Screening and guided self-help intervention for anxiety and depression in patients with type 2 diabetes

Strategies for timely recognition and adequate treatment of mental disorder in diabetes are urgently needed. The aims of this study are to develop and evaluate an intervention for anxiety disorder and major depressive disorder (depression) in patients with type 2 diabetes (T2DM) by diabetes nurses (DNs) in primary care that requires minimal effort of all caregivers involved.

In this pilot, an open clinical study with pre-post test, seven trained DNs screened their patients. Patients screen-positive for anxiety disorder or depression underwent a standardised interview (MINI) by a researcher for validation. Patients fulfilling DSM-IV-TR criteria for anxiety disorder or depression were offered a self-help intervention supported and monitored by the DN in one-to-one guidance. Follow-up assessment was at six months.

Of 311 eligible patients, 111 consented to screening. Fifty-five patients were screened positive; 26 screen-positives were confirmed. Of the latter, 16 started and 15 completed the guided self-help intervention. Anxiety symptoms dropped 3.2 points (p=0.011), depressive symptoms 5.7 points (p=0.007), and somatic symptom severity 2.9 points (p=0.041) on the Patient Health Questionnaire. Diabetes-related negative emotions (PAID-NL) dropped 3.8 points (p=0.048). General functioning (EuroQol) improved by 14 points (p=0.007), and emotional role-functioning (SF-36) showed 33.4 points improvement (p=0.010). To conclude, trained DNs succeeded in screening and guiding a self-help intervention; mental and somatic symptoms, general functioning, and quality of life improved significantly.

This pilot strongly indicates that DNs can perform screening and one-to-one guidance regarding a self-help intervention for anxiety disorder and depression, playing an important role in the early detection and follow up of co-morbid mental disorders complicating diabetes. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd.