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.
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
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.
Approximately 51% of patients with major depression
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.
There were large gaps in both recognition and quality of depression
care provided to patients with major depression
within a health maintenance organization system.