Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3061 — Screening and Recognition of Depression in Primary Care among Veterans with Diabetes Mellitus

Author List:
Jones LE (Roudebush VAMC Center of Excellence on Implementing Evidence-Based Practice (CIEBP), University of Iowa College of Public Health)
Carney Doebbeling C (Roudebush VAMC Center of Excellence on Implementing Evidence-Based Practice (CIEBP), Indiana University School of Medicine)

Objectives:
Cross-sectional studies report prevalence rates of 20-33% for depression in veterans with diabetes mellitus (DM). The Veterans Health Administration (VHA) requires annual depression screening exams for veterans seen in primary care clinics. Among all VHA users, screening for depression is high (>75%). However, rates of depression screening and treatment of depression for veterans with DM in the primary care setting is unknown. The objective of this study was to determine primary care screening rates for depression and the prevalence of recognized depression in veterans with DM.

Methods:
A 100% sample (n=15,676) of veterans with DM from the Roudebush VAMC in Indianapolis was analyzed. DM was indicated by receipt of insulin/oral agent(s) or 2+ ICD-9 codes for DM within a 24-month period. Subjects were included if they were followed for at least 12-months and had a primary care visit during that period. Results and dates of depression screens were included in the clinical data (01/2000-04/2005). Subjects who screened positive for depression were next classified as having a recognized or unrecognized depression. Recognition of depression was based on ICD-9 codes for depression or receipt of pharmacotherapy or psychotherapy within 3-months of the positive depression screen. Descriptive statistics are reported.

Results:
15,676 veterans met criteria for DM. Of those, 10,944 (69.8%) met inclusion criteria. 54% (n=5,946) received a primary care depression screener within 12-months. Approximately 20% (n=1,153) of veterans with DM screened positive for depression. Among those with a positive depression screen, slightly more than half (n=598) were recognized as having depression within 3-months of the positive depression screening exam. Recognition for the majority (93%) of those subjects was based on receipt of antidepressants or psychotherapy.

Implications:
Screening rates for depression in primary care among veterans with DM in the VHA is poor and below national VHA averages. Clinical recognition and treatment of depression is poor – slightly more than 50%.

Impacts:
Given the poor outcomes that have been associated with non-recognition and appropriate treatment of depression, it is crucial that veterans with DM receive recommended depression screening exams in primary care. Close monitoring of veterans at risk of depression, such as those with DM, may result in better health outcomes. Screening exams translated into proactive care is necessary to ensure that treatment is provided to veterans who screen positive for depression.