Depressive Symptoms, not Completing a Depression Screening Questionnaire, and Risk of Poor Compliance with Regular Primary Care Visits in Patients with Type 2 Diabetes: The Japan Diabetes Outcome Intervention Trial 2 (J-DOIT2) Study Group

Objectives: To explore the association between depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale or not completing the questionnaire and subsequent risk of poor compliance with regular visits to primary care physician in patients with type 2 diabetes. Methods: Using data from patients with type 2 diabetes who participated in the Japan Diabetes Outcome Intervention Trial 2 (J-DOIT2) Pilot Study, which was conducted at primary care settings, we examined the association between depressive symptoms or not completing the questionnaire and risk of poor compliance with regular visits as an event. Results: Among 1 584 patients who participated in the J-DOIT2 Pilot Study, we excluded 140 who did not meet inclusion criteria or who declined participation after randomization, leaving 1 444 for entry in the present analysis. During 1 409 person-years of follow-up (median 1 year), 90 events were observed (incidence rate 63.9/1 000 person-years). The multivariable-adjusted hazard ratio of poor compliance with regular visits in those having depressive symptoms was 1.23 (95% CI: 0.46-3.31). In contrast, the multivariable-adjusted hazard ratio of poor compliance in those not completing the questionnaire was 2.26 (95% CI: 1.94-2.63). Conclusion: Not completing a questionnaire was significantly associated with an increased risk of poor compliance with the maintenance of regular visits to a primary care physician in patients with type 2 diabetes. Patients who do not comply with questionnaire surveys require increased attention to ensure their compliance with regular visits, and thereby ensure better diabetes outcomes.