Evaluation of a Stepped Care Approach to Manage Depression in Diabetes

"Diabetes-Specific CBT (5 group sessions) focusing on diabetes-related problems and distress ('DIAMOS - Strengthening Diabetes Motivation').~Includes:~* Diabetes problem analysis/ definition~* Diabetes problem solving intervention~* Cognitive restructuring of diabetes problems~* Activation of personal and social resources~* Goal definition and agreement"

"Depression-Specific CBT (6 single sessions) focusing on depressive cognitions and affective problems (manualised).~Includes:~* Functional explanatory model of depression~* Cognitive restructuring of negative thoughts~* Practice of alternative beneficial thoughts~* Specific cognitive interventions regarding self-criticism, guilt, low self-esteem, fear, and inactivity."

Non-responders to previous treatment steps will be referred to an psychotherapist and/or psychiatrist for intensified treatment. Treatments procedures will be monitored and interventions will be scored to enable the evaluation of treatment effects.

"Standard diabetes education and professional care.~Includes:~* Health care and specific topics (e. g. blood pressure)~* Diabetes complications~* Healthy and unhealthy foods, cooking recommendations and recipes~* Foot care: exercises, care and control, injuries, and diabetic neuropathy~* Sports, activities and exercise~* Social aspects of living with diabetes"