Pharmacist input to depression screening and management in patients with diabetes: a systematic review

Abstract

Introduction: Depression affects approximately 5% of the global adult population, and its clinical and economic burden is particularly pronounced among individuals with chronic conditions such as diabetes mellitus, where it is frequently underdiagnosed and inadequately managed. Pharmacists play an important role in managing chronic diseases, including depression, through screening and medication management. Aim: This systematic review aimed to critically appraise and synthesize evidence on pharmacist input in screening and managing depression among patients with diabetes, either as sole providers or as part of a multidisciplinary team, and assess their impact on clinical outcomes and quality of life. Method: A systematic literature search was conducted in March 2023 and updated in March 2025 across Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and International Pharmaceutical Abstracts (IPA) databases, and reported in accordance with the PRISMA 2020 guidelines. Studies, irrespective of their design and published in English, reporting any pharmacist input in screening and managing depression among patients with diabetes, were included. No date restrictions were applied. Data extraction was based on Donabedian’s quality-of-care model, which categorizes findings into structure, process, and outcome. The results were presented in both narrative and tabular formats. Quality was assessed by two independent researchers via the Mixed Methods Appraisal Tool. Results: Among the 1,852 records screened, 10 studies met the inclusion criteria. The studies described pharmacist input in depression screening n = 4, medication therapy management n = 6, telehealth services n = 2, and shared medical appointments n = 1. The most reported setting was outpatient clinics, n = 5. All studies demonstrated the positive impact of pharmacists on depression screening, treatment initiation, and medication adherence., Some interventions failed to significantly improve clinical parameters such as HbA1c levels or depressive symptoms. Barriers included limited physicians’ response to screening results and a lack of structured care models. Conclusion: The positive impact of pharmacist interventions on this patient cohort is evident despite the variability across settings and intervention designs, reflecting the adaptability of pharmacist services. Results also suggest the need for standardized models of care and consistent outcome reporting.