title: Limited effect of screening for depression with written feedback in outpatients with diabetes mellitus: a randomised controlled trial.
abstract: OBJECTIVE
  The aim of this study was to test the effectiveness of a screening procedure for depression (SCR) vs care as usual (CAU) in outpatients with diabetes. The primary outcome measured was depression score and the secondary outcomes were mental healthcare consumption, diabetes-distress and HbA(1c).
  
  
  METHODS
  In a multicentre parallel randomised controlled trial, 223 outpatients with diabetes, who had an elevated depression score, were randomly assigned to SCR (n = 116) or CAU (n = 107), using computer generated numbers. SCR-patients were invited for a Composite International Diagnostic Interview (CIDI) to diagnose depression and/or anxiety (interviewers were not blinded for group assignment). As part of the intervention, patients and their physicians were informed of the outcome of the CIDI in a letter and provided with treatment advice. At baseline and 6 month follow-up, depression and diabetes-distress were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Problem Areas in Diabetes survey (PAID). HbA(1c) levels were obtained from medical charts.
  
  
  RESULTS
  Mean CES-D depression scores decreased from baseline to 6 months in both groups (24 ± 8 to 21 ± 8 [CAU] and 26 ± 7 to 22 ± 10 [SCR] respectively [p < 0.001]), with no significant differences between groups. Neither diabetes-distress nor HbA(1c) changed significantly within and between groups. The percentage of patients receiving mental healthcare increased in the SCR group from 20% to 28%, compared with 15% to 18% in the CAU group.
  
  
  CONCLUSIONS
  Depression screening with written feedback to patient and physician does not improve depression scores and has a limited impact on mental healthcare utilisation, compared with CAU. It appears that more intensive depression management is required to improve depression outcomes in patients with diabetes.
authors.affiliation: Centre of Research on Psychology in Somatic Diseases, Department of Medical Psychology & Neuropsychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands. f.pouwer@uvt.nl
authors.forename: F
authors.initials: F
authors.lastname: Pouwer
authors.forename: C J
authors.initials: CJ
authors.lastname: Tack
authors.forename: P H L M
authors.initials: PH
authors.lastname: Geelhoed-Duijvestijn
authors.forename: E
authors.initials: E
authors.lastname: Bazelmans
authors.forename: A T
authors.initials: AT
authors.lastname: Beekman
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: F J
authors.initials: FJ
authors.lastname: Snoek
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000175:diagnosis*; D003920:Diabetes Mellitus / Q000523:psychology*; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010045:Outpatients; D014956:Writing