Abstract
Aims: Despite substantial evidence of its adverse effects on the presentation and course of type 2 diabetes mellitus (T2DM), depression is still under recognised and under diagnosed in primary care. The aims of the two studies presented here were to: (a) examine the prevalence of depression in patients with T2DM in primary care practices in Victoria, and (b) investigate the barriers that health professionals experience in identifying and managing co-morbid depression in T2DM. Methods: Study 1: Seven general practices in metropolitan and rural Victoria were selected on 3 criteria: (1) sufficiently large numbers of patients with T2DM; (2) the diagnosis of T2DM could be verified by patient record, and (3) an on-site GP was able to follow-up patients. All patients with T2DM were screened for depression using 2 standard measures (HADS and PHQ-9). Study 2: Participants (n = 149) were health professionals working with T2DM patients who completed a self-report questionnaire assessing barriers to depression identification and management. Results: Across all 7 practices, the proportion of patients with T2DM reporting moderate-severe depression ranged from 9% to 12%. A further 12% reported mild depression. Patients reporting mild levels of depression were found to have high levels of cholesterol and 97% had hypertension. Health professionals identified specific barriers at the patient, practitioner and system levels that impeded identification and management of co-morbid depression. Conclusion: Our results show that prevalence rates of clinical depression are higher than those reported in the general population. Barriers need to be addressed at multiple levels. Health checks should include screening for depression and related risk factors. Implementation of effective prevention and treatment programs must become standard clinical practice. We discuss a program that has been trialled in Australia for management of co-morbid depression in primary care and a training program for health professionals.