4.13.3.0 De­pres­sion

Rec­om­men­da­tions

4.20 Pro­viders should con­sid­er an­nu­al screen­ing of all pa­tients with di­a­betes, es­pe­cially those with a self-re­ported his­to­ry of de­pres­sion, for de­pres­sive symp­toms with age-‍ap­pro­pri­ate de­pres­sion screen­ing mea­sures, rec­og­niz­ing that fur­ther eval­u­a­tion will be nec­es­sary for in­di­vid­u­als who have a pos­i­tive screen. B

4.21 Be­gin­ning at di­ag­no­sis of com­pli­ca­tions or when there are significant changes in med­i­cal sta­tus, con­sid­er as­sessment for de­pres­sion. B

4.22 Re­fer­rals for treat­ment of de­pres­sion should be made to men­tal health pro­viders with ex­pe­ri­ence using cog­ni­tive be­hav­ioral ther­a­py, interper­sonal ther­a­py, or other ev­i­dence-‍based treat­ment ap­proaches in con­junc­tion with col­lab­o­ra­tive care with the pa­tient’s di­a­betes treat­ment team. A

His­to­ry of de­pres­sion, cur­rent de­pres­sion, and an­tide­pres­sant med­i­ca­tion use are risk fac­tors for the de­vel­opment of type 2 di­a­betes, es­pe­cially if the in­di­vid­u­al has other risk fac­tors such as obe­si­ty and fam­i­ly his­to­ry of type 2 di­a­betes (96–98). El­e­vat­ed de­pres­sive symp­toms and de­pres­sive disor­ders af­fect one in four pa­tients with type 1 or type 2 di­a­betes (99). Thus, rou­tine screen­ing for de­pres­sive symp­toms is in­di­cat­ed in this high-‍risk pop­u­la­tion in­clud­ing peo­ple with type 1 or type 2 di­a­betes, ges­ta­tion­al di­a­betes mel­li­tus, and post­par­tum di­a­betes. Re­gard­less of di­a­betes type, women have significant­ly high­er rates of de­pres­sion than men (100).

Rou­tine mon­i­tor­ing with pa­tient-‍ap­pro­pri­ate val­i­dat­ed mea­sures can help to iden­tify if re­fer­ral is war­rant­ed. Adult pa­tients with a his­to­ry of de­pres­sive symp­toms or dis­or­der need on­go­ing mon­i­tor­ing of de­pres­sion re­cur­rence with­in the con­text of rou­tine care (96). In­te­grat­ing men­tal and phys­i­cal health care can im­prove out­comes. When a pa­tient is in psy­cho­log­i­cal ther­a­py (talk ther­a­py), the men­tal health pro­vider should be in­cor­po­rat­ed into the di­a­betes treat­ment team (101).