Centre of Research on Psychology in Somatic Diseases, Department of Medical Psychology & Neuropsychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.
Diabetologia. 2011 Apr;54(4):741-8. doi: 10.1007/s00125-010-2033-0. Epub 2011 Jan 11.
AIMS/HYPOTHESIS: The aim of this study was to test the effectiveness of a screening procedure for depression (SCR) vs care as usual (CAU) in outpatients with diabetes. The primary outcome measured was depression score and the secondary outcomes were mental healthcare consumption, diabetes-distress and HbA(1c).
In a multicentre parallel randomised controlled trial, 223 outpatients with diabetes, who had an elevated depression score, were randomly assigned to SCR (n = 116) or CAU (n = 107), using computer generated numbers. SCR-patients were invited for a Composite International Diagnostic Interview (CIDI) to diagnose depression and/or anxiety (interviewers were not blinded for group assignment). As part of the intervention, patients and their physicians were informed of the outcome of the CIDI in a letter and provided with treatment advice. At baseline and 6 month follow-up, depression and diabetes-distress were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Problem Areas in Diabetes survey (PAID). HbA(1c) levels were obtained from medical charts.
Mean CES-D depression scores decreased from baseline to 6 months in both groups (24 ± 8 to 21 ± 8 [CAU] and 26 ± 7 to 22 ± 10 [SCR] respectively [p < 0.001]), with no significant differences between groups. Neither diabetes-distress nor HbA(1c) changed significantly within and between groups. The percentage of patients receiving mental healthcare increased in the SCR group from 20% to 28%, compared with 15% to 18% in the CAU group.
CONCLUSIONS/INTERPRETATION: Depression screening with written feedback to patient and physician does not improve depression scores and has a limited impact on mental healthcare utilisation, compared with CAU. It appears that more intensive depression management is required to improve depression outcomes in patients with diabetes.
目的/假设：本研究旨在测试抑郁筛查程序（SCR）与常规护理（CAU）对糖尿病门诊患者的有效性。主要结局指标为抑郁评分，次要结局指标为精神保健服务利用、糖尿病困扰和糖化血红蛋白（HbA(1c)）。
在一项多中心平行随机对照试验中，223 名患有糖尿病且抑郁评分升高的门诊患者，使用计算机生成的数字随机分配至 SCR 组（n = 116）或 CAU 组（n = 107）。SCR 组患者被邀请参加复合国际诊断访谈（CIDI）以诊断抑郁和/或焦虑（访谈者未对分组进行盲法）。作为干预的一部分，患者及其医生会收到 CIDI 结果的信函，并提供治疗建议。在基线和 6 个月随访时，使用流行病学研究中心抑郁量表（CES-D）和糖尿病问题区域调查（PAID）测量抑郁和糖尿病困扰。HbA(1c)水平从病历中获得。
两组的 CES-D 抑郁评分均从基线降至 6 个月（CAU 组从 24 ± 8 降至 21 ± 8，SCR 组从 26 ± 7 降至 22 ± 10 [p < 0.001]），两组间无显著差异。组内和组间的糖尿病困扰和 HbA(1c)均无显著变化。SCR 组接受精神保健服务的患者比例从 20%增加到 28%，而 CAU 组从 15%增加到 18%。
结论/解释：与 CAU 相比，向患者和医生提供书面反馈的抑郁筛查并未改善抑郁评分，对精神保健服务的利用影响有限。似乎需要更强化的抑郁管理来改善糖尿病患者的抑郁结局。
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