Rates and risks for co-morbid depression in patients with Type 2 diabetes mellitus: results from a community-based study

Abstract

Aims/hypothesis. There is accumulating evidence that depression is common in people with Type 2 diabetes. However, most prevalence-studies are uncontrolled and could also be inaccurate from selection-bias, as they are conducted in specialized treatment settings. We studied the prevalence and risk factors of comorbid depression in a community-based sample of older adults, comparing Type 2 diabetic patients with healthy control subjects. Methods. A large (n=3107) community-based study in Dutch adults (55-85 years of age) was conducted. Pervasive depression was defined as a CES-D score greater than 15. Diagnosis of Type 2 diabetes was obtained from self-reports and data from general practitioners. Results. A number of 216 patients (7%) were identified as having Type 2 diabetes. The prevalence of pervasive depression was increased in people with Type 2 diabetes and co-morbid chronic disease (20%) but not in patients with Type 2 diabetes only (8%), compared with the healthy control subjects (9%). Regression analyses in diabetic patients yielded that being single, being female, having functional limitations, receiving instrumental support and having an external locus of control were associated with higher levels of depression. Conclusions/interpretation. The Results suggest that the prevalence of pervasive depression is increased in patients with Type 2 diabetes and co-morbid disease(s), but not in patients with Type 2 diabetes only. Functional limitations that often accompany co-morbid chronic disease could play an essential role in the development of depression in Type 2 diabetes. These findings can enable clinicians and researchers to identify high-risk groups and set up prevention and treatment programs. [Diabetologia (2003) ArticlesRates and risks for co-morbid depression in patients with Type 2 diabetes mellitus: results from a community-based study diabetes was 20.5%, versus 11.4% in non-diabetic subjects [1]. It was also concluded that depression does not only have a negative effect on the quality of life of people with diabetes [2] but also on their glycaemic control [3,4,5], and it is associated with increased health-care use and health-care costs [6]. However, many studies aiming to determine the prevalence of depression in Type 2 diabetes are not accurate because of selection bias as they have been conducted in specialised hospitals that treat patients with problematic diabetes. Moreover, potential confounders such as sex, socio-economic status, obesity, concomitant medical illness or complications of diabetes are often not addressed. The authors therefore concluded that additional analyses are required to determine In a recent meta-analysis, the presence of Type 2 diabetes doubled the odds of co-morbid depression. In that study, data of 18 controlled studies were used, and the mean unadjusted prevalence of depression in

How to screen for depression and emotional problems in patients with diabetes: comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment

“…The negative consequences of depression in diabetes are not restricted to patients who suffer from clinical depression; such consequences are also manifested by diabetic patients who have elevated depressive symptoms [3,5,10]. Furthermore, some prospective studies have demonstrated that non-diabetic people with elevated depressive symptoms have a six-fold higher risk of developing clinical depression in the future [44][45][46][47].…”

“…Compared with nondepressed diabetic patients, depressed diabetic patients have poorer glycaemic control [1,2], a higher risk of multimorbidity and mortality [3,4], increased functional impairment [5], and poorer adherence to diet, exercise, and diabetes self-management [6,7]. In addition, coexisting depression has a negative impact on the quality of life of patients with diabetes [8,9] and is associated with a significant increase in total expenditure on health care [10].…”

“…Besides general demographic and psychosocial characteristics, certain diabetes-related stressors are associated with elevated depression rates in diabetes; these stressors include the presence of complications, poor glycaemic control, and treatment with insulin [5,12,14,15].…”

Epidemiology of depression in diabetes: International and cross-cultural issues

“…However, this does not exclude the possibility that biological factors account for the difference in the prevalence of depression between diagnosed and undiagnosed diabetes. For example, diabetes complications have been linked to the development of depression (Teodorczuk et al, 2010;Pouwer et al, 2003). Unfortunately differences in diabetes-related complications between people with undiagnosed diabetes and this with diagnosed diabetes were not taken into consideration in the above mentioned studies.…”

Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study

“…In keeping with the activity restriction model of depression [18], it is postulated that illness-related functional disability and restrictions in activities of daily living (ADL) are responsible for depressive affect. In the context of diabetes, for example, the results of a large community-based study indicate that functional limitations play an important role in the development of depression in people with type 2 diabetes [19]. This finding is of particular relevance to DPN in view of its association with severe physical disability, and in some patient populations it fully accounts for diabetes-related functional limitations [2].…”