title: The influence of depressive symptoms on clinician-patient communication among patients with type 2 diabetes.
abstract: 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.
authors.affiliation: Department of Internal Medicine, California Pacific Medical Center, San Francisco, California 94118, USA. swensosl@sutterhealth.org
authors.forename: Sara L
authors.initials: SL
authors.lastname: Swenson
authors.forename: Monica
authors.initials: M
authors.lastname: Rose
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Anita
authors.initials: A
authors.lastname: Stewart
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003863:Depression / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011320:Primary Health Care; D011369:Professional-Patient Relations; D012720:Severity of Illness Index