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Improving Depression Screening in Adults with Diabetes

Tiffany Amaya 

St. Thomas University 

NUR-611-AP2.25/SU2

Dr. Janet M. Huxley

July 26, 2025

Improving Depression Screening in Adults with Diabetes

PICOT Question In adult patients with diabetes (P), how does adherence to evidence-based preventive screening guidelines (I) by nurse practitioners in primary care settings (C) affect the identification and management of depression (O) over a 12-month period (T)?

Purpose and Rationale for the Scholarly Project

This scholarly project is aimed at assessing how the compliance with evidence-based screening guidelines can enhance the identification and treatment of depression in adults with diabetes in primary care by nurse practitioners (NPs). This project is important because of the well-established comorbidity of diabetes and depression whose interrelations worsen the outcome of physical health difficulties and puts health systems under economic pressure. It is indicated that up to 30 percent of diabetic patients develop depression, and among them, less than 50 percent are appropriately identified and treated (Li et al., 2022). The changes related to aligning the practices of NP with those of preventive screens should be associated with the better outcomes of patients, higher adherence to the treatment, and, possibly, reduced costs of the overall healthcare system once the complications of diabetes are reduced.

Background on the Problem or Population of Interest

More than 37 million people in the United States encounter diabetes, and it is linked with the doubled likelihood of having depression (Centers for Disease Control and Prevention [CDC], 2023). The presence of depression in patients with diabetes results in the lack of compliance with treatment plans, inadequate lifestyle, and decrease in the glycemic control, which elevates morbidity and mortality (Katon et al., 2015). More than that, the comorbid depression is usually unidentified in busy primary care center with available screening tools (i.e., PHQ-9) that are validated to identify depression early (American Diabetes Association [ADA], 2023). Such missed opportunities emphasize the necessity to strengthen the guideline-based practices among NPs, who often represent the primary care providers in chronic diseases treatment.

Significance of the Problem to Nursing and Health Care

Managing unrecognized depression among diabetic groups is squared with overall healthcare agendas, such as chronic disease, mental health integration and prevention. Depression itself is the main cause of disability all over the world, and when combined with such a chronic disease as diabetes, it creates a huge burden on the patient and his family as well as on the overall healthcare system (World Health Organization [WHO], 2023). Variability of screening patterns among primary care givers compromises the national goals of integrated care. NPs have a front-line position in supporting healthcare delivery, and thus, screening patients with diabetes and their mental health can help them bridge this gap. The project will promote the triple aim of healthcare: enhancing patient experience, population health improvement, and overall decrease in the costs of per capita healthcare.

Project Value to the Nursing Practice

This academic endeavor will improve the NP practice by the need to focus on incorporation of evidence-based mental health care screening routines into care of patients with diabetes. Increasing the stability of screening will help NPs to identify, refer, and treat depression on time leading to better outcomes in patients. It is anticipated that the results can be in the form of improved rates of diagnosis of depression, better glycemic control, and patient satisfaction. These findings confirm the clinical practice recommendations of the U.S. Preventive Services Task Force (USPSTF) and the ADA which suggest screening at-risk groups regularly when it comes to depression (Depression and Suicide Risk in Adults: Screening, 2023). The larger implication of the project includes other chronic disease population, as well as the practice, which shows the potential of becoming a prototype of integrated behavioral health efforts in various populations of patients.

References

American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Supplement_1), S1–S290. https://doi.org/10.2337/dc23-Sint

Depression and suicide risk in Adults: screening. (2023, June 20).  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-adults

Katon, W., Russo, J., Lin, E. H., Schmittdiel, J., Ciechanowski, P., Ludman, E., Peterson, D., Young, B., & Von Korff, M. (2012). Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial. Archives of general psychiatry, 69(5), 506–514. https://doi.org/10.1001/archgenpsychiatry.2011.1548

Li, C., Ford, E. S., Zhao, G., Ahluwalia, I. B., Pearson, W. S., & Mokdad, A. H. (2022). Prevalence and correlates of undiagnosed depression among U.S. adults with diabetes: The Behavioral Risk Factor Surveillance System, 2019. Journal of Affective Disorders, 307, 216–224. https://doi.org/10.1016/j.jad.2022.03.072

QuickStats: Percentage* of Adults Aged ≥18 Years with Diagnosed Diabetes,† by Urbanization Level§ and Age Group — National Health Interview Survey, United States, 2022¶. (2024).  MMWR Morbidity and Mortality Weekly Report,  73(2), 49.  https://doi.org/10.15585/mmwr.mm7302a5

World Health Organization. (2023). Depression. https://www.who.int/news-room/fact-sheets/detail/depression

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