IJCM_349A: Uncovering the hidden burden: a mixed-methods study on the implementation of depression screening among persons with Type 2 Diabetes Mellitus in an urban primary care setting

Abstract

Background: Diabetes is linked with depression, but screening rates for depression are low, indicating a need for periodic screening among those with diabetes Objective: The study aims to determine depression prevalence and associated factors in persons with Type-2 Diabetes Mellitus (T2DM) in an urban primary care setting of Karnataka, as well as implementation challenges in depression screening for persons with T2DM as perceived by healthcare providers Methodology: We carried out a mixed-methods study over a period of six months at an Urban Primary Health Centre (UPHC) in Bengaluru. Depression screening was carried out in 110 persons with T2DM using Patient Health Questionnaire-9. Key Informant Interviews were carried out among various health care providers of the UPHC. Data was captured using EpiCollect Version 5.0. Univariate logistic regression was carried out to find the factors associated with depression. Results: Of the 110 participants, 60 (54.5%) screened positive for depression. Duration of diabetes (95% CI=0.203,0.943; P=0.035); presence of comorbidities (Odds Ratio=3.226; 95% CI=1.362,7.638; P=0.008), presence of complications (Odds Ratio=3.000; 95% CI=1.341,6.713; P=0.008) were found to be significantly associated with depression. The key facilitators for screening were willingness to implement screening, empathetic attitude, and awareness of mental health whereas the challenges included lack of training in mental health assessment and patient reluctance to adhere to treatment due to stigma. Conclusion: More than half the study participants screened positive for depression, with significant associations found between depression and duration of diabetes, comorbidities, and complications. Several challenges in implementing depression screening for T2DM in primary care settings were noted.