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Depression Screening Disparities among Veterans with Diabetes as Compared to the General Veteran Population

¹Roudebush VAMC HSR&D Center of Excellence on Implementing Evidence-Based Practice, Indianapolis, IN
²Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN
³Regenstrief Institute, Indianapolis, IN

ccarneyd{at}iupui.edu

ABSTRACT

Objective.: To describe the proportion of veterans with diabetes screened for depression as compared to the general population of veterans (GenPop)

Research Design and Methods.: Electronic medical records (FY2001-FY2004) from a Midwestern Veterans Health Administration (VHA) facility and VHA External Peer Review Program (EPRP) data. Facility-level data included inpatient and outpatient encounters, including depression screen results. EPRP data were facility-level summary data, which detailed the proportion of GenPop veterans nationwide and at the Midwestern facility who were screened for depression. Logistic regression tested for associations between depression screen receipt and screening positive and demographic/clinical characteristics among patients with diabetes.

Results.: Depression screening among those with diabetes improved from 62% in FY2001 to 83% in FY2004. Screening was 9-23% lower and 11-22% lower in patients with diabetes as compared to the GenPop of veterans nationwide and at the Midwestern facility, respectively. 17% of subjects with diabetes screened positive, two-times higher than in the GenPop. Female gender (OR=0.45; CI₉₅: 0.35-0.60) and unknown HbA1c (OR=0.40; CI₉₅: 0.34-0.46) were associated with lower odds of screening receipt. A 50% service-connected disability rating was inversely associated with screening (OR=0.84; CI₉₅: 0.72-0.99), but positively associated with screening positive for depression (OR=1.56; CI₉₅: 1.33-1.82).

Conclusions.: Screening for depression among veterans with diabetes improved 21% but is considerably lower than the proportion of GenPop veterans screened nationally and at the facility of interest. Targeted interventions to improve screening in patients with diabetes are required based on evidence that screening translates into increased provider recognition and treatment of depression.

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