Assessment Of Depression In Patients Research Articles

Voice-based depression assessment in patients with gynecological cancer.

161 Background: Although depression in patients with cancer can lead to a deterioration of treatment adherence and quality of life (QOL), diagnosis of depression in patients with cancer is difficult due to symptoms overlapping with side effects of cancer treatment such as fatigue. Traditional screening tools like the PHQ-9 questionnaire are underutilized in clinical practice. Recently, interest has grown in utilizing patients' voices to assess their mental well-being. This study aims to evaluate depression in patients with gynecological cancer and explore the usefulness of voice analysis as a depression detection tool. Methods: PHQ-9 scores were collected from 197 patients with gynecological cancer, with 28 cases undergoing longitudinal assessments at diagnosis, postoperatively, and during chemotherapy. Voice recordings were obtained from 70 patients at diagnosis, alongside serum samples from 22 patients. The PHQ-9 scores were compared across different treatment periods, with a specific focus on patients exhibiting a PHQ score of ≧10, who can be diagnosed with Major Depressive Disorder (MDD). The provision of supportive care for MDD patients was also verified. A random forest model was developed from voice features obtained from 70 patients, with hyperparameter tuning and cross-validation to predict mild depression. Serum metabolites were comprehensively analyzed between depression prediction group and normal prediction group by the depression prediction model. Results: Mean PHQ-9 scores decreased over time since diagnosis; initially 6.50 ± 4.99 (mean ±SD), post-operatively 6.18 ± 4.25, and during chemotherapy 4.88 ± 4.29. The frequencies of MDD also decreased over the clinical course; at diagnosis 24.3%, post-operatively 15.5%, and during chemotherapy 15.4%. Out of 17 cases of MDD during chemotherapy, only one (6.25%) received psychiatric intervention. All MDD cases during chemotherapy had PHQ-9 scores of 5 or higher, representing mild depression at diagnosis. Mild depression at diagnosis could be predicted with an AUC of 0.89 using voice features. Metabolites identified by the voice-based depression prediction model were associated with depression, such as xanthine, methionine, and taurocholic acid. Conclusions: Depression during chemotherapy is often not intervened. Patients with mild depression at diagnosis tend to develop MDD during chemotherapy. Voice-based mental health assessment at diagnosis is possibly a promising screening tool for depression during subsequent cancer treatment. Clinical trial information: UMIN000044266 .

Assessment of depression in patients with open-angle glaucoma

Background/Aim. Depression can be caused by a life situation. The aim of the study was to determine the influence of glaucomatous damage on the frequency of occurrence of depression, as well as to determine the risk factors for the onset of depression in patients with open-angle glaucoma (OAG). Methods. The study was designed as a clinical, observational study (cross-sectional study). The research included 150 patients of both genders over the age of 40 with a confirmed diagnosis of OAG. Anamnestic and sociodemographic data were collected by a questionnaire and detailed ophthalmological examinations were performed. The Beck Depression Inventory-II scale was used as a measurement instrument to assess depression. Results. A high (51.3%) prevalence of depressive symptoms in patients with OAG was confirmed. The patients who suffered from depression more often were women, people with lower monthly earnings, and lower mean deviation values of the visual field index. In patients with advanced glaucoma, a significantly higher frequency of depressive symptoms was observed. Conclusion. Due to the high prevalence of depressive symptoms, it is important to introduce a multidisciplinary approach to treatment by ophthalmologists and psychiatrists. Detecting and treating depressive symptoms at an early stage of the disease leads to a significant reduction in treatment costs and patient disability.

Development of a nomogram prediction model for depression in patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease with depression as one of its most common symptoms. The aim of this study is to establish a nomogram prediction model to assess the occurrence of depression in patients with SLE. Based on the Hospital Anxiety and Depression Scale cutoff of 8, 341 patients with SLE, recruited between June 2017 and December 2019, were divided into depressive and non-depressive groups. Data on socio-demographic characteristics, medical history, sociopsychological factors, and other risk factors were collected. Between-group differences in clinical characteristics were assessed with depression as the dependent variable and the variables selected by logistic multiple regression as predictors. The model was established using R language. Marital status, education, social support, coping, and anxiety predicted depression (p < 0.05). The nomogram prediction model showed that the risk rate was from 0.01 to 0.80, and the receiver operating characteristic curve analysis showed that the area under the curve was 0.891 (p < 0.001). The calibration curve can intuitively show that the probability of depression predicted by the nomogram model is consistent with the actual comparison. The designed nomogram provides a highly predictive assessment of depression in patients with SLE, facilitating more comprehensive depression evaluation in usual clinical care.

Quality of Life and Depression Assessment in Patients with Acute Coronary Syndrome: A Cross-Sectional Study.

Acute Coronary Syndrome (ACS) is currently the leading cause of death in industrialized countries. Morbidity after ACS includes physical and mental disorders affecting the patient's whole life situation and Quality of Life (QoL). The main aim of the study was to assess QoL and depression among post-ACS patients. This was a cross-sectional observational study. A total of 112 patients who fulfilled the inclusion criteria were included in this study. A semi-structured questionnaire was administered to the patients to collect data from the patients. In this study, men and women aged 18 - 80 with ACS; patients diagnosed with Non-ST Segment Elevated Myocardial Infarction (NSTEMI) or STEMI or Angina Pectoris were included. Patients with severe mental, and physical illness and dementia were excluded from the study. QoL and depression assessment was done by RAND 36-Item Health Survey and Hamilton Depression Rating scale, respectively. Among 112 post-ACS patients, 78 patients were males, and 38 patients were females. The mean age of the study population was 64.25 ± 9.029 and with most individuals in the category of 61 - 70 years. The majority of study populations were married (71.5%) and lived with their families (92.9%). In this study group, 42.9 % of the population reported at least high school education (SSLC) and 54.5% were full-time employees. Most of the patients (91.1%) were taking the medication regularly, while 55.4% of patients reported regular compliance with the follow-up. This study identified that, among various factors, older age, female gender, lower income, unemployment, low education status, poor compliance with medication, and depressive symptoms led to poor QoL. This study confirms a negative correlation between depressive symptoms and QoL. This study's results reveal the magnitude of depression that is prevalent in the primary health care clinic that goes undiagnosed and unmanaged. Hence, it is recommended to properly screen depressive symptoms in ACS patients. Therefore, concurrently, better QoL can be achieved by managing both depression and ACS.

Assessment of Depression in Patients with Acute Stroke

Objectives: &#x0D; &#x0D; To assess degree and severity of depression&#x0D; To describe the symptomatic profile of depression&#x0D; Analyse the relation between depression and demographic, predisposing and precipitating factors.&#x0D; &#x0D; Materials and Methods: A cross-sectional study was done on 160 subjects chosen by random sampling technique from the Department of General Medicine of Saveetha Medical College and Hospital using Montgomery-Asberg Depression Rating Scale.&#x0D; Results: 68% of the cases with acute stroke was assessed and found to have depression according to Montgomery-Asberg Depression Rating Scale.&#x0D; Conclusion: Post-Stroke Depression is expected in patients diagnosed with acute stroke.

Assessment of Depression in Patients with COVID-19

The COVID-19 pandemic is probably the greatest natural disaster of our generation and the 21st century with a great impact on mental health. The present study aims to quantify, with the help of the Beck questionnaire, the degree of depression in a group of 109 patients with moderate forms of COVID-19, hospitalized in the Second Clinic of the Clinical Hospital for Infectious Diseases St. Cuv. Parascheva Galati during the period: 1.01-30.03.2021. Of these, 35 patients (32.11%) had varying degrees of depression, and had an age and body mass index statistically significantly higher than those without depression. These patients also had statistically significantly higher Charlson scores of cumulative comorbidities and required longer hospitalization than patients without depression. The severity of COVID-19 and the percentage of favorable prognosis did not show statistically significant differences between the two groups. Our study reveals a lower incidence of depression among patients with COVID-19 compared to existing studies in the literature. This can be explained by the fact that our study is conducted at the end of the first year of the pandemic when antiviral therapy schemes stabilized and population vaccination began. The high genetic variability of the virus, which can determine at any time the appearance of new strains with greater aggression, contagion or with mutations on the spike protein, maintains the need to keep non-specific preventive measures and the mental tension related to this pathology. Thus, intrapandemic psychiatric disorders remain a major public health problem and require strong government prevention and control measures.

Classifying Major Depressive Disorder Using fNIRS During Motor Rehabilitation

Major depressive disorder (MDD) has shown to negatively impact physical recovery in a variety of medical events (e.g., stroke and spinal cord injuries). Yet depression assessments, which are typically subjective in nature, are seldom considered to develop or guide rehabilitation strategies. The present study developed a predictive depression assessment technique using functional near-infrared spectroscopy (fNIRS) that can be rapidly integrated or performed concurrently with existing physical rehabilitation tasks. Thirty-one volunteers, including 14 adults clinically diagnosed with MDD and 17 healthy adults, participated in the study. Brain oxy-hemodynamic (HbO) responses were recorded using a 16-channel wearable continuous-wave fNIRS device while the volunteers performed the Grasp and Release Test in four 16-minute blocks. Ten features, extracted from HbO signals, from each channel served as inputs to XGBoost and Random Forest algorithms developed for each block and combination of successive blocks. Top 5 common features resulted in a classification accuracy of 92.6%, sensitivity of 84.8%, and specificity of 91.7% using the XGBoost classifier. This study identified mean HbO, full width half maximum and kurtosis, as specific neuromarkers, for predicting MDD across specific depression-related regions of interests (i.e., dorsolateral and ventrolateral prefrontal cortex). Our results suggest that a wearable fNIRS head probe monitoring specific brain regions, and limiting extraction to few features, can enable quick setup and rapid assessment of depression in patients. The overarching goal is to embed predictive neurotechnology during post-stroke and post-spinal-cord-injury rehabilitation sessions to monitor patients' depression symptomology so as to actively guide decisions about motor therapies.

Assessment of Depression in Patients of Type-2 Diabetes Mellitus Attending a Tertiary Care Centre

Assessment of Depression in Patients of Type-2 Diabetes Mellitus Attending a Tertiary Care Centre

Screening, assessment and treatment for depression in patients with chronic heart failure

Patients with chronic heart failure (CHF) have clinically significant depression at a rate two to three times higher than the general population. Depression is associated with poorer survival, limitations in daily functioning, and more frequent adverse cardiac outcomes. Guidelines on the management of CHF have highlighted a need for screening and assessment of depression in patients with CHF using validated instruments such as the Beck Depression Inventory and the Patient Health Questionnaire, which should be administered routinely post-hospitalisation, while recognising that not all symptoms are related to CHF alone. Following referral to a mental health specialist, collaborative care, cognitive behavioural therapy, and positive psychology interventions are most likely to deliver benefits for depression in people with CHF. They may also benefit from assistance with any limitations in terms of physical activity and fatigue, health behaviours, social isolation, and adherence to their medical treatment.

The Accuracy of the Edmonton Symptom Assessment System for the Assessment of Depression in Patients With Cancer: A Systematic Review and Meta-Analysis.

Depression is a common health problem among patients with cancer. The Edmonton Symptom Assessment System (ESAS) is one of many tools that have been used to evaluate depression in these patients. Nevertheless, the diagnostic performance and the appropriate cutoff point of the ESAS for the assessment of depression in these patients have varied in the studies. To determine the diagnostic accuracy and the optimal cutoff point for the ESAS for the assessment of depression in patients with cancer. PubMed, Scopus, CINAHL, and Cochrane library databases from inception to September 18, 2016. Paired reviewers independently screened abstracts and full-text articles for all cross-sectional studies published in English and compared these with the ESAS in the depression (ESAS-D) subscale with reference to standard tests for the assessment of depression. Two reviewers serially abstracted the data and independently assessed the risk of bias by using the Quality Assessment of Diagnostic Accuracy Studies 2. A total of 6 studies were eligible for review. Our meta-analysis showed the optimal cutoff point of the ESAS-D ≥ 4, with pooled sensitivity and specificity at 53% (95% confidence interval [CI]: 38%-67%) and 90% (95% CI: 82%-94%), respectively. The positive likelihood ratio and diagnostic odds ratio of the ESAS-D ≥ 4 were 5.2 (95% CI: 3.1-8.6) and 10 (95% CI: 5-19). There was a high degree of heterogeneity between the studies ( P value <.001, I2 = 96%). We suggest that an ESAS-D ≥ 4 could be used to detect possible cases of depression in patients with cancer. Registration: Our study protocol was registered with the International Prospective Register of Systematic Reviews on October 4, 2016, and was last updated on January 11, 2017 (registration number CRD42016048288).

Depression Assessment in Patients Diagnosed with Parkinson’s Disease for Clinical Practice

To show the complexity of patients with Parkinson’s disease (PD) by illustrating an accurate profile based on the prevalence of depression and other complications, as well as differences observed among patients from UK and USA, for further good practices recommendations. A cross sectional descriptive study was conducted using an electronic survey among patients from UK and USA diagnosed with PD. Patients (n=104) were screened for depression by using the Zung Self-Rating Depression Scale (ZSDS). Prevalence of movement and nervous system symptoms was assessed by using multiple choice questions and the distress of each category was scored from 0 to 3 (0–no, 1–mild, 2-moderate, 3-severe) where a higher score indicates greater distress. Comparisons between patient groups were made with ANOVA and two-tailed t-test, correlations were interpreted based on calculations of Pearson’s R and descriptive statistics summarized the features of the sample. Most of the patients were from UK (65.38%), 50.96% were female and 54.81% showed depression according to the ZSDS. Comparisons between UK and USA patient groups disclosed no significant differences (all p>0.05). Patients aged 40-50 showed a higher incidence of depression and a more severe stage (p=0.025<0.05). Prevalence of movement and nervous system symptoms as well as the distress of these symptoms are up to two times higher in patients with depression than in those without (p<0.05). In patients with depression according to the ZSDS, 50.88% consider themselves not being depressed and in those that do not have depression according to the ZSDS, 14.89% consider themselves depressed. All patients with PD revealed a complex profile and require good management of frequent comorbidities. Prevalence of depression calls for medical professionals to be vigilant in the screening process.

Assessment of Depression in Patients With Cirrhosis of Liver

Assessment of Depression in Patients With Cirrhosis of Liver

Depression and anxiety in patients with coronary artery disease, measured by means of self-report measures and clinician-rated instrument.

The presence of depression symptomatology significantly deteriorates the prognosis for the patient. There are many instruments developed to measure depression and anxiety in clinical trials; however, the suitability of the specific scale for screening these disorders in cardiovascular patients is debatable. The aim of current study is to verify which of the major assessment instruments is the most relevant for the screening evaluation of depression and anxiety in patients with cardiovascular system diseases. The sample studied consisted of 120 patients with stable coronary artery disease (CAD). They did not display serious psychiatric or somatic disorders. To assess depressive and anxiety symptoms we used self-reporting measures (BDI-II, HADS, SSAI/STAI, and PHQ), the results of which were compared to results obtained on the basis of a clinician-rating instrument (HRSD). We found that depressive symptoms assessed on the basis of HRSD, BDI-II, and PHQ-9 were equivalent in results, while the results obtained in HADS-D were significantly lower. Anxiety symptoms were found at approximate levels in HADS, SSAI, and GAD-7. The assessment of somatic symptoms in patients with CAD indicates that 87.5% of the subjects reported somatic symptoms of various intensity. Screening assessment of depression in patients with CAD gives different results depending on the tool used. We found that HADS significantly underestimates the percentage of patients with symptoms of depression in patients with CAD. Assessing anxiety symptoms with the aid of HADS gave outcomes close to the results gained by use of other tools.

The patient health questionnaire-9: validation among patients with glaucoma.

BackgroundDepression and anxiety are two common normal responses to a chronic disease such as glaucoma. This study analysed the measurement properties of the depression screening instrument - Patient Health Questionnaire-9 (PHQ-9) using Rasch analysis to determine if it can be used as a measure.MethodsIn this hospital-based cross-sectional study, the PHQ-9 was administered to primary glaucoma adults attending a glaucoma clinic of a tertiary eye care centre, South India. All patients underwent a comprehensive clinical evaluation. Patient demographics and sub-type of glaucoma were abstracted from the medical record. Rasch analysis was used to investigate the following properties of the PHQ-9: behaviour of the response categories, measurement precision (assessed using person separation reliability, PSR; minimum recommended value 0.80), unidimensionality (assessed using item fit [0.7–1.3] and principal components analysis of residuals), and targeting.Results198 patients (mean age ± standard deviation = 59.83±12.34 years; 67% male) were included. The native PHQ-9 did not fit the Rasch model. The response categories showed disordered thresholds which became ordered after category reorganization. Measurement precision was below acceptable limits (0.62) and targeting was sub-optimal (−1.27 logits). Four items misfit that were deleted iteratively following which a set of five items fit the Rasch model. However measurement precision failed to improve and targeting worsened further (−1.62 logits).ConclusionsThe PHQ-9, in its present form, provides suboptimal assessment of depression in patients with glaucoma in India. Therefore, there is a need to develop a new depression instrument for our glaucoma population. A superior strategy would be to use the item bank for depression but this will also need to be validated in glaucoma patients before deciding its utility.

The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment.

BackgroundCardiovascular disease and mental health both hold enormous public health importance, both ranking highly in results of the recent Global Burden of Disease Study 2010 (GBD 2010). For the first time, the GBD 2010 has systematically and quantitatively assessed major depression as an independent risk factor for the development of ischemic heart disease (IHD) using comparative risk assessment methodology.MethodsA pooled relative risk (RR) was calculated from studies identified through a systematic review with strict inclusion criteria designed to provide evidence of independent risk factor status. Accepted case definitions of depression include diagnosis by a clinician or by non-clinician raters adhering to Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) classifications. We therefore refer to the exposure in this paper as major depression as opposed to the DSM-IV category of major depressive disorder (MDD). The population attributable fraction (PAF) was calculated using the pooled RR estimate. Attributable burden was calculated by multiplying the PAF by the underlying burden of IHD estimated as part of GBD 2010.ResultsThe pooled relative risk of developing IHD in those with major depression was 1.56 (95% CI 1.30 to 1.87). Globally there were almost 4 million estimated IHD disability-adjusted life years (DALYs), which can be attributed to major depression in 2010; 3.5 million years of life lost and 250,000 years of life lived with a disability. These findings highlight a previously underestimated mortality component of the burden of major depression. As a proportion of overall IHD burden, 2.95% (95% CI 1.48 to 4.46%) of IHD DALYs were estimated to be attributable to MDD in 2010. Eastern Europe and North Africa/Middle East demonstrate the highest proportion with Asia Pacific, high income representing the lowest.ConclusionsThe present work comprises the most robust systematic review of its kind to date. The key finding that major depression may be responsible for approximately 3% of global IHD DALYs warrants assessment for depression in patients at high risk of developing IHD or at risk of a repeat IHD event.

Sleep and depression assessment in patients with non-malignant chronic pain with extended release hydromorphone treatment

Chronic benign pain has been correlated with sleep disorders and depression. The objective of this study is to describe the relationship between sleep disorders, doses of OROS hydromorphone and depression symptoms in the management of patients with non malignant severe chronic pain. A descriptive retrospective study of 32 patients. Pittsburgh Sleep Quality Index (PSQI), Beck depression questionnaire (DBI) and VAS before and 1 month after inclusion in the treatment with OROS hydromorphome was accomplished through medical record review.

Web-Based Assessment of Depression in Patients Treated in Clinical Practice

Calls for the use of standardized assessments in clinical practice have been increasing. A Web-based administration of outcome assessments offers several potential advantages over paper-and-pencil assessments, such as patient convenience, reduced missing data, reduced costs, automatic scoring, and generation of large databases. The present study from the Rhode Island Methods to Improve Diagnostic Assessments and Services (MIDAS) project evaluated the acceptability, reliability, and validity of a Web-based administration of a depression scale in patients receiving ongoing care for depression. From June 2009 to July 2010, fifty-three depressed outpatients completed a Web-based and a paper version of the Clinically Useful Depression Outcome Scale (CUDOS). The vast majority of patients met DSM-IV criteria for either major depressive disorder (n = 36) or bipolar disorder (n = 9). Patients were also asked to complete a brief 6-question survey of the acceptability of the 2 modes of scale administration. At the time of the visit, the patients' psychiatrist completed the Montgomery-Asberg Depression Rating Scale (MADRS) and rated patients on the Clinical Global Impressions-Severity of Illness (CGI-S) scale and Global Assessment of Functioning (GAF). The correlation between the Web-administered and paper versions of the CUDOS was high (P < .001). The mean scores were similar on the paper and Internet administrations. The internal consistency of the paper and Internet administrations of the CUDOS was high (both values, Cronbach α = .93), and all item-scale correlations for the paper and Internet versions were significant (median for paper administration = 0.76; median for Internet administration = 0.74). The paper and Internet versions of the CUDOS were equally correlated with clinicians' ratings on the MADRS, CGI-S, and GAF (all P values < .001). Patients reported high levels of satisfaction with Internet administration and preferred this method of monitoring outcome to paper administration in the office (all P values < .001). The results of this first study of the use of a Web-based system of monitoring outcome in routine clinical practice supported the reliability and validity of Internet administration of a depression scale, and patients clearly preferred Internet administration to completion of a paper-and-pencil questionnaire in the office.

P02-70 - The new rasch-based depression screening (DESC): Evaluation and validation in different patient groups and a large German population sample

IntroductionComorbid depression in somatic illness is highly prevalent. However, most depression questionnaires show violation of unidimensionality and hypersensitivity of items.ObjectivesThe Depression Screening (DESC) is a new self-rating scale for the measurement of depression severity that we developed from a calibrated Rasch-homogeneous item bank (N = 367) to improve short depression assessment in patients beyond psychiatric settings.AimTo present data for both parallel forms (10 questions each) of the DESC, and to examine its Rasch model qualities in different patient groups and a representative German general population sample.MethodsPatient groups with depression, heart disease, neurological or otolaryngological disease (N = 333) were investigated with the DESC accompanied by diagnostic interviews and established depression scales. The demographic sample (N = 2509) was interviewed face to face, too. Adherence to Rasch model assumptions was determined with analysis of model fit, and further measures. Norm values were calculated.ResultsBoth DESC versions feature different but highly correlated item sets. Cut-off scores with good sensitivity (0.82, 0.81) and specificity (0.78, 0.77) for the diagnosis of an affective disorder were developed with ROC analyses. No serious Differential Item Functioning in Rasch analyses for both scales was found. In the German validation sample the Rasch dimension “depression” explained 68.5% and 69.3% respectively of the variance. Validity was determined through sufficient intercorrelations with other scales (e.g. BDI, HADS).ConclusionsOur studies support the good psychometric RASCH qualities of both DESC forms and offer important advancements in depression screening being of use for time-limited clinical and research applications.

Scales for Evaluating Depressive Symptoms in Chinese Patients With Schizophrenia

There have been few studies evaluating depressive symptoms in Chinese patients with schizophrenia. Thus, we planned to compare the diagnostic validity of 4 commonly used assessment scales for depression in schizophrenia in China. The association between different depression scales and between depression scales and negative symptoms were also studied. The study population consisted of 101 inpatients meeting the DSM-IV criteria for schizophrenia. Depression in the study subjects was defined by the DSM-IV criteria for a major depressive episode. The negative subscale of the PANSS was used to assess the negative symptoms in schizophrenia. The following 4 depression scales were assessed for their diagnostic validity as measures of depressive disorder in schizophrenia: the Calgary Depression Scale for Schizophrenia (CDSS), the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Rating Scale for Depression (HAM-D), and the depression subscale of the PANSS (PANSS-D). The depression scales were found to be highly intercorrelated with each other. Of the 4 depression scales studied, only CDSS can discriminate between depression and a PANSS negative symptoms subscale score or negative item scores. The areas under the receiver operating characteristic curves of the CDSS, HAM-D, MARDS, and PANSS-D were 0.954, 0.881, 0.828, and 0.897, respectively. The area under the receiver operating characteristic curve of the CDSS was significantly greater than those of the HAM-D, the MARDS, and the PANSS-D. Our study suggests that the CDSS may provide optimal assessment of depression in patients with schizophrenia.

Clinical Depression Versus Distress Among Patients With Type 2 Diabetes

We sought to determine differences between structured interviews, symptom questionnaires, and distress measures for assessment of depression in patients with diabetes. We assessed 506 diabetic patients for major depressive disorder (MDD) by a structured interview (Composite International Diagnostic Interview [CIDI]), a questionnaire for depressive symptoms (Center for Epidemiological Studies Depression Scale [CESD]), and on the Diabetes Distress Scale. Demographic characteristics, two biological variables (A1C and non-HDL cholesterol), and four behavioral management measures (kilocalories, calories of saturated fat, number of fruit and vegetable servings, and minutes of physical activity) were assessed. Comparisons were made between those with and without depression on the CIDI and the CESD. Findings showed that 22% of patients reached CESD > or = 16, and 9.9% met a CIDI diagnosis of MDD. Of those above CESD cut points, 70% were not clinically depressed, and 34% of those who were clinically depressed did not reach CESD scores > or = 16. Those scoring > or = 16, compared with those < 16 on the CESD, had higher A1C, kilocalories, and calories of saturated fat and lower physical activity. No differences were found using the CIDI. Diabetes distress was minimally related to MDD but substantively linked to CESD scores and to outcomes. Most patients with diabetes and high levels of depressive symptoms are not clinically depressed. The CESD may be more reflective of general emotional and diabetes-specific distress than clinical depression. Most treatment of distress, however, is based on the depression literature, which suggests the need to consider different interventions for distressed but not clinically depressed diabetic patients.