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The Influence of Depressive Symptoms on Clinician–Patient Communication Among Patients With Type 2 Diabetes

Swenson, Sara L. MD*; Rose, Monica PhD; Vittinghoff, Eric PhD; Stewart, Anita PhD§; Schillinger, Dean MD

doi: 10.1097/MLR.0b013e31816080e9
Original Article

Background: Depression is associated with poor chronic illness outcomes, but it is unknown whether depression influences the quality of communication during the clinical encounter. We investigated whether diabetes patients with depressive symptoms, compared with those without depressive symptoms, report worse clinician–patient communication, and which domains of communication are most affected.

Methods: We surveyed 231 ethnically diverse, English-speaking patients with diabetes to ascertain their experiences of communication with their primary care clinician. We selected measures from the interpersonal processes of care (IPC) instrument to assess communication and dichotomized the 7 subscales into “optimal” or “suboptimal” communication. We used the Clinical Epidemiologic Services for Depression (CES-D 10) to categorize patients as having no (CES-D 10 score <10), mild (CES-D 10 score 10–14), or severe (CES-D 10 score >14) depressive symptoms. We used multivariable logistic regression to evaluate the relationship between depressive symptoms and communication subscales.

Results: Thirty-five percent of subjects reported severe depressive symptoms. Compared with those with no depressive symptoms, the presence of severe depressive symptoms was independently associated with suboptimal communication in 4 of 7 subscales: elicitation of patient problems, concerns, and expectations (adjusted odds ratio [AOR], 2.94; 95% confidence interval [CI], 1.14–7.61); explanations of condition (AOR, 3.79; 95% CI, 1.41–10.21); empowerment (AOR, 2.98; 95% CI, 1.35–6.58); and decision-making (AOR, 2.56; 95% CI, 1.14–5.78).

Conclusions: Diabetes patients with severe depressive symptoms are more likely than those without depressive symptoms to report suboptimal clinician–patient communication across multiple domains of communication, especially those that involve more interactive and “patient-centered” communication. Further investigation of this relationship may uncover explanatory mechanisms and help guide interventions for improving care for both conditions.

From the *Department of Internal Medicine, California Pacific Medical Center, San Francisco, California; †Community Behavioral Health Services, Department of Public Health, San Francisco, California; ‡Department of Epidemiology and Biostatistics, University of California, San Francisco, California; §Institute for Health and Aging, University of California, San Francisco, California; and ¶Department of Medicine, Center for Vulnerable Populations, San Francisco General Hospital, University of California, San Francisco, California.

Supported by the Robert Wood Johnson Foundation grant 042970 and an NRSA training grant NRSA 1 T32 HP19025 (to S.L.S.), grant K23 RR16539 (to D.S.), and a CTSA grant UL1 RR024131.

Reprints: Sara L. Swenson, MD, Department of Internal Medicine, California Pacific Medical Center, 3801 Sacramento Street, Suite 325, San Francisco, CA 94118. E-mail:

© 2008 by Lippincott Williams & Wilkins.