Journal of Affective Disorders 142S1 (2012) S80–S88 Depression and diabetes: The role and impact of models of health care systems Richard G. Roberts a , Linda Gask b, *, Brian Arndt a , Peter Bower c , James Dunbar d , Christina M. van der Feltz-Cornelis e,f,g , Jane Gunn h , Maria Inez Padula Anderson i a University of Wisconsin School of Medicine & Public Health, Madison, WI 53715, USA b Health Sciences Research Group and Greater Manchester CLAHRC, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK c Health Sciences Research Group, NIHR School for Primary Care Research, University of Manchester, M13 9PL, UK d Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, 3280 Victoria, Australia e Tilburg University, Department of Clinical Psychology, 5000 LE Tilburg, The Netherlands f GGZ Breburg, Academic Psychiatry Department, Tilburg, The Netherlands g Trimbos Instituut, Utrecht, The Netherlands h Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia i Rio de Janeiro State University/Faculty of Medical Sciences, Department of Family and Community Medicine, Vila Isabel, Rio de Janeiro, Brazil ARTICLE INFO ABSTRACT Keywords: Depression Diabetes Health systems Primary care Objectives: Depression and diabetes often occur together and their comorbidity has a significant and detri- mental impact on health outcomes. The aims of this paper are to review the existing international literature on approaches to health care for comorbid depression and diabetes and draw out the key conclusions for both research and future development in health care delivery. Methods: Narrative review of the literature with synthesis by an international team of authors. Results: The synthesized findings are discussed under four main headings: specialty and generalist care; models for co-ordinating and integrating care; community approaches to service delivery; and the role of health policy. Limitations: The review only included literature published in English. Conclusions: Translating basic and clinical research findings into improved treatment and outcomes of those with depression and diabetes remains a substantial challenge. There is little research on the difficulties of identifying and implementing best practice into routine health care. Systems need to be designed so that evidence-based interventions are provided in a timely way, with appropriate professional expertise where required. © 2012 Elsevier B.V. All rights reserved. 1. Background Depression and diabetes often occur together (Anderson et al., 2001; Golden et al., 2004) and comorbidity has a significantly detrimental impact on health outcomes (Moussavi et al., 2007). With services commonly organized around the care of individual conditions, comorbidity poses a significant challenge, and the way in which health care is organized and delivered seems likely to be central to the achievement of improved outcomes. Although evidence based interventions for treatment of this specific comorbidity are available (van der Feltz-Cornelis et al., 2010), consideration of how to deliver care optimally for comorbid diabetes and depression can also illuminate some of the key questions faced generally in managing comorbid long-term medical and mental conditions. Trigwell and his colleagues (1997) have described a “pyramid” of * Address for correspondence: Linda Gask, Professor of Primary Care Psychiatry, Health Sciences Research Group and Greater Manchester CLAHRC, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, M13 9PL, UK. 0165-0327/$ – see front matter © 2012 Elsevier B.V. All rights reserved. three levels of psychological problems in diabetes that may require intervention at different points in a health care system according to type and severity (see Fig. 1). However, a critical evaluation is needed on how health care delivery might be optimally configured to achieve this. 1.1. Characterizing models of health care delivery A good health system delivers quality services to all people, when and where they need them. A well functioning health system responds in a balanced way to a population’s needs and expectations by: “improving the health status of individuals, families and commu- nities defending the population against what threatens its health protecting people against the financial consequences of ill-health providing equitable access to people-centred care”. (World Health Organization) Healthcare has been characterized, organized, and delivered in myriad ways across the globe. Various conceptual frameworks