The combined approach of using the WHO-5 questionnaire (for depression) in combination with either the PAID-5 or PAID-1 questionnaire (for diabetes distress) is a simple tool for detecting depression, monitoring patient well-being overtime, and guiding the extent to which the subsequent management of depressive symptoms should focus on specific aspects related to diabetes management (Table 3). It is important to
emphasize that patients meeting the criteria for suspected clinical or subclinical depression need clinical verification of the diagnosis and severity (including assessment of suicidal ideation, psychosis and bipolar manifestation) through appropriate history taking and symptom enquiry. The differential diagnoses of general anxiety disorder, panic disorder and/or an underlying eating disorder should also be considered.
Following verification of depression, other etiologies for depression such as dementia, alcoholism and hypothyroidism should be excluded.