Assessing the prevalence of depression among individuals with diabetes in a Medicaid managed-care program.
OBJECTIVE
To determine the prevalence of self-reported depression symptoms among diabetic individuals enrolled in Gold Choice, a Medicaid managed care organization specifically for people with mental health and/or substance abuse diagnoses; and to assess the sensitivity and specificity of individuals' self-report with encounter data.


METHODS
The 9-item depression scale of the Patient Health Questionnaire (PHQ-9) was mailed to 454 Gold Choice members in Western New York diagnosed with diabetes; and 249 completed PHQ-9 forms were returned (55% response rate). The PHQ-9 forms were compared to primary care encounter data to determine whether the respondents had been diagnosed with depression. Descriptive and inferential statistical analysis was undertaken.


RESULTS
The majority (56%) of individuals in the sample screened positive for depression (PHQ-9 > or = 10), and half (49%) did not have evidence of a diagnosis in their encounter data. The percentage of those diagnosed with depression rose with increasing PHQ-9 severity levels, with 63% of individuals with the most severe depression (PHQ-9 > or = 20) having a diagnosis. This trend was statistically significant, confirmed by independent sample t-tests and chi-square tests. The sensitivity of the PHQ-9 was moderate (66%), as was the specificity (52%).


CONCLUSIONS
The results of this study suggest that depressive disorders may be under-recognized and under-treated amongst individuals with diabetes in the primary care setting. Half (51%) of those with PHQ-9 scores > or = 10 had depression diagnoses, suggesting poor compliance rates and/or a need for therapy reassessment.
Kahn
Linda S
LS
State University of New York at Buffalo, USA. lskahn@buffalo.edu
Fox
Chester H
CH
McIntyre
Roger S
RS
Tumiel-Berhalter
Laurene
L
Berdine
Diane E
DE
Lyle
Heather
H
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008403:Mass Screening; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010349:Patient Compliance; D015995:Prevalence; D011320:Primary Health Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology