Cognitive Behavior Therapy for Depression in Type 2 Diabetes Mellitus: A Randomized, Controlled Trial
Publication: Annals of Internal Medicine
Volume 129, Number 8
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Abstract
Background:
Psychotherapy is the principal nonpharmacologic method for the management of depression, but its usefulness for depressed patients with diabetes remains unknown.
Objective:
To assess the efficacy of cognitive behavior therapy (CBT) for depression in patients with diabetes.
Design:
Randomized, controlled trial.
Setting:
Referral-based academic medical center.
Patients:
51 patients with type 2 diabetes and major depression.
Intervention:
Patients were assigned either to a group that received 10 weeks of individual CBT or to a control group that received no specific antidepressant treatment. All patients participated in a diabetes education program to control for the effects of supportive attention and the possible influence of enhanced diabetes control on mood.
Measurements:
Degree of depression was measured by using the Beck Depression Inventory; glycemic control was measured by using glycosylated hemoglobin levels. Outcomes were assessed immediately after treatment and 6 months after treatment.
Results:
The percentage of patients achieving remission of depression (Beck Depression Inventory score ≤ 9) was greater in the CBT group than in the control group: posttreatment, 85.0% of patients in the CBT group (17 of 20) compared with 27.3% of controls (6 of 22) achieved remission (difference, 57.7 percentage points [95% CI, 33 to 82 percentage points]) (P < 0.001); at follow-up, 70.0% of patients in the CBT group (14 of 20) compared with 33.3% of controls (7 of 21) achieved remission (difference, 36.7 percentage points [CI, 9 to 65 percentage points]) (P = 0.03). Post-treatment glycosylated hemoglobin levels were not different in the two groups, but follow-up mean glycosylated hemoglobin levels were significantly better in the CBT group than in the control group (9.5% compared with 10.9%; P = 0.03).
Conclusions:
The combination of CBT and supportive diabetes education is an effective nonpharmacologic treatment for major depression in patients with type 2 diabetes. It may also be associated with improved glycemic control.
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Information & Authors
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Published In
Annals of Internal Medicine
Volume 129 • Number 8 • 15 October 1998
Pages: 613 - 621
History
Published in issue: 15 October 1998
Published online: 15 August 2000
Keywords
Copyright
© 1998 American College of Physicians.
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Cognitive Behavior Therapy for Depression in Type 2 Diabetes Mellitus: A Randomized, Controlled Trial. Ann Intern Med.1998;129:613-621. doi:10.7326/0003-4819-129-8-199810150-00005
Cognitive Behavior Therapy for Depression in Type 2 Diabetes Mellitus: A Randomized, Controlled Trial. Ann Intern Med.1998;129:613-621. doi:10.7326/0003-4819-129-8-199810150-00005
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