Differences in the Clinical Recognition of Depression in Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)

We compared, by race/ethnicity, likelihood of clinical recognition of depression (diagnosis and/or treatment) of patients who reported depressive symptoms in a well-characterized community-based population with diabetes. We used a survey follow-up study of 20,188 patients with diabetes from Kaiser Permanente Northern California. Analyses were limited to subjects (n=910) meeting criteria for depression (Patient Health Questionnaire score ≥ 10 on survey) and no clinical recognition (see below) 12 months prior to survey. Clinical recognition of depression was defined by a depression diagnosis, referral to mental health services, or antidepressant medication prescription within 12 months. During the 12 months after self-reporting depressive symptoms, only 12%, 8%, 8%, 14%, and 15% of African American, Asian, Filipino, Latino, and white patients were clinically recognized for depression. After adjusting for sociodemographics, limited English proficiency, and depression symptom severity, racial/ethnic minorities were less likely to be clinically recognized for depression compared to whites (relative risk: Filipino: 0.30, Asian: 0.43, African American: 0.62, and Latino: 0.53). Overall, 88% of patients who reported significant self-reported depressive symptoms failed to receive clinical recognition of depression within 12 months. Filipinos and Latinos who had self-reported depressive symptoms were less likely to be clinically recognized with depression than whites. The low likelihood of clinical recognition has general public health implications, given the high prevalence of depression among diabetes patients and its clinical importance. Findings merit further research to investigate possible modifiable patient or provider factors.