Behavioral and Clinical Factors Associated With Depression Among Individuals With Diabetes

Abstract

OBJECTIVE -The goal of this study was to determine the behavioral and clinical characteristics of diabetes that are associated with depression after controlling for potentially confounding variables. RESEARCH DESIGN AND METHODS-A population-based mail survey was sent to patients with diabetes from nine primary care clinics of a health maintenance organization. The Patient Health Questionnaire was used to diagnose depression, and automated diagnostic, pharmacy, and laboratory data were used to measure diabetes treatment intensity, HbA 1c levels, and diabetes complications.RESULTS -Independent factors that were associated with a significantly higher likelihood of meeting criteria for major depression included younger age, female sex, less education, being unmarried, BMI Ն30 kg/m 2 , smoking, higher nondiabetic medical comorbidity, higher numbers of diabetes complications in men, treatment with insulin, and higher HbA 1c levels in patients Ͻ65 years of age. Independent factors associated with a significantly higher likelihood of meeting criteria for minor depression included younger age, less education, non-Caucasian status, BMI Ն30 kg/m 2 , smoking, longer duration of diabetes, and a higher number of complications in older (Ն65 years) patients.CONCLUSIONS -Smoking and obesity were associated with a higher likelihood of meeting criteria for major and minor depression. Diabetes complications and elevated HbA 1c were associated with major depression among demographic subgroups: complications among men and HbA 1c among individuals Ͻ65 years of age. Older patients with a higher number of complications had an increased likelihood of minor depression. Diabetes Care 27:914 -920, 2004A recent meta-analysis of 39 studies in patients with diabetes reported an estimate of major depression in 11% of patients based on structured psychiatric interviews and elevated depression symptoms in 31% based on depression-rating scales (1). Prior research on sociodemographic predictors of depression in patients with diabetes has shown high risk for female sex (2-4), younger age (2-4), less education (2-6), and less income (1,3,4,7). Depression has also been found in two recent metaanalyses to have significant associations with increased HbA 1c levels (8) and diabetes complications (9). Most of the studies included in these meta-analyses had small, nonrepresentative samples and did not fully characterize the depressed versus the nondepressed patients in terms of the number of complications, type of diabetes, insulin dependence, behavioral risk factors (i.e., smoking, obesity), medical comorbidity, socioeconomic variables, race, or ethnicity (1,8,9). The lack of reporting of sociodemographic and clinical variables in most studies is a significant limitation, as analyses of the association between depression and diabetes severity and HbA 1c have often not controlled for potentially important confounding variables (1,8,9).The small sample sizes also precluded the study of potentially important interactions such as the effect of age and sex on ...

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