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Diabetologia
Published in: Diabetologia 4/2011

Open Access 01-04-2011 | Article

Limited effect of screening for depression with written feedback in outpatients with diabetes mellitus: a randomised controlled trial

Authors: F. Pouwer, C. J. Tack, P. H. L. M. Geelhoed-Duijvestijn, E. Bazelmans, A. T. Beekman, R. J. Heine, F. J. Snoek

Published in: Diabetologia | Issue 4/2011

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Abstract

Aims/hypothesis

The aim of this study was to test the effectiveness of a screening procedure for depression (SCR) vs care as usual (CAU) in outpatients with diabetes. The primary outcome measured was depression score and the secondary outcomes were mental healthcare consumption, diabetes-distress and HbA1c.

Materials and methods

In a multicentre parallel randomised controlled trial, 223 outpatients with diabetes, who had an elevated depression score, were randomly assigned to SCR (n = 116) or CAU (n = 107), using computer generated numbers. SCR-patients were invited for a Composite International Diagnostic Interview (CIDI) to diagnose depression and/or anxiety (interviewers were not blinded for group assignment). As part of the intervention, patients and their physicians were informed of the outcome of the CIDI in a letter and provided with treatment advice. At baseline and 6 month follow-up, depression and diabetes-distress were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Problem Areas in Diabetes survey (PAID). HbA1c levels were obtained from medical charts.

Results

Mean CES-D depression scores decreased from baseline to 6 months in both groups (24 ± 8 to 21 ± 8 [CAU] and 26 ± 7 to 22 ± 10 [SCR] respectively [p < 0.001]), with no significant differences between groups. Neither diabetes-distress nor HbA1c changed significantly within and between groups. The percentage of patients receiving mental healthcare increased in the SCR group from 20% to 28%, compared with 15% to 18% in the CAU group.

Conclusions/interpretation

Depression screening with written feedback to patient and physician does not improve depression scores and has a limited impact on mental healthcare utilisation, compared with CAU. It appears that more intensive depression management is required to improve depression outcomes in patients with diabetes.
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Metadata
Title
Limited effect of screening for depression with written feedback in outpatients with diabetes mellitus: a randomised controlled trial
Authors
F. Pouwer
C. J. Tack
P. H. L. M. Geelhoed-Duijvestijn
E. Bazelmans
A. T. Beekman
R. J. Heine
F. J. Snoek
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 4/2011
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-010-2033-0

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