Prevalence of depression and associated risk factors among persons with type-2 diabetes mellitus without a prior psychiatric history: a cross-sectional study in clinical settings in urban Nepal

Abstract

BackgroundDiabetes is a growing health problem in South Asia. Despite an increasing number of studies exploring causal pathways between diabetes and depression in high-income countries (HIC), the pathway between the two disorders has received limited attention in low and middle-income countries (LMIC). The aim of this study is to investigate the potential pathway of diabetes contributing to depression, to assess the prevalence of depression, and to evaluate the association of depression severity with diabetes severity. This study uses a clinical sample of persons living with diabetes sequelae without a prior psychiatric history in urban Nepal.MethodsA cross-sectional study was conducted among 385 persons living with type-2 diabetes attending tertiary centers in Kathmandu, Nepal. Patients with at least three months of diagnosed diabetes and no prior depression diagnosis or family history of depression were recruited randomly using serial selection from outpatient medicine and endocrine departments. Blood pressure, anthropometrics (height, weight, waist and hip circumference) and glycated hemoglobin (HbA1c) were measured at the time of interview. Depression was measured using the validated Nepali version of the Beck Depression Inventory (BDI-Ia).ResultsThe proportion of respondents with depression was 40.3%. Using multivariable analyses, a 1-unit (%) increase in HbA1c was associated with a 2-point increase in BDI score. Erectile dysfunction was associated with a 5-point increase in BDI-Ia. A 10mmHg increase in blood pressure (both systolic and diastolic) was associated with a 1.4-point increase in BDI-Ia. Other associated variables included waist-hip-ratio (9-point BDI-Ia increase), at least one diabetic complication (1-point BDI-Ia increase), treatment non-adherence (1-point BDI-Ia increase), insulin use (2-point BDI-Ia increase), living in a nuclear family (2-point BDI-Ia increase), and lack of family history of diabetes (1-point BDI-Ia increase). Higher monthly income was associated with increased depression severity (3-point BDI-Ia increase per 100,000 rupees, equivalent US$1000).ConclusionsDepression is associated with indicators of more severe diabetes disease status in Nepal. The association of depression with diabetes severity and sequelae provide initial support for a causal pathway from diabetes to depression. Integration of mental health services in primary care will be important to combat development of depression among persons living with diabetes.

Correlates and depression among married women outpatients with Type II diabetes: an exploratory study

“…However, in some studies, women and married people are reported to be at a higher risk of depression. 18,21 In this study, those over 50 years of age, having low education level, unemployed, having three or more children and married to a husband with lower education level were determined to be at a greater risk of depression. The participants with three or more children were found to be at risk of depression 1.848 times more than were those with two or fewer children.…”

“…In Niraula et al's (2013) study, the prevalence of depression among people with diabetes was found as 40.3%. 18 In a systematic review designed to estimate the prevalence of clinically depressed patients with Type II diabetes, Ali et al (2006) found that the prevalence of depression was significantly higher among patients with type 2 diabetes (17.6%) than those without diabetes (9.8%). They also found that the prevalence among females with diabetes (23.8%) was higher than their male counterparts with diabetes (12.8%).…”

Prevalence and Factors Influencing Depression among Adolescents with Type-1 Diabetes – A Cross-Sectional Study

“…Several studies conducted across the world unanimously agree that, the depression is a major mental health problem in adolescents with type 1 diabetes. Dusan et al reports the prevalence to be 38.5%, 4 Niruala et al reports 40.3%, 11 Hood et al reports 15.2%, 6 Sendela J et al reports 17%, 12 and Silversetin J reports that depression is two times more common in subjects with type 1 diabetes compared to type-2 diabetes. 5 This wide variation in the prevalence across the studies may be due to variety of scales available and differences in the modes of administration.…”

Mental Disorders in Subjects with Diabetes: A Systematic Review

“…Results were for anxiety (56.7%) and depression (53.1%) in women group who was 18-34 years [14]. Niraula et al [15] showed in 385 patients with diabetes and clinical depression was 40.3% of the total sample. Among those depressed patients, 48.2% were female and 31.7% were male.…”

“…11% of participants resulted positive for depression. Results showed that 21% of participants had scores for an anxiety disorder and, finally, 20.7% reported eating disorder [15]. De Ornelas et al in 2013 [16], reported 210 patients who were evaluated and divided in two groups, patients with Type 1/2 diabetes.…”