title: Depressive symptoms in patients with type 2 diabetes in the ambulatory care setting: opportunities to improve outcomes in the course of routine care.
abstract: OBJECTIVE
  To assess the frequency of untreated, self-reported depressive symptoms in a cross section of adult ambulatory patients with type 2 diabetes and to identify demographic and/or clinical characteristics associated with depressive symptoms in study patients.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Three ambulatory care clinics in the southwestern United States in fall 2005.
  
  
  METHODS
  217 primary care patients aged 18 years or older with a diagnosis of type 2 diabetes.
  
  
  METHODS
  Administration of the Zung Self-rating Depression Scale (Zung SDS).
  
  
  METHODS
  Self-reported data on demographic characteristics and depressive symptoms. Data for insurance, comorbid conditions, and glycosylated hemoglobin (A1C) values were abstracted from patient charts.
  
  
  RESULTS
  Depressive symptoms (Zung SDS score > or =50) were identified in 72.1% of patients. Overall, 13% of the patients with a diagnosis of depression (based on patient charts) were not receiving treatment. Factors significantly associated with depressive symptoms were past history of depression (beta= 0.53, P < 0.01), Medicaid insurance (beta= 0.15, P < 0.02), and insulin use (beta= 0.12, P < 0.05).
  
  
  CONCLUSIONS
  The results suggest that possible undetected or untreated depression can be assessed in patients with type 2 diabetes through use of a self-rating scale in the course of routine ambulatory care. Adding the Zung SDS screen to routine care protocols could facilitate improved detection and treatment of comorbid depression in ambulatory patients with type 2 diabetes.
authors.affiliation: College of Pharmacy, Touro University, Vallejo, CA 94592, USA. bijal.shah@touro.edu
authors.forename: Bijal M
authors.initials: BM
authors.lastname: Shah
authors.forename: Gireesh V
authors.initials: GV
authors.lastname: Gupchup
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Borrego
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Raisch
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Knapp
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008403:Mass Screening / Q000379:methods; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012307:Risk Factors; D012647:Self-Assessment; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin