; and the †Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.

Supported by grants #MH41739 and #MH016473 from the National Institute of Mental Health Services Division in Bethesda, Maryland (to Dr. Katon).

Reprints: Wayne J. Katon, MD, Professor and Vice-Chair, Director of Health Services Research & Psychiatric Epidemiology, Department of Psychiatry & Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific, Seattle, WA 98195-6560. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.