الفهرس 
Introduction and RationalOnly 14 pages are availabe for public view
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Abstract
Most people with diabetes who have depression are treated in primary care settings. However, studies suggest that consistent recognition and treatment of depression is less than optimal in primary care settings. One barrier to early recognition and treatment of depression among individuals with diabetes is the difficulty in separating the symptoms of depression from the symptoms of poor management of diabetes. For example, fatigue, gain or loss of weight, change in appetite, and sleep disturbances are common symptoms of both depression and poor diabetes management. The difficulties of distinguishing diabetes-related symptoms from depression were highlighted in a recent study which showed that the depression-diabetes symptom association is stronger than the association of diabetes symptoms with measures of glycemic control and diabetes complications (Parker G et al., 2010).
Unfortunately, the challenges of treating individuals with diabetes and depression are influenced by both patient-related and healthcare system-related factors. Patient-related factors include stigma and negative perceptions of any aspect of mental illness such as depression. Consequently, patients may not acknowledge their depression or their lack of adherence to treatment recommendations as these may reflect personal failure (Young-Hyman D & Peyrot M, 2008).
In addition, financial constraints, side effects of antidepressants, and implication of a mental health diagnosis on employment and insurability are