title: Screening for depression and diabetes-related distress in a diabetes outpatient clinic.
abstract: OBJECTIVE
  To investigate: (1) the willingness of patients with diabetes to participate in a screening programme; (2) the extent to which patients with diabetes who screen positive endorse need for psychosocial care; (3) the rate of referral to psychosocial care during screening vs. usual care.
  
  
  METHODS
  Four hundred and ninety-nine patients with diabetes were invited to complete the Center for Epidemiologic Studies Depression and the Problem Areas in Diabetes questionnaires. Patients screening positive on either instrument were invited for an interview. One year after screening was withdrawn, rates of referral to psychosocial care were assessed from physician reports of patient referrals.
  
  
  RESULTS
  In total, 349/499 (70%) patients with diabetes completed the questionnaire. Patients who did not take up the screening were younger, smoked more often and had higher HbA(1c) values. 'No-shows' for clinical appointments accounted for 74% of non-participation. Of the 104 (30% of 349) patients screening positive, 45 accepted an invitation for an interview. Finally, 36/104 (35%) would like a referral for psychological care. Seven per cent of patients were referred to psychological care during screening compared with 1% when screening was withdrawn.
  
  
  CONCLUSIONS
  Results raise questions as to whether screening is the most efficient way to identify patients with psychological problems. Many patients did not take up the screening, especially those with low adherence to diabetes care in general. Furthermore, few patients screening positive wanted to be referred. Screening should be evaluated in the context of consideration of alternative ways to identify at-risk patients, including providing resources to deal with patients with already known adjustment and adherence problems.
authors.affiliation: Department of Health Sciences, Section Health Psychology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands. j.fleer@umcg.nl
authors.forename: J
authors.initials: J
authors.lastname: Fleer
authors.forename: K A
authors.initials: KA
authors.lastname: Tovote
authors.forename: J C
authors.initials: JC
authors.lastname: Keers
authors.forename: T P
authors.initials: TP
authors.lastname: Links
authors.forename: R
authors.initials: R
authors.lastname: Sanderman
authors.forename: J C
authors.initials: JC
authors.lastname: Coyne
authors.forename: M J
authors.initials: MJ
authors.lastname: Schroevers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D003866:Depressive Disorder / Q000175:diagnosis*; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D055815:Young Adult