Distress, Depression, or Both? Exploring Differences in the DDS-17 and the PHQ-9 in Diabetes Specialty Clinic

Abstract

Diabetes-related distress (DRD) is distinctly different from depression and is more common than depression in people with diabetes. DRD has serious negative outcomes, including poor glycemic control. DRD has been identified in more than 40% of people with diabetes. Recent ADA Standards recommend assessing and addressing DRD; however, in clinical settings, confusion may exist concerning utility of screening for DRD. This study explores differences in our population between scores on DRD and depression screening measures. At the USAF Diabetes Center of Excellence (DCOE), a military specialty clinic, adult patients were administered the Patient Health Questionnaire (PHQ-9) and the Diabetes-related Distress Scale (DDS-17) as part of standard care from June 2015 through August 2016. Distinct areas of DRD are: 1) Emotional Burden (EB); 2) Physician-related Distress (PD); 3) Regimen-related Distress (RD); and 4) Interpersonal Distress (ID). DDS-17 was categorized as <2.0=little or no distress; 2.0-2.9=moderate distress; and ≥3=high distress. A score ≥ 10 was considered positive for depression on the PHQ-9. Patients (n=314) completed both the DDS-17 and the PHQ-9. Most patients had neither symptoms of depression nor DRD (70.4%). However, 23.9% scored high on the DDS-17 in at least one domain while 11.8% screened positive for depression. Overall, highest DRD was found in EB (17.0%) and RD (15.7%). Furthermore, 56 patients screened positive for DRD, but not for depression (17.8%). Nearly half of patients that screened positive for depression did not have DRD (5.7%). Our study reinforces ADA guidelines to screen and treat DRD as a distinct psychosocial issue. If a clinic does not screen for DRD, they are missing an opportunity to address this common experience. High distress was found in nearly one-quarter of our patients. Regular screening for distress related to demands of living with diabetes is crucial in identifying and preventing poor health outcomes associated with DRD. Disclosure J.L. Wardian: None. K.E. Kanzler: None. T.J. Sauerwein: Speaker's Bureau; Self; Merck & Co., Inc., AstraZeneca. M.W. True: None. M.A. Glotfelter: None.