Diabetes with Co-Morbid Depression
Research and reviews from the CDC and the Robert Wood Johnson Foundation, among others, recognize that health disparities in diabetes result from complex interactions of individuals with social, political, and environmental factors (1). Therefore, interventions designed to reduce these disparities and improve health care for African-Americans and Latinos with diabetes must also intervene at multiple levels. That same research also indicates that optimal disease management for patients with diabetes should include mechanisms for screening and managing depression. An article in the ...view middle of the document...
Patients with diabetes are twice as likely to experience depression as those without diabetes. While diabetic patients who are also depressed show an increased incidence of diabetic complications, screening for depression in diabetics is not routine.(3) Moreover, patients with diabetes who have co-morbid depression have decreased medication adherence, poorer adherence to exercise and diet, and poor glycemic control,(4) Diabetics with depression have total health care expenditures that are 4.5 times more than for those who are not depressed. Predictors of co-morbid depression included: age less than 64 years; female; at least a high school education; income less than 124% of federal poverty level; and perceived worsening of health status. Interventions must therefore include strategies to identify and treat patients with diabetes and co-morbid depression with support groups, self-management classes, and supportive community health workers, counselors on the diabetes care team, medications, and as-needed referral to psychotherapeutic care.
1. Cohen, “The Spectrum of Prevention,” Injury Prevention (1999;5:203-207]
2. Kahn, et al, “Assessing the Prevalence of Depression Among Individuals with Diabetes in a Medicaid Managed-Care Program:” INT’L. J. PSYCHIATRY IN MEDICINE, Vol. 38(1) 13-29, 2008.
4. NYC Community Health Profiles, The Health of Washington Heights/Inwood, Manhattan, NYC Community Health Profiles, 2003; 1(24):1–12, New York, NYC DHMH, 2003.