Diabetic teens can be easily screened for depression

By MD Will Boggs

NEW YORK (Reuters Health) - Diabetic adolescents can be easily screened for depression using a self-administered electronic version of the Children's Depression Inventory (CDI), a feasibility study shows.

"Depression is two-to three-fold higher in adolescents with diabetes than the general population and when unrecognized is likely to persist into adulthood," Dr. Sarah D. Corathers from Cincinnati Children's Hospital Medical Center in Ohio told Reuters Health.

"Earlier identification and treatment of depression is predicted to remove barriers to adherence and improve coping skills with chronic illness thus leading to more effective self-management behaviors and improved outcomes across a lifetime with diabetes," she added.

Dr. Corathers and colleagues conducted a feasibility and outcomes study of 528 eligible adolescents, including 509 (96%) who received at least one depression screen during the first year.

Most adolescents (80%) had low risk CDI scores (<10), but 12% scored as moderate risk (10-15), and 8% scored as high risk (>15). Seven percent (37 adolescents) endorsed "suicidal ideation."

Before this process was put into place, only 5% of adolescents with type 1 diabetes were referred to outpatient psychology for evaluation of depression. Within four months, the weekly rate of depression screening had increased to a median of 85%, where it has remained.

Referrals for CDI scores of 10 and higher and/or endorsement of suicidal ideation generated an average of 2.7 social work and 1.5 outpatient psychology services referrals weekly, the authors reported online October 14th in Pediatrics.

Most of the youngsters in the study (58%) rated depression screening as highly important, and similar percentages felt screening should be done every six months (38%) or annually (34.5%).

Among staff who responded, all rated depression screening as highly important, and most felt screening should occur every six months (54%).

Higher CDI scores were associated with significantly lower blood glucose monitoring frequency and significantly higher HbA1c levels, although the differences were modest.

"The 'lessons learned' from this process highlight a critical point," the researchers say. "The integration of depression screening into a busy clinical setting is challenging but feasible."

"Implementation took approximately one year with continued refinement of the process following that time frame," Dr. Corathers said.

"Integration of depression screening into routine clinical practice (blood pressure check, height, weight, point of care A1c, CDI survey) has helped to remove some of the stigma or taboo around discussion of mental health issues in the medical sub-specialty setting," Dr. Corathers said.

She added, "The crucial elements for the success of this project (include) selecting a standard screening instrument for depression and defining objective criteria for mental health referrals."

"The rationale for screening was communicated to families and staff, which resulted in high acceptance of screening," Dr. Corathers said. "Lastly, the team identified ways to make the process as efficient and easy to complete as possible, such as use of computer tablets and automating scoring to improve timeliness and accuracy of results."

"Based upon our current research," the investigators say, "it is recommended that screening occur at least annually and be examined within the context of how depression scores relate to diabetes management to inform health-promoting clinical interventions."

"Implications of this research are wide reaching as this process may serve as a model for integration of depression screening across a variety of clinical settings for youth with chronic health conditions," they add.

SOURCE: http://bit.ly/H6Gxsd

Pediatrics 2013.