Depression prevalence, screening, and treatment in adult outpatients with type 1 and type 2 diabetes: A nationally representative cross-sectional study (National Ambulatory Medical Care Survey 2014-2019).

BACKGROUND

Studies have shown that the presence of diabetes or depression may increase the risk for developing the other. The primary objective of this study is to describe the current prevalence of comorbid depression and the rate of screening and treatment for comorbid depression in US adult outpatients with diabetes compared to those without diabetes.

METHODS

We analyzed data from the 2014-2019 National Ambulatory Medical Care Survey. Descriptive statistics, univariate analyses, and multivariable regression models were developed with weighting factors applied.

RESULTS

Depression prevalence is higher in those with diabetes than without diabetes. Females with diabetes have higher rates of depression (15.4%) compared to females without diabetes (13.7%) or males with diabetes (9.1%). Screening rates for depression are extremely low (<6%) in patients with diabetes and without diabetes. Patients with diabetes and depression are less likely to be screened than those with depression alone.

LIMITATIONS

The cross-sectional design of the study cannot establish causality and has inherent limitations in capturing temporal relationships. The reliance on ICD codes limits the scope of diagnosis and underestimates rates of comorbidity if depression is not formally diagnosed. The NAMCS cohort only includes ambulatory visits to office-based physicians, so depression diagnoses and screening rates among patients who visit other health care settings or are not seeing physicians would be underestimated.

CONCLUSIONS

Depression is prevalent in people with diabetes. Screening rates are unacceptably low, indicating a gap in recommended care and underreporting of depression. More routine screening and treatment are necessary to align with guideline-recommended care.