title: Demographic, clinical and psychosocial factors identify a high-risk group for depression screening among predominantly Hispanic patients with Type 2 diabetes in safety net care.
abstract: OBJECTIVE
  Identify biopsychosocial factors associated with depression for patients with Type 2 diabetes.
  
  
  METHODS
  A quasi-experimental clinical trial of 1293 patients was predominantly Hispanic (91%) female (62%), mean age 53 and average diabetes duration 10 years; 373 (29%) patients were depressed and assessed by Patient Health Questionnaire-9. Demographic, baseline clinical and psychosocial variables were compared between depressed and nondepressed patients.
  
  
  RESULTS
  Bivariate analyses found depression significantly associated (p<0.05) with female gender, diabetes emotional burden and regimen distress, BMI ≥ 30, lack of an A1C test, diabetes duration, poor self-care, number of diabetes symptoms and complications, functional and physical characteristics (pain, self-rated health condition, Short-Form Health Survey SF-physical, disability score and comorbid illnesses), as well as higher number of ICD-9 diagnoses and emergency room use. A multivariable regression model with stepwise selection identified six key risk factors: greater disability, diabetes symptoms and regimen distress, female gender, less diabetes self-care and lack of A1C. In addition, after controlling for identified six factors, the number of psychosocial stressors significantly associated with increased risk of depression (adjusted odds ratio=1.37, 95% confidence intervals: 1.18-1.58, p<.0001).
  
  
  CONCLUSIONS
  Knowing biopsychosocial factors could help primary care physicians and endocrinologists identify a high-risk group of patients needing depression screening.
authors.affiliation: School of Social Work, University of Southern California. Electronic address: ell@usc.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ell
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington. Electronic address: wkaton@u.washington.edu.
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.affiliation: School of Social Work, University of Southern California. Electronic address: peylee@usc.edu.
authors.forename: Pey-Jiuan
authors.initials: PJ
authors.lastname: Lee
authors.affiliation: David Geffen School of Medicine at UCLA and the Los Angeles County Department of Health Services. Electronic address: JGuterman@dhs.lacounty.gov.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Guterman
authors.affiliation: School of Social Work, University of Southern California; Edward R. Roybal Institute on Aging, University of Southern California; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California. Electronic address: shinyiwu@usc.edu.
authors.forename: Shinyi
authors.initials: S
authors.lastname: Wu
mesh_terms: D000328:Adult; D003710:Demography; D003863:Depression / Q000175:diagnosis* / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011203:Poverty; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States
keywords: Depression; Risk factors; Safety net; Type 2 diabetes