Pharmacist screening for depression among patients with diabetes in an urban primary care setting

Objectives: To identify possible undiagnosed and under-treated depression in patients with diabetes in an urban primary care setting using screening by a student pharmacist, to develop a better understanding of the influence of comorbid depression on diabetes control, and to identify predictors of increased risk for comorbid depression. Methods: Patients from an underserved, low-income, inner-city setting who were receiving primary follow-up diabetes care at five Cincinnati Health Department clinics were evaluated for depression using the Zung Self-rating Depression Scale (SDS). A student pharmacist questioned patients on their medical history and documented the information. After the appointment, the student pharmacist also gathered information from patient medical charts, including patient characteristics, age, social history, pertinent laboratory results (glycosylated hemoglobin [A1C], fasting blood glucose, lipid panel information), and documented comorbidities. A positive screen for depression was defined as an SDS score of 50 or more, and the result of the screening was documented as a clinical note in the patient's medical chart. Based on SDS scores, severity of depressive symptoms was categorized as mild (50-59), moderate (60-69), or severe (>= 70). Results: 45 patients (2 with type 1 diabetes and 43 with type 2 diabetes, 41 aged > 40 years, 35 black, 31 women, and 31 uninsured) were enrolled in the study. Based on the data collected and SDS results, 12 patients (27%) had a current diagnosis of depression from their primary care physician. For this group of 12, the SDS acted as a quality-assurance tool, identifying 3 patients (25%) as adequately treated (SDS scores < 50), 6 (50%) as undertreated (SDS scores >= 50 with pharmacologic and/or nonpharmacologic therapy), and 3 (25%) as not treated at all ( SDS scores >= 50 without pharmacologic or nonpharmacologic therapy). Of the 33 patients (73%) without a current diagnosis of depression, 16 (48%) screened positive for depression and 17 were not depressed (52%). No significant differences were observed between nondepressed and depressed participants in mean A1C or fasting blood glucose. Conclusion: Poorly controlled depression in patients with diabetes can be identified by pharmacists in the primary care setting via use of a brief screening tool such as the SDS.