Screening for Depression and Other Psychological Problems in Diabetes

This book is divided into two main sections, and covers a broad range of issues important for health practitioners to be aware of when caring for people with co-morbid diabetes and depression. Section One of the book contains the overall ideas and the more recent developments in measuring psychological morbidity in people with diabetes. When attempting to identify people with depression or other psychological problems, it is important for practitioners to recognize the limitations of screening as well as its utility. Issues such as the basic principles regarding when and when not to screen, the cultural applicability of tools, different questionnaire formats and key concepts such as sensitivity and specificity of tools, and their positive and negative predictive value, will be considered. In particular there has been increased interest in the concept of diabetes-related distress and several tools have been developed to measure this. There are broad-based measures of distress such as the Problem Areas in Diabetes (PAID) scale, the Diabetes Adjustment Scale (DAS), The Diabetes Health Profile, The Fear of Hypoglycemia Scale, etc. There are also a range of generic quality of life tools which have been used effectively in people with diabetes; for example the Medical Outcomes Survey Short-Forms (SF36, SF12), the World Health Organisation Well-being questionnaire (WHO-5) and the EQ5-D. These tools are important because they measure aspects of psychological well-being that are specifically associated with the experience of having a long-term conditions and so have important implications for both self-care and health care practice. The potential overlap of symptoms of depression and symptoms of diabetes-related distress are considered in this section and the implications for practice discussed. Section Two covers the most commonly used tools that have been used to screen for depression. For each tool considered some information which is easily referred to by the readeris set out in a table which includes details of the authors, time of first use, country where it was first developed, some examples of the questions used, the languages it is available in, data on sensitivity/specificity. Each instrument will then be discussed in terms of its use in research as well as practice, and its applicability in different patient groups, different cultural settings and so on. Guidance on the practical use of each tool is included, and the most popular depression screening tools are focussed on.

Current epidemiological evidence suggests that at least one third of people with diabetes suffer from clinically relevant depressive disorders which often go unrecognized and untreated. Research also shows that people with depressive disorders have an increased risk of developing Type 2 diabetes. Furthermore, the prognosis is poorer for either disease when they are co-morbid than when they occur separately. Co-morbid depression and diabetes has a huge impact on quality of life and diabetes management, and is an important public health problem. While there are many screening instruments available to identify individuals who may have depression, selecting the most appropriate tool for use in a busy diabetes clinic or primary care setting may not be straightforward.

Screening for Depression and Other Psychological Problems in Diabetes: A Practical Guide provides an up-to-date overview of available instruments for screening for depression in diabetes. The book reviews the most commonly used screening tools and considers their utility in a range of settings and countries. Guidance on the practical use of each tool is also provided. Other psychological problems found to be common in people with diabetes as well as diabetes-specific emotional difficulties are also considered.

This book will appeal to a range of health care practitioners caring for people with diabetes, including diabetologists, general practitioners, practice nurses and diabetes specialist nurses. The issues considered here are applicable to all diabetes populations across the world and thus this book will appeal to a broad international readership as well as to researchers in the field of diabetes and mental health.