Screening, Referral and Treatment of Depression by Australian Cardiologists.

BACKGROUND: Depression is common in cardiovascular disease (CVD). Clinical practice guidelines recommend routine depression screening by cardiologists. The aim of the study was to undertake a national survey of Australian cardiologists' clinical practice behaviours in relation to depression screening, referral, and treatment. METHODS: The Cardiovascular Disease and Depression Questionnaire was sent to 827 eligible cardiologist members of Cardiac Society of Australia and New Zealand, of which a total of 524 were returned (63%). RESULTS: Most Australian cardiologists do not routinely ask their patients about depression and only 3% routinely use depression screening instruments. Most cardiologists (>70%) think that General Practitioners (Primary Care Physicians) are primarily responsible for identifying and treating depression in CVD. Cardiologists, who understand the prognostic risks of depression in CVD and feel confident to identify and treat depression, were more likely to screen, refer and/or treat patients for depression. CONCLUSIONS: Australian cardiologists rarely use validated depression screening measures. Several brief instruments are available for use and can be easily integrated into routine patient care without taking additional consultation time.

Development and validation of the Diabetes Management Orientation Scale (DMOS): assessing culturally related approaches to diabetes self-management.

AIMS: Self-management behaviours of type 2 diabetes are improved by self-efficacy while the role of culture is not well understood. This study explored cultural individualist and collectivist aspects of self-management and their relationship to diabetes control. METHODS: 94 Adults with type 2 diabetes for over 1 year and Chinese spoken as a first language at home recruited through healthcare providers completed the newly developed Diabetes Management Orientation Scale (DMOS), and a validated Diabetes Self-Efficacy Scale (DSES). Exploratory factor analysis and logistic regression was used to examine the factor structure and relationship to glycemic control. RESULTS: Three factors were extracted from the DMOS: Individualist, Collectivist, and Balanced Personal Responsibility (BPR) Orientations to self-management. BPR orientation was the only significant psychosocial predictor of glycemic control in this population (odds ratio of 2.85 for having good diabetes control; HbA1c<7.0). Self-efficacy did not predict glycemic control in our sample. CONCLUSIONS: Self-management education and clinical care that builds on BPR orientation may be more important than a sole focus on strengthening self-efficacy. The DMOS has external validity and is potentially useful for both practice and research. Future research should explore how BPR orientation is developed, and whether it predicts glycemic control within more individualist cultures.