Management of Comorbid Depression in Veterans with Diabetes

Objective: Patients with diabetes have an increased risk of developing depression. Comorbid depression in patients with diabetes affects their health-related quality of life, diabetes self-management, and health care utilization. The purpose of this study was to examine the feasibility of screening for depression in patients with diabetes while they were hospitalized for medical illness. Methods: The electronic health records of 193 patients admitted to medical units at a local facility from July 2016 to December 2016 were assessed for the presence of diabetes. Twenty-one patients with type 2 diabetes and with glycated hemoglobin above 7% were consented and screened for depression using the Patient Health Questionnaire (PHQ-2). Seven patients with positive symptoms for depression were enrolled in the study. The researcher alerted the medical provider via the electronic medical record about the patients with depression symptoms and the provider discussed options for management of depression with the patient and initiated treatment. The patients answered the PHQ-9, the Veterans RAND-12 and the Stanford Diabetes Questionnaire at baseline and at eight weeks and 12 weeks after discharge from the hospital. Five patients completed the study. At the completion of the study, the hospitalist team providers and the patients answered survey questions about the process. Results: The process of screening for depression at admission, notifying the provider by way of electronic medical record that the patient screened positive for depression with suggestions for medication and psychiatric counseling was feasible and acceptable to providers. Patients also felt the program was acceptable and helped them get the assistance they needed for depression. Statistics are not reported due to the small sample size. Conclusion: The results suggest that screening for depressive symptoms while admitted with medical illness was feasible and acceptable to patients and providers. A randomized controlled pilot study will be conducted next to establish efficacy.