Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study.
OBJECTIVE
The broad objective of this study was to examine multiple dimensions of depression in a large, diverse population of adults with diabetes. Specific aims were to measure the association of depression with: (1) patient characteristics; (2) outcomes; and (3) diabetes-related quality of care.


METHODS
Cross-sectional analyses were performed using survey and chart data from the Translating Research Into Action for Diabetes (TRIAD) study, including 8790 adults with diabetes, enrolled in 10 managed care health plans in 7 states. Depression was measured using the Patient Health Questionnaire (PHQ-8). Patient characteristics, outcomes and quality of care were measured using validated survey items and chart data.


RESULTS
Nearly 18% of patients had major depression, with prevalence 2-3 times higher among patients with low socioeconomic status. Pain and limited mobility were strongly associated with depression, controlling for other patient characteristics. Depression was associated with slightly worse glycemic control, but not other intermediate clinical outcomes. Depressed patients received slightly fewer recommended diabetes-related processes of care.


CONCLUSIONS
In a large, diverse cohort of patients with diabetes, depression was most prevalent among patients with low socioeconomic status and those with pain, and was associated with slightly worse glycemic control and quality of care.
Waitzfelder
Beth
B
Pacific Health Research Institute, Honolulu, HI, United States. beth.e.waitzfelder@kp.org
Gerzoff
Robert B
RB
Karter
Andrew J
AJ
Crystal
Stephen
S
Bair
Mathew J
MJ
Ettner
Susan L
SL
Brown
Arleen F
AF
Subramanian
Usha
U
Lu
Shou-En
SE
Marrero
David
D
Herman
William H
WH
Selby
Joseph V
JV
Dudley
R Adams
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019538:Health Care Surveys; D006801:Humans; D016018:Least-Squares Analysis; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D051346:Mobility Limitation; D010043:Outcome and Process Assessment, Health Care; D010146:Pain / Q000523:psychology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012648:Self Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human