What is the effect of routinely assessing and addressing depression and diabetes distress using patient reported outcome measures in improving outcomes among adults with type 2 diabetes?

Problem

Up to four in ten people with type 2 diabetes experience problems related to mental health, such as depression, anxiety, and diabetes distress. Diabetes guidelines recommend assessment of depressive symptoms and diabetes distress during diabetes care using patient reported outcome measures. This systematic review examines the effect of routinely assessing and addressing depressive symptoms and diabetes distress using patient reported outcome measures in improving outcomes among adults with type 2 diabetes.

Approach

Medline, Embase, CINAHL Complete, PsycInfo, The Cochrane Library and Cochrane Central Register of Controlled Trials were searched using a pre-specified strategy on August 3rd 2020. Eligible studies include studies of adults with type 2 diabetes with the intervention includes both completion of a patient reported outcomes measure of depressive symptoms or diabetes distress and feedback of the responses to a healthcare professional. Two review authors independently screened abstracts and full texts with disagreements resolved by a third reviewer, if required, using Covidence software. Two reviewers undertook risk of bias assessment using Cochrane Risk of Bias 2 tool. Due to heterogeneity of the interventions, a narrative synthesis of the studies is underway.

Findings

The systematic search identified 3,581 citations of which 147 full-text citations were assessed for eligibility, and eight studies met the inclusion criteria. Three studies were rated as some concerns on the risk of bias assessment. Six of the studies used the Patient Health Questionnaire-9 to assess depressive symptoms, with two of these also administering a diabetes distress measure (Diabetes Distress Scale and Problem Areas in Diabetes scale). Two studies measured diabetes distress only as part of the intervention. Patient reported outcome measure responses were frequently collected (6/8 studies) by study team members not involved in ongoing clinical care, either via the telephone or at the clinic. All studies had an associated complex co-intervention, such as telephone counselling, case management or clinical decision support. Results showed improvement in mental and emotional health in six studies. Two studies showed improved self-management, with one study showing improvement in glycaemia. No studies assessed changes in person-centred communication.

Consequences

This review's findings provide a foundation for understanding how patient reported outcome measures for assessing depressive symptoms and diabetes distress are used in the care of people with type 2 diabetes. The review highlights that patient reported outcome measure collection in type 2 diabetes is most frequently by trained study team members with responses linked to complex interventions. There is a need for scalable interventions to support assessing and addressing depressive symptoms and diabetes distress in routine general practice.