Measuring and assessing depression in people with diabetes : implications for clinical practice

Diabetes is an increasing global health and economic burden that is frequently associated with and worsened by clinically significant depression or anxiety. This chapter focuses on the history and evolution of the concept of depression and will also describe some of the uncertainties and controversy surrounding psychiatric nosology. Depression as a syndrome of pathological emotions should be diagnosed using operationalized criteria; however, at the same time, depression should not be reified as a discrete construct with absolute boundaries. Depression is often comorbid with anxiety and other mental disorders, which could be clinically important for diabetes. As with other medical syndromes, there is substantial heterogeneity between patients within psychiatric diagnostic groups. Clinically significant depression is defined using cutoff scores for self-rated symptoms using various psychometrics, which correlate reasonably well with operationalized diagnoses. Both methods classify persons into clinically significant dichotomies of depression for diabetes. This chapter considers the implications of these diagnoses for clinical practice and makes suggestions as to the way forward both in terms of the identification of people with comorbid depression and diabetes and for treatment and care. Computerized assessment, for example, with computerized adaptive testing (CAT), can facilitate time-efficient depression screening in busy clinic settings.