title: Differences in the clinical recognition of depression in diabetes patients: the Diabetes Study of Northern California (DISTANCE).
abstract: BACKGROUND
  It is unknown to what extent the gap between need and care for depression among patients with diabetes differs across racial/ethnic groups. We compared, by race/ethnicity, the likelihood of clinical recognition of depression (diagnosis or treatment) of patients who reported depressive symptoms in a well-characterized community-based population with diabetes.
  
  
  METHODS
  We used a survey follow-up study of 20,188 patients with diabetes from Kaiser Permanente Northern California. Analyses were limited to 910 patients who scored 10 or higher on the Patient Health Questionnaire (PHQ-8) which was included in the survey and who had no clinical recognition of depression in the 12 months prior to survey. Clinical recognition of depression was defined by a depression diagnosis, referral to mental health services, or antidepressant medication prescription.
  
  
  RESULTS
  Among the 910 patients reporting moderate to severe depressive symptoms on the survey and who had no clinical recognition in the prior year, 12%, 8%, 8%, 14%, and 15% of African American, Asian, Filipino, Latino, and white patients, respectively, were clinically recognized for depression in the subsequent 12 months. After adjusting for sociodemographics, limited English proficiency, and depressive symptom severity, racial/ethnic minorities were less likely to be clinically recognized for depression compared with whites (relative risk: Filipino: 0.30, African American: 0.62).
  
  
  CONCLUSIONS
  More work is needed to understand the modifiable patient and provider factors that influence clinical recognition of depression among diabetes patients from different racial/ethnic groups, and the potential impact of low rates of clinical recognition on quality of care.
authors.affiliation: Center for Diabetes Translational Research, Kaiser Permanente-Division of Research, 2000 Broadway, Oakland, CA 94612, USA.
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Hudson
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Alicia
authors.initials: A
authors.lastname: Fernandez
authors.forename: Melissa
authors.initials: M
authors.lastname: Parker
authors.forename: Alyce S
authors.initials: AS
authors.lastname: Adams
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Jufen
authors.initials: J
authors.lastname: Zhou
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Adler
mesh_terms: D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D011320:Primary Health Care