A retrospective multisite examination of depression screening practices, scores, and correlates in pediatric diabetes care
Open accessAbstract
Psychosocial guidelines recommend routine screening of depressive symptoms in adolescents and young adults (AYA) with diabetes. Best practices for screening in routine care and patient characteristics associated with depressive symptoms require further investigation. The purpose of this study was to examine psychometric properties of the Patient Health Questionnaire (PHQ-2 and PHQ-9); document rates of depressive symptoms and related clinical actions; and evaluate associations with patient characteristics. The Patient Health Questionnaire (PHQ-2 or PHQ-9) was administered at five pediatric academic medical centers with 2,138 youth with type 1 diabetes. Screening was part of routine clinical care; retrospective data from electronic health records were collected for the first screening date as well as 12 months prior. The PHQ demonstrated good psychometric properties. Evaluation of item-level PHQ-9 data identified 5.0% of AYA with at least moderate depressive symptoms who would not have been flagged for further screening using the PHQ-2 only. On the PHQ-9, 10.0% of AYA with type 1 diabetes endorsed elevated depressive symptoms and 7.0% endorsed thoughts of self-harm. Patients with moderate or greater depressive symptoms had a 43.9% documented referral rate for mental health treatment. Higher BMI, older age, public insurance, shorter diabetes duration, higher HbA1C, and a diabetic ketoacidosis (DKA) event in the past year were associated with depressive symptoms. The PHQ-9 identified AYA with elevated depressive symptoms that would not have been identified using the PHQ-2. Depressive symptoms were associated with negative diabetes indicators. To improve referral rates, standardized methods for provision and documentation of referrals are needed.
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Multisite studies have demonstrated feasibility of implementing depressive symptom screening protocols in diabetes clinics.
“Multisite studies have demonstrated feasibility of implementing depressive symptom screening protocols in diabetes clinics and published practical guides for implementation (336)(337)(338)(339)391).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [337]
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- Authors
- Mulvaney, S. A., Mara, C. A., Kichler, J. C., Majidi, S., Driscoll, K. A., Westen, S. C., Rawlinson, A., Jacobsen, L. M., Adams, R. N., Hood, K. K., & Monaghan, M.
- Affiliations
- Vanderbilt University (US)
- Cincinnati Children's Hospital Medical Center (US)
- Barbara Davis Diabetes Center, Aurora, CO, USA
- University of Florida (US)
- Stanford Medicine (US)
- Children's National (US)
- Corresponding author
- Mulvaney, Shelagh A
- ORCID
- Venue
- Translational Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-11-25
- Volume
- 11
- Issue
- 1
- Pages
- 122-131
- ISSN
- 1613-9860 (ISSN-L)
- 1869-6716
- PMC
- PMC7877294
- OpenAlex
- W2991137526
- Cited by
- 26
- References
- 33
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 7 · 2022: 6 · 2021: 3 · 2020: 3
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Translational Behavioral Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR002243)
- Vanderbilt University (UL1TR001427)
- University of Florida
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- depression screening, type 1 diabetes, adolescents and young adults, Patient Health Questionnaire, PHQ-2, PHQ-9, depressive symptoms, self-harm, mental health referral, psychometric properties, diabetes complications, HbA1c, diabetic ketoacidosis, body mass index, insurance status
- MeSH terms
- Adolescent, Aged, Child, Depression, Diabetes Mellitus, Type 1, Humans, Mass Screening, Psychometrics, Surveys and Questionnaires, Retrospective Studies, Young Adult
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