Depression-Diabetes Care Disparities, Adverse Outcomes

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DESCRIPTION (provided by applicant): Our goal is to develop an epidemiological basis for integrated management of diabetes, depressive illness, and associated clinical and behavioral risk factors. Persons with diabetes depression co-morbidity are more likely to have diabetes complications, poorer clinical control, increased behavioral risk factors, and increased disability. The proposed research will provide an empirical basis for an integrated, biopsychosocial approach for care of the two million Americans afflicted by diabetes and major depression. This research will build on a completed survey of 4839 persons with diabetes in Group Health Cooperative (GHC) that assessed diabetes care, depression, disability, and associated risk factors for diabetes and heart disease. We will carry out a 5-year follow-up survey with all survivors to assess depression and disability outcomes, and patient priorities for their care. We will use GHC and Washington State death records to measure mortality. Glycemic, blood pressure, and lipid control, diabetic complications, and quality of health care will be monitored over the five-year follow-up period using GHC medical records. The research goal will be achieved by accomplishing three aims: Aim 1: Assess predictors of adverse outcomes - We will develop risk-prediction models for the incidence of adverse outcomes including: 5-year all-cause mortality, coronary disease (CAD) and cerebrovascular (CVA) mortality, incident microvascular and macrovascular complications, poor clinical control (glycemic, blood pressure and lipid control), deterioration in activities of daily living and major depression. A major focus will be the contribution of depression to adverse diabetes outcomes. Aim 2: Identify disparities in health care for depressed vs. non-depressed persons with diabetes. We will assess whether depression-diabetes co-morbidity is associated with disparities in the quality of health care for: clinical control (glycemic, blood pressure and lipid control); preventive screening and treatment; and for behavioral risk factor reduction (interventions for obesity, sedentary lifestyle, and smoking cessation). Aim 3: Set priorities for integrated services - We will assess criteria relevant to priorities for integrated management of diabetes, depression and associated behavioral risk factors.