Psychosocial interventions for people with diabetes and co-morbid depression. A systematic review

Abstract

Aims and objectives: To examine the effectiveness of psychosocial interventions on depressive symptoms and glycaemic control of adults with Type 1 or 2 diabetes and co-morbid depression.

Background: Diabetes is a chronic disease that affects as many as 382 million people in the world. Diabetes management is a challenging daily task which can be overwhelming and lead to depression. Both diabetes and co-morbid depression have a negative bidirectional influence on each other, which is detrimental for the individual's quality of life. This co-morbidity places a huge burden on the individual, family, health care system, and the economy, with an associated 50-75% increase in health care costs.

Design: A systematic review.

Methods: Four electronic databases were searched including Cochrane Library, CINAHL, MEDLINE, and PsycINFO for articles written in English from the year 1998 to 2013. Data extraction of vital information from included studies was conducted and the effect sizes were calculated for the outcomes.

Results: Ten interventional primary studies were retrieved from the search; six were randomised studies. Nine out of ten studies reported that psychosocial interventions were effective for depression with effect sizes ranging from small (-0.24) to large (-1.74). No effect was found for the glycaemic control outcome. The interventions came in a myriad of intervention type, delivery method, duration, and intensity, therefore a meta-analysis was not conducted. The review found that nurses were competent in delivering psychosocial interventions for this population. Methodological quality was below average amongst the study with various biases present.

Conclusions: The results and effect sizes were promising but due to the high number of bias risks, it cannot be determined if psychosocial interventions were found to be effective in people with diabetes and co-morbid depression.

Relevance to clinical practice: Psychosocial interventions have the potential to make improvements in depression, alleviating the global burden on people with diabetes, keeping in mind the best intervention modality tailoring to the client's needs and preferences. Nurses and other health professionals involved in caring for this group are in a good stead to carry out these interventions.

Keywords: Co-morbidity; Depression; Depressive symptoms; Diabetes mellitus; Glycaemic control; Nurses; Psychosocial interventions; Systematic review.