Clinical Depression Versus Distress Among Patients With Type 2 Diabetes
Not just a question of semantics
- Lawrence Fisher, PHD1,
- Marilyn M. Skaff, PHD1,
- Joseph T. Mullan, PHD2,
- Patricia Arean, PHD3,
- David Mohr, PHD3,
- Umesh Masharani, MD4,
- Russell Glasgow, PD5 and
- Grace Laurencin, MD1
- 1Department of Family and Community Medicine, University of California, San Francisco, California
- 2Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
- 3Department of Psychiatry, University of California, San Francisco, California
- 4Department of Medicine, University of California, San Francisco, California
- 5Kaiser Permanente of Colorado, Denver, Colorado
- Address correspondence and reprint requests to Lawrence Fisher, PhD, Department of Family and Community Medicine, Box 0900, University of California San Francisco, San Francisco, CA 94143. E-mail: fisherl{at}fcm.ucsf.edu
Abstract
OBJECTIVE—We sought to determine differences between structured interviews, symptom questionnaires, and distress measures for assessment of depression in patients with diabetes.
RESEARCH DESIGN AND METHODS—We assessed 506 diabetic patients for major depressive disorder (MDD) by a structured interview (Composite International Diagnostic Interview [CIDI]), a questionnaire for depressive symptoms (Center for Epidemiological Studies Depression Scale [CESD]), and on the Diabetes Distress Scale. Demographic characteristics, two biological variables (A1C and non-HDL cholesterol), and four behavioral management measures (kilocalories, calories of saturated fat, number of fruit and vegetable servings, and minutes of physical activity) were assessed. Comparisons were made between those with and without depression on the CIDI and the CESD.
RESULTS—Findings showed that 22% of patients reached CESD ≥16, and 9.9% met a CIDI diagnosis of MDD. Of those above CESD cut points, 70% were not clinically depressed, and 34% of those who were clinically depressed did not reach CESD scores ≥16. Those scoring ≥16, compared with those <16 on the CESD, had higher A1C, kilocalories, and calories of saturated fat and lower physical activity. No differences were found using the CIDI. Diabetes distress was minimally related to MDD but substantively linked to CESD scores and to outcomes.
CONCLUSIONS—Most patients with diabetes and high levels of depressive symptoms are not clinically depressed. The CESD may be more reflective of general emotional and diabetes-specific distress than clinical depression. Most treatment of distress, however, is based on the depression literature, which suggests the need to consider different interventions for distressed but not clinically depressed diabetic patients.
- CESD, Center for Epidemiological Studies Depression Scale
- CIDI, Composite International Diagnostic Interview
- DDS, Diabetes Distress Scale
- DSM-IV, Diagnostic and Statistical Manual of Psychiatric Disorders, 4th edition
- IPAQ, International Physical Activity Questionnaire
- MDD, major depressive disorder
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted November 20, 2006.
- Received July 31, 2006.
- DIABETES CARE
