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Screening for Depression in Patients With Diabetes Mellitus

From the School of Psychology (M.M., F.D.), Center for National Research on Disability and Rehabilitation Medicine, School of Medicine (J.H., J.K.), Center for National Research on Disability, School of Psychology, (J.K.). University of Queensland, Brisbane, Australia.

Address correspondence and reprint requests to Justin Kenardy, PhD, University of Queensland, Brisbane, Australia. E-mail: j.kenardy{at}uq.edu.au

Objectives: The first aim of this study was to compare the effectiveness of four commonly used depression screening measures for medically ill populations in identifying depression within a diabetes sample. The second aim was to examine whether the inclusion of a measure for physical symptoms specific to diabetes is also necessary for a diagnosis of depression or alternatively whether any overlap would obscure the effect on the screening measure for depression.

Research Design and Methods: One hundred fifty patients with Type 2 diabetes in two large public hospital outpatient clinics completed a questionnaire which included the Center for Epidemiological Studies—Depression Scale (CES-D), the Silverstone Concise Assessment for Depression (SCAD), the Hospital Anxiety and Depression Scale (HADS), and the Depression in the Medically Ill (DMI) Questionnaire. Patient scores on these questionnaires were then assessed against their responses on the Composite International Diagnostic Interview Short Form and the Diabetes Symptom Checklist to determine their effectiveness.

Results and Conclusions: Logistic regression and receiver operating curves analysis, including areas under the curves, suggested selecting the CES-D, rather than the DMI-10, HADS or SCAD for screening for depression in a Type 2 diabetic patient. The CES-D performed well at predicting depression, had high sensitivity and specificity, and did not require the addition of diabetes symptoms to aid in diagnosis.

Key Words: depression • diabetes • assessment • diagnosis • screening • mood disorders

Abbreviations: CES-D = Center for Epidemiological Studies—Depression Scale; SCAD = Silverstone Concise Assessment for Depression; HADS = Hospital Anxiety and Depression Scale; DMI = Depression in the Medically Ill Questionnaire; non-est = non-estimable; PPV = positive predictive value; NPV = negative predictive value; ROC = receiver operating curve; AUC = area under the curve; DSC = Diabetes Symptom Checklist.