Depression Screening Disparities Among Veterans With Diabetes Compared With the General Veteran Population

Abstract

We sought to describe the proportion of veterans with diabetes screened for depression compared with the general population of veterans. Electronic medical records (fiscal years 2001-2004) from a Midwestern Veterans Health Administration (VHA) facility and VHA External Peer Review Program (EPRP) data were used for the study. Facility-level data included inpatient and outpatient encounters, which included depression screen results. EPRP data were facility-level summary data, which detailed the proportion of general population veterans nationwide and patients at the Midwestern facility who were screened for depression. Logistic regression tested for associations between depression screen receipt and screening positive and demographic/clinical characteristics among patients with diabetes. Depression screening among those with diabetes improved from 62% in fiscal year 2001 to 83% in 2004. Screening was 9-23% lower and 11-22% lower in patients with diabetes compared with the general population of veterans nationwide and patients at the Midwestern facility, respectively. Seventeen percent of subjects with diabetes screened positive, which is two times higher than in the general population. Women (odds ratio 0.45 [95% CI 0.35-0.60]) and subjects with unknown A1C (0.40 [0.34-0.46]) were less likely to be screened for depression. A >or=50% service-connected disability rating was inversely associated with screening (0.84 [0.72-0.99]) but positively associated with screening positive for depression (1.56 [1.33-1.82]). Screening for depression among veterans with diabetes improved 21% but is considerably lower than the proportion of general population veterans screened nationally and at the facility of interest. Targeted interventions to improve screening in patients with diabetes are required based on evidence that screening translates into increased provider recognition and treatment of depression.