Integration of psychiatric care in diabetes education clinics and regular psychiatric follow-up may be helpful in managing the severity of depressive symptoms in patients with diabetes mellitus and concurrent major depressive disorder (MDD), according to findings published in the Canadian Journal of Diabetes.
In the study, a retrospective chart review of patients with type 1 and 2 diabetes as well as comorbid MDD (n=24; 10 men), patients received integrated outpatient psychiatric care at a diabetes education clinic in Newmarket, Ontario, Canada. The Patient Health Questionnaire-9 (PHQ-9) scale was used to assess the severity of depressive symptoms at each visit. Researchers assessed the overall change in PHQ-9 scoring between the first and most recent visit to examine the efficacy of the program in managing depressive symptoms. Additionally, the investigators examined the association between the number of days between individual clinic visits and the changes in PHQ-9 scores between the clinic appointments.
In regard to the PHQ-9 depression rating scale score, no significant change was observed between the first and most recent clinic visit (P =.356). Patients with improvements in PHQ-9 scores had more clinic visits compared with patients with no improvements (P =.0271).
The investigators found a negative correlation between changes in PHQ-9 scores between the first and most recent clinic visits and both the number of visits (Pearson coefficient, -0.56; P =.005) and the overall time patients were followed by the diabetes education clinic (Pearson coefficient, -0.42; P =.040). In contrast, there was a positive correlation between the change in PHQ-9 between individual appointments and time between visits (Pearson coefficient, 0.26; P =.027). The findings suggested that the absence of regular follow-up correlated with a higher risk of deterioration.
Limitations of this study included the small sample size, its retrospective nature, and the restriction of the analysis to a single geographic region in Canada.
The investigators suggest that regular long term “follow-up with psychiatric care promotes anti-depressant medication compliance and allows for anti-depressant dosage optimization” in patients with comorbid diabetes and MDD.
Jackson W, Gaurav M. Efficacy of depression management in an integrated psychiatric-diabetes education clinic for co-morbid depression and diabetes mellitus [published online May 12, 2020]. Can J Diabetes. doi: 10.1016/j.jcjd.2020.03.013.