Psychological care in a national health service: challenges for people with diabetes.

Recently, there has been a growing interest in psychological problems in people with diabetes and a concomitant increasing concern that these often go unreported and, thus, unidentified and treated. This has serious implications for both the self-management of diabetes and the individual's quality of life. In this review article we consider the question of screening for depression in people with diabetes within a national health service in the UK. The inadequacies of psychological care for patients with diabetes are discussed, in particular with regard to the importance of distinguishing between depressive symptoms and emotional distress related to having diabetes. Criteria for assessing the validity of screening for depression are discussed, together with national and international recommendations, with particular emphasis on current practice. The screening strategy currently recommended for implementation in primary care in the UK is outlined. The need for rigorous evaluation of screening initiatives is highlighted and a key conclusion is that case-finding alone is unlikely to be effective in terms of improving patient outcomes unless considered and applied in the context of overall case management. This review highlights the barriers and challenges to optimizing care for patients with co-morbid diabetes and depression, and outlines the therapies currently available in the UK, which might be disseminated in other countries.