Diabetes Standards of Care and Resources for Clinicians and Educators

To screen for depression, use a screening tool that is simple to administer and assess such as the Patient Health Questionnaire (PHQ-2). Other screening tools may be used, however, the PHQ has been validated in many populations, is relatively short and simple to use, and is designed for use in the primary care setting. Its longer version, the PHQ-9, can also be used as a screening tool as well as to track depression severity over time and assist with decisions regarding treatment intensification. Routine use of the PHQ-9 at protocol-defined follow-up points in a manner similar to blood pressure tracking for hypertension is recommended. Even in higher risk populations, such as those with diabetes, the optimal frequency for depression screening is unknown.

Depression screening alone has not been shown to improve outcomes. Screening must be incorporated into an effective collaborative care system that provides ongoing treatment, appropriate treatment intensification at timely intervals, care coordination and assertive follow-up, patient self-management support, psychoeducation, and monitoring to ensure resolution of depressive symptoms. Collaborative care teams (primary care provider, nurse care manager or other case manager, and consulting psychiatrist) have been shown to be particularly effective, though protocol-driven case management even without ongoing psychiatric oversight can also be effective.