The course of depressive symptoms in primary care patients with type 2 diabetes: results from the Diabetes, Depression, Type D Personality Zuidoost-Brabant (DiaDDZoB) Study

Abstract

Aims/hypothesisThe aim of the study was to examine the course (incidence, recurrence/persistence) of depressive symptoms in primary care patients with type 2 diabetes and to identify significant predictors of these different course patterns.MethodsA cohort of 2,460 primary care patients with type 2 diabetes was assessed for demographic, clinical and psychological factors in 2005 and followed-up in 2007 and 2008. Depression was defined as a score of ≥12 on the Edinburgh Depression Scale. Multivariate logistic regression analyses were used to determine whether several depression-course patterns could be predicted by means of demographics, medical co-morbidities and psychological factors.ResultsA total of 630 patients (26%) met the criterion for depression at one or more assessments. In the subgroup with no baseline depression, incident depression at follow-up was present in 14% (n = 310), while recurrence/persistence in those with baseline depression was found in 66% (n = 212).The presence of any depression was associated with being female, low education, non-cardiovascular chronic diseases, stressful life events and a self-reported history of depression. Incident depression was predicted by female sex, low education and depression history, while patients with a history of depression had a 2.5-fold increased odds of recurrent/persistent depression.Conclusions/interpretationDepression is common in primary care patients with type 2 diabetes, with one in seven patients reporting incident depression during a 2.5 year period. Once present, depression often becomes a chronic/recurrent condition in this group. In order to identify patients who are vulnerable to depression, clinicians can use questionnaire data and/or information about the history of depression.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-011-2411-2) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Depression: a common and burdensome complication of diabetes that warrants the continued attention of clinicians, researchers and healthcare policy makers

“…This finding is in line with results from another longitudinal study with a 3 year follow-up, examining the course (incidence, recurrence/persistence) of depressive symptoms in 2460 primary care patients with type 2 diabetes with the additional aim of identifying significant predictors of these different course patterns [13]. In this study, depression was assessed by means of a self-reported measure.…”

“…Of all participants with type 2 diabetes, 26% met the criterion for depression at one or more assessments. Incident depression at follow-up was present in 14% of individuals, whilst recurrence/persistence in those with baseline depression was found in 66% [13]. History of depression was a key clinical predictor of future depression and, once present, depression often became a recurrent condition [13].…”

“…For example, in a Dutch study among outpatients with diabetes, the frequency of recording emotional problems in patient medical charts was investigated [20]; emotional problems were recorded in only 20-25% of individuals who had moderate to severe levels of anxiety or depression [20]. Clinicians have the option use questionnaire data and/or information about the patient's history of depression to identify patients who are vulnerable to depression or experience higher levels of diabetes-related distress [13]. When diabetes healthcare teams decide to use screening tools such as the Patient Health Questionnaire-9 (PHQ-9) for depression, or the Problem Area in Diabetes Questionnaire to assess diabetes-related distress, it is important that the assessment is embedded in a stepped care approach or a collaborative care approach for depression [21].…”

Comorbilidad en personas con depresión que consultan en centros de la atención primaria de salud en Santiago, Chile

“…El 55,47% de la muestra total padecía alguna comorbilidad psiquiátrica (IC 95% BCa 50,00-61,72) y la comorbilidad médica crónica fue autoreportada en 42 …”

“…La relación bidireccional entre la depresión y la hipertensión arterial o la diabetes mellitus se encuentra bien documentada 38 , complicando el pronóstico 39,40 , implicando un mayor uso de servicios 41 , y un aumento en el riesgo de recurrencia del trastorno afectivo 42 . En Chile, los síntomas depresivos en pacientes hipertensos de APS son comunes 43 , y han sido asociados a control insatisfactorio de la presión arterial 44 .…”