This is a summary of important findings from a continuous quality improvement (CQI) program for type 2 diabetes care in Aboriginal and Torres Strait Islander primary health care (PHC). The program has been in place for more than 10 years, with 175 health centres across Australia giving the ABCD National Research Partnership permission to analyse data from this program.

Researchers looked at data from audits of type 2 diabetes care in community controlled, government and non-government health services in very remote, remote, rural and urban areas. They found important messages about improving mental health and wellbeing care for Aboriginal and Torres Strait Islander people with type 2 diabetes. The messages are relevant to caring for people with other chronic illnesses, such as heart disease and kidney disease.

The ABCD National Research Partnership works across states and territories in Australia to improve the quality of primary health care available to Indigenous people.

This document contains two research briefs containing:


	A summary of research findings for Aboriginal and Torres Strait Islander Health Workers/Health Practitioners
	A summary of research findings for Community Health Board

Alison Laycock

English

Analysis and Policy Observatory (APO)

Approximately 7 in 50 Aboriginal and Torres 
Strait Islander adults have type 2 diabetes...
People who have type 2 diabetes are at high risk  
for depression
Work to improve PHC systems for mental health and 
wellbeing care for your community
Participate in training in mental health and wellbeing screening, 
assessment, treatment, record keeping and referral
… compared with 2 in 50 non-
Indigenous Australians 
Aboriginal and Torres Strait 
Islander people are at least 3 
times more likely to have type 2 
diabetes than non-Indigenous 
Australians ³
Having diabetes gives 
you 2 times the risk of 
having depression ¹,²
3 x
2 x
This is a summary of important findings from a continuous quality improvement 
(CQI) program for type 2 diabetes care in Aboriginal and Torres Strait Islander 
primary health care (PHC) centres. The program has been in place for more 
than 10 years, with 175 health centres across Australia giving the ABCD National 
Research Partnership permission to analyse data from the program. 
Researchers looked at data from audits of type 2 diabetes care in community 
controlled, government and non-government health services in very remote, 
remote, rural and urban areas. They found important messages about improving 
mental health and wellbeing care for Aboriginal and Torres Strait Islander people 
with type 2 diabetes. The messages are relevant to caring for people with other 
chronic illnesses, such as heart disease and kidney disease.
Key messages for action
1
2
3
Diabetes and depression: Improving  
the quality of care for your community
A summary of research findings for Aboriginal and  
Torres Strait Islander Health Workers/Health Practitioners
Evidence from general practice in Australia and other 
countries shows that approximately 30% of people who 
have diabetes suffer from depression.1,4 Guidelines for 
diabetes care and general practice worldwide recommend 
that clients with type 2 diabetes be screened for depression, 
and be given follow up and management that matches 
their mental health needs.
There are gaps in knowledge about the extent of depression 
in Aboriginal and Torres Strait Islander people who have 
type 2 diabetes. Given the high levels of mental distress 
among those with the disease compared with the general 
population,5 we would expect that many Aboriginal 
and Torres Strait Islander people who have diabetes also 
experience depression.6 People with other chronic illnesses 
are likely to be at risk as well.
Despite what we know and expect, our research shows low 
rates of screening for social and emotional wellbeing with 
clients who have type 2 diabetes. Screening rates are even 
lower for clients with severe disease.7 Records over five 
years show the following statistics.
This raises questions. Why aren’t more health practitioners documenting cases of  
depression in clinical records more often? Is the diagnosis not made? Is a diagnosis made, 
but not recorded?6
People who have type 2 diabetes are at high risk  
for depression1
What questions about mental health and wellbeing screening and care for your clients who 
have diabetes are raised by your CQI data?
No documented depression Documented depression 
Health centres
Client health records with recorded symptoms of depression
About 1/4 of the 
health centres had no 
documented depression 
in the medical records 
of clients with type 2 
diabetes6
1/3 of the client records had  
no recorded diagnosis of depression
Some clients had been prescribed Selective Serotonin 
Reuptake Inhibitors (SSRI) medication, which may have 
been to treat depression6
In the other health centres 
documented depression varied 
from 3% to 37%6
1/3
3%
37%
Health centres
Overall, health centres need to improve:
•  social and emotional wellbeing screening and diagnosis
•  recording of depression in the records of clients with diabetes who have complications or 
poorly controlled diabetes
•  recording of PHC mental health and wellbeing services for clients who have type 2 diabetes
•  strategies for depression care.6,7
Work to improve PHC systems for mental health and  
wellbeing care for your community2
How well do your health centre systems work to provide these items of care?
In primary health care services there is a high burden of 
chronic disease and mental ill health, and high demand for 
‘sickness care’. Many health centre teams find it difficult to 
provide their communities with good quality mental health 
and wellbeing care.7
This is largely because health centre teams need training 
in mental health and wellbeing screening, assessment, 
treatment and referral to help them integrate it into primary 
health care. They also need support and supervision from 
specialist mental health professionals.6,7
In addition, the collection and use of information about 
service delivery and clinical indicators for mental health 
could be improved.6,7 This would provide more data for 
improving the quality of mental health and wellbeing care.
Participate in training in mental health and wellbeing screening, 
assessment, treatment, record keeping and referral3
What are your team’s training needs in mental health and wellbeing care?  
Who do you go to when you need expert advice?
Most health centres could improve social and 
emotional wellbeing screening for clients with 
chronic illnesses such as type 2 diabetes
Depression diagnosis and care could be 
improved in many health centres
Most health centres need to improve systems for 
recording information about mental health and 
wellbeing services provided to clients (including 
clients with diabetes)
Training and specialist support can help your 
team to build mental heath and wellbeing care 
into routine work 6,7
Many health centre teams need training in 
mental health and wellbeing assessment, 
treatment and referral
What the research shows 
References
1  Anderson, R. J., et al. 2001, The prevalence of comorbid depression in adults with 
diabetes a meta-analysis, Diabetes Care, 24(6): 1069–78.
2  Reddy, P., Ford, D. & Dunbar, J. A. 2010, Improving the quality of diabetes care in 
general practice, Australian Journal of Rural Health, 18(5):187–93.
3  Australian Bureau of Statistics (ABS) 2013, Aboriginal and Torres Strait Islander Health 
Survey: First Results, Australia 2012–13, ABS Cat. No. 4727.0.55.001, ABS, Canberra.
4  Bruce, D., et al. 2005, A prospective study of depression and mortality in patients with 
type 2 diabetes: The Fremantle Diabetes Study, Diabetologia, 48(12):2532–9.
5  ABS & Australian Institute of Health and Welfare (AIHW) 2008, The Health and Welfare of 
Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS Cat. No. 4704.0, ABS 
and AIHW, Canberra.
6  Si, D., et al. 2011, Indigenous community care: Documented depression in patients with 
diabetes, Australian Family Physician, 40(5):331–3.
7  Schierhout, G., et al. 2013, Do competing demands of physical illness in type 2 diabetes 
influence depression screening, documentation and management in primary care: A 
cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care 
settings, International Journal of Mental Health Systems, 7(1):16.
Acknowledgments
The active support, enthusiasm and 
commitment of the staff and management of 
the participating health services and research 
organisations, and of the ABCD National 
Research Partnership Project team, have been 
vital to the success of the ABCD Project. This 
support is gratefully acknowledged
This project has been supported by funding from the National 
Health and Medical Research Council (#545267) and the Lowitja 
Institute, and by in-kind and financial support from a range of 
community controlled and government agencies. 
For more information 
ABCD National Research Partnership
e abcd@menzies.edu.au  
t +61 7 3169 4201 
w www.menzies.edu.au/abcd
 
One21seventy
e one21seventy@menzies.edu.au 
t 1800 082 474  
w www.one21seventy.org.au 
Prepared by: Alison Laycock, guided by Lynette O’Donoghue, Damian Rigney 
and Phillipa Cole
With feedback from: R. Bailie, V. Matthews, G. Schierhout, D. Si,  
A. Sheahan, C. Croft, J. Bailie, F. Cunningham, D. Mosca, S. Ferguson-Hill,  
A. De Witt, C. Juanta-Avila, A. Graham, R. Kwedza, S. Street, J. Mein, J. Fagan, 
J. Newham, P. Ryan, K. Copley, J. Campbell, D. Aanundsen, L. Patel, V. Gordon 
and participants at NT CQI Collaborative, November 2014
Date: May 2015
Approximately 7 in 50 Aboriginal and Torres 
Strait Islander adults have type 2 diabetes...
Make it a priority to improve the quality of mental health  
and wellbeing care in your health service
The primary health care team needs training and 
professional support in mental health and wellbeing care
… compared with 2 in 50 non-
Indigenous Australians 
Aboriginal and Torres Strait 
Islander people are at least 3 
times more likely to have type 2 
diabetes than non-Indigenous 
Australians ³
Having diabetes gives 
you 2 times the risk of 
having depression ¹,²
3 x
2 x
This is a summary of important findings from a continuous quality improvement 
(CQI) program for type 2 diabetes care in Aboriginal and Torres Strait Islander 
primary health care (PHC) centres. The program has been in place for more 
than 10 years, with 175 health centres across Australia giving the ABCD National 
Research Partnership permission to analyse data from the program. 
Researchers looked at data from audits of type 2 diabetes care in community 
controlled, government and non-government health services in very remote, 
remote, rural and urban areas. They found important messages about improving 
mental health and wellbeing care for Aboriginal and Torres Strait Islander  
people with type 2 diabetes, messages that are relevant to care for other  
chronic illnesses such as heart disease and kidney disease.
Key messages for action
1
2
Diabetes and depression: Improving  
the quality of care for your community
A summary of research findings for Community 
Health Boards 
Evidence from general practice in Australia and other 
countries shows that approximately 30% of people who 
have diabetes suffer from depression.1,4 Guidelines for 
diabetes care, and general practice worldwide, recommend 
that clients with type 2 diabetes be screened for depression, 
and have follow-up and management that matches their 
mental health needs.
There are gaps in knowledge about the extent of depression 
in Aboriginal and Torres Strait Islander people with type 2 
diabetes. Given the high levels of mental distress compared 
with the general population,5 we would expect that many 
Aboriginal and Torres Strait Islander people who have 
diabetes also experience depression.6 People with other 
chronic illnesses are likely to be at risk as well.
Despite what we know and expect, our research shows 
there are low rates of screening for social and emotional 
wellbeing with clients who have type 2 diabetes – and 
even lower rates for those with severe disease.7 Records 
over five years show the following statistics.
Make it a priority to improve the quality of mental health  
and wellbeing care in your health service1
This raises questions for health centres. Why aren’t more health practitioners documenting 
cases of depression in clinical records more often? Is the diagnosis not made? Is a diagnosis 
made but not recorded?6
What questions about systems for mental health and wellbeing screening and care for 
clients who have chronic illnesses are raised by your service’s CQI data? 
No documented depression Documented depression 
Health centres
Client health records with recorded symptoms of depression
About 1/4 of the 
health centres had no 
documented depression 
in the medical records 
of clients with type 2 
diabetes6
1/3 of the client records had no recorded  
diagnosis of depression
Some clients had been prescribed a medication  
to treat depression6
In the other health centres 
documented depression varied 
from 3% to 37%6
1/3
3%
37%
Health centres
The primary health care team needs training and professional 
support in mental health and wellbeing care2
How are staff in your health centre or service supported to provide mental health  
and wellbeing care?
Most health centres could improve social and emotional wellbeing 
screening for clients with chronic illnesses such as type 2 diabetes
Depression diagnosis and care could be improved in many health 
centres
Most health centres need to improve systems for recording information 
about mental health and wellbeing services provided to clients 
(including clients with diabetes)
Training and specialist support can help staff to build mental health 
and wellbeing care into their routine work 6,7
Many health centre teams need training in mental health and wellbeing 
assessment, treatment and referral
What the research shows 
In primary health care services there is a high burden of 
chronic disease and mental ill health, and high demand for 
‘sickness care’. Many health centre teams find it difficult to 
provide communities with good quality mental health and 
wellbeing care.7 
This is largely because PHC workers need training in mental 
health work – screening, assessment, treatment and 
referral – to help them integrate it into PHC.  
They also need support and supervision from specialist 
mental health professionals.6,7
In addition, the collection and use of information about 
service delivery and clinical indicators for mental health 
could be improved.6,7 This would provide more data for 
improving the quality of mental health and wellbeing care.
References
1  Anderson, R. J., et al. 2001, The prevalence of comorbid depression in adults with 
diabetes a meta-analysis, Diabetes Care, 24(6): 1069–78.
2  Reddy, P., Ford, D. & Dunbar, J. A. 2010, Improving the quality of diabetes care in 
general practice, Australian Journal of Rural Health, 18(5):187–93.
3  Australian Bureau of Statistics (ABS) 2013, Aboriginal and Torres Strait Islander Health 
Survey: First Results, Australia 2012–13, ABS Cat. No. 4727.0.55.001, ABS, Canberra.
4  Bruce, D., et al. 2005, A prospective study of depression and mortality in patients with 
type 2 diabetes: The Fremantle Diabetes Study, Diabetologia, 48(12):2532–9.
5  ABS & Australian Institute of Health and Welfare (AIHW) 2008, The Health and Welfare of 
Australia's Aboriginal and Torres Strait Islander Peoples 2008, ABS Cat. No. 4704.0, ABS 
and AIHW, Canberra.
6  Si, D., et al. 2011, Indigenous community care: Documented depression in patients with 
diabetes, Australian Family Physician, 40(5):331–3.
7  Schierhout, G., et al. 2013, Do competing demands of physical illness in type 2 diabetes 
influence depression screening, documentation and management in primary care:  
A cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health 
care settings, International Journal of Mental Health Systems, 7(1):16.
Acknowledgments
The active support, enthusiasm and 
commitment of the staff and management of 
the participating health services and research 
organisations, and of the ABCD National 
Research Partnership Project team, have been 
vital to the success of the ABCD Project. This 
support is gratefully acknowledged
This project has been supported by funding from the National 
Health and Medical Research Council (#545267) and the Lowitja 
Institute, and by in-kind and financial support from a range of 
community controlled and government agencies. 
For more information 
ABCD National Research Partnership
e abcd@menzies.edu.au  
t +61 7 3169 4201 
w www.menzies.edu.au/abcd
 
One21seventy
e one21seventy@menzies.edu.au 
t 1800 082 474  
w www.one21seventy.org.au 
Prepared by: Alison Laycock, guided by Lynette O’Donoghue, Damian Rigney 
and Phillipa Cole
With feedback from: R. Bailie, V. Matthews, G. Schierhout, D. Si,  
A. Sheahan, C. Croft, J. Bailie, F. Cunningham, D. Mosca, S. Ferguson-Hill,  
A. De Witt, C. Juanta-Avila, A. Graham, R. Kwedza, S. Street, J. Mein, J. Fagan, 
J. Newham, P. Ryan, K. Copley, J. Campbell, D. Aanundsen, L. Patel, V. Gordon 
and participants at NT CQI Collaborative, November 2014
Date: May 2015


A prospective study of depression and mortality in patients with type 2 diabetes: The Fremantle Diabetes Study,

Australian Bureau of Statistics (ABS) 2013, Aboriginal and Torres Strait Islander Health Survey: First Results, Australia 2012–13,

Australian Institute of Health and Welfare (AIHW)

Do competing demands of physical illness in type 2 diabetes influence depression screening, documentation and management in primary care: A cross-sectional analytic study in Aboriginal and Torres Strait Islander primary health care settings,

Improving the quality of diabetes care in general practice,

Indigenous community care: Documented depression in patients with diabetes,

The prevalence of comorbid depression in adults with diabetes a meta-analysis, Diabetes Care,

Diabetes and depression: improving the quality of care for your community

http://apo.org.au/sites/all/modules/pubdlcnt/pubdlcnt.php?nid=55566&file=http://apo.org.au/files/Resource/diabetes-and-depression.pdf

Diabetes and depression: improving the quality of care for your community

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Analysis and Policy Observatory (APO)