Association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan

Distress and depression among patients with diabetes mellitus: prevalence and associated factors: a cross-sectional study

PURPOSE

This study aimed to validate the internal consistency of the Persian version of the diabetes distress scale-17 (DDS-17) and to investigate the prevalence of diabetes distress (DD), depression, and possible relevant factors.

METHODS

This was a cross-sectional study on 820 diabetes patients (62.4 % females) in Tehran, Iran between January and June 2017. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the protocol. Patients filled out a demographic and health survey, DDS-17, the Beck Depression Inventory Second Edition (BDI-II) and the Summary of Diabetes Self-Care Activities Measure (SDSCA). DDS-17 consist of emotional burden, and physician, regimen, and interpersonal related distress. The correlation between DDS subscales and association between DDS and BDI-II or SDSCA scores were assessed using SPSS.

RESULTS

The mean age was 58.91 ± 12.35 years. Majority of patients had high DD (37.2 %) and severe depression (38.7 %). The general and specific diets got the highest score in six SDSCA subscales. The Persian version of DDS-17 had excellent internal consistency with Cronbach's alpha coefficient of 0.924. The DDS score had significant relationship with socioeconomic level (p < .001), type of DM (p < .001), type of treatment (p < .001), glycemic control status (p < .001), complication (p < .001) and depression level (p < .001). The level of hemoglobin A1c was the most useful predictor of DDS score (p < .001).

CONCLUSIONS

High prevalence of depression and distress in patient with diabetes calls for greater emphasizes on the importance of enhanced physicians and patients' knowledge in these areas.

Depression and Diabetes Distress in South Asian Adults Living in Low- and Middle-Income Countries: A Scoping Review

OBJECTIVES

In this study, we conducted a scoping review to identify the prevalence of both depression and diabetes distress in patients with type 2 diabetes in low- and middle-income countries in South Asia.

METHODS

This scoping review was grounded in the methodology of Arksey and O'Malley by searching for relevant studies using Ovid MEDLINE, PsycINFO and Cumulative Index of Nursing and Allied Health Literature databases, as well as grey literature sources and hand searches. Two reviewers independently screened and extracted data from articles that met the inclusion criteria.

RESULTS

A total of 46 studies were included, with only 1 addressing both depression and diabetes distress. We present 42 total articles on depression and 5 on diabetes distress. The prevalence of type 2 diabetes and elevated depressive symptoms ranged from 11.6% to 67.5%, whereas the prevalence of diabetes distress ranged from 18.0% to 76.2%.

CONCLUSIONS

The prevalence of elevated depressive symptoms was found to be much higher than that reported in data from high-income countries and in data on South Asians living in high-income countries. Diabetes distress was found to be lower compared with other studies; however, the scarcity of data makes this observation inconclusive. Variations in depression inventories, lack of culturally tailored inventories and the focus on urban clinic-based populations are identified as limitations and areas requiring further research. Our review provides evidence for the need of increased mental health screening and treatment in diabetes care in South Asian countries.

Prevalence and Associated Factors of Anxiety and Depression Among Patients with Type 2 Diabetes in Kerman, Southern Iran

PURPOSE

Depression and anxiety are common disorders in patients suffering from type 2 diabetes. These disorders can lead to premature morbidity, exacerbate disease complications, make patients suffer more, and increase health-care costs. As diabetes has increased worldwide recently, it is necessary to reduce the prevalence of factors that are associated with depression and anxiety in diabetes patients. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors, including metabolic components among people with type 2 diabetes.

PATIENTS AND METHODS

We performed a cross-sectional study in 1500 patients with type 2 diabetes in Kerman, in the southern part of Iran. The prevalence of depression and anxiety was estimated using the Beck Depression Inventory and the Hamilton Anxiety questionnaires, respectively. After calculating the proportions of depression and anxiety, univariate logistic regression was performed. Factors whose P-values were smaller than 0.2 in univariate logistic regression were included in multiple logistic regression for confounder adjustments. The analysis was performed using SPSS version 20.

RESULTS

The rates of depression and anxiety were 59% (95% CI: 54.48-63.12) and 62% (95% CI: 59.51-66.27), respectively. Factors found to be independently associated with anxiety were high FBS, high LDL-C, high TG, hypertension, complications, low physical activity. Factors found to be independently associated with depression were female gender, older age, high BMI, high FBS, high LDL-C, low HDL-C, high TG, high HbA1c, hypertension, and low physical activity. Complications were independently associated with anxiety but not with depression. Female gender, older age, high BMI, low HDL-C, and high HbA1c were independently associated with depression but not with anxiety.

CONCLUSION

Current findings demonstrated that a large proportion of patients with type 2 diabetes suffer from depression and anxiety. This study also identified factors associated with these disorders. Controlling some metabolic variables will decrease the prevalence of these disorders and improves clinical remedy and quality of life in patients with type 2 diabetes.

Depression among people living with type 2 diabetes in an urbanizing community of Nepal

BACKGROUND

Diabetes mellitus is a major public health problem which accounts for serious medical and economic consequences. Depression is an important associated condition that upsets the management and complications of diabetes. This study aimed to measure the prevalence of depression among people living with Type 2 Diabetes and to examine the factors linked with it.

METHODS

This community based, cross-sectional study was conducted among 278 people living with type 2 diabetes in Duhabi-Bhaluwa municipality, Nepal. A face to face interview was conducted using a pre-tested semi-structured questionnaire to gain information on socio-demographic characteristics and clinical profile of the participants. Depression was assessed using the Beck Depression Inventory (BDI-II) scale. Variables were categorical and were thus, compared with Pearson's chi-square tests and binary logistic regression models.

RESULTS

The prevalence of depression in this study was 22.7%. Most people indicative of having depression were of older age, females, below secondary level education, with a smaller family size, with low family income, using insulin, without a family history of diabetes and/or having an additional illness. However, multivariate analysis showed that the only significant factors for depression were older age, education below secondary level, homemaker, smaller family size, using insulin and having an additional illness.

CONCLUSION

The prevalence of depression in this study is consistent with that reported by other communities. Factors like older age, lower education level, being a homemaker, living in a small size family, insulin use and additional illness could increase the likelihood of developing Major Depressive disorder among people with type 2 diabetes, hence, psychosocial assessment is necessary along with diabetes management plan in a primary health care setting.

Predictive Factors of Anxiety and Depression in Patients with Acute Coronary Syndrome

OBJECTIVE

To identify the predictive factors of anxiety and depression in patients with acute coronary syndrome.

METHODS

Cross-sectional and retrospective study conducted with 120 patients hospitalized with acute coronary syndrome. Factors interfering with anxiety and depression were assessed.

RESULTS

Anxiety was related to sex, stress, years of education, and depression, while depression was related to sex, diabetes mellitus, obesity, years of education, and trait-anxiety.

CONCLUSIONS

Obesity and anxiety were considered predictive factors for depression, while depression and fewer years of education were considered predictive factors for anxiety.

Study of fatigue, depression, and associated factors in type 2 diabetes mellitus in industrial workers

INTRODUCTION

Type 2 diabetes mellitus is a significant health problem and imposes great physical, financial and psychological burden among the affected population. Among people with diabetes, fatigue is a pervasive and distressing complaint, which is further accentuated by presence of depression.

OBJECTIVE

To assess the prevalence of fatigue and depression and associated clinical and socio demographic correlates in type 2diabetes.

MATERIALS AND METHODS

This cross sectional study included 100 patients of diabetes type 2 and equal number of healthy controls between the ages of 18 to 70 years. A detailed evaluation of socio demographic and clinical parameters was made. Participants were also assessed for presence of depression and fatigue using PHQ-9 and Fatigue Severity Scale(FSS)respectively.

RESULTS

Fatigue and depression was found in 68 % and 53 % of diabetic participants. Diabetic patients were 10.37 times and 4.80 times more likely to suffer from fatigue and depression respectively. Both fatigue and depression were found to be significantly associated with duration of illness, fasting and post prandial blood glucose level, diabetic complications and Body Mass Index (BMI). Fatigue was also strongly correlated with depression in study sample.

CONCLUSIONS

Fatigue and depression are reasonably correlated with type 2 diabetes. Various clinical parameters of diabetes are strongly associated with both fatigue and depression. Fatigue itself has significant correlation with depression in type 2 diabetes. Regular monitoring of biochemical parameters are paramount to predict the development of fatigue and depression in type 2 diabetes.

Prevalence of Depression among Type 2 Diabetic Outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia

Background. The emotional consequences of diabetes have been scrutinized by a number of investigative teams and there are varying reports about the association of depression with type 2 diabetes mellitus. However, there is limited data about this in Ethiopia. Therefore, the purpose of this study was to assess the prevalence of comorbid depression among type 2 diabetic outpatients. Methods and Materials. Institution based cross-sectional study design was conducted on a random sample of 276 type 2 diabetic outpatients from Black Lion General Specialized Hospital. Systematic random sampling technique was used to get these individual patients from 920 type 2 diabetic outpatients who have an appointment during the data collection period. Patients' depression status was measured using Patient Health Questionnaire 9 (PHQ 9). Result. Totally 264 type 2 diabetic outpatients were interviewed with a response rate of 95.6%. The prevalence of depression among type 2 diabetic outpatients was 13%. Based on PHQ 9 score, 28.4% (75) fulfilled the criteria for mild depression, 12.1% (32) for moderate depression, 2.7% (7) for moderately severe depression, and 1.5% (4) for severe depression. But 45.8% (121) of patients had no clinically significant depression. Conclusion. This study demonstrated that depression is a common comorbid health problem in type 2 diabetic outpatients with a prevalence rate of 13%.

Depression and type 2 diabetes in low- and middle-income countries: a systematic review

Eighty percent of people with type 2 diabetes reside in low- and middle-income countries (LMICs). Yet much of the research around depression among people with diabetes has been conducted in high-income countries (HICs). In this systematic review we searched Ovid Medline, PubMed, and PsychINFO for studies that assessed depression among people with type 2 diabetes in LMICs. Our focus on quantitative studies provided a prevalence of comorbid depression among those with diabetes. We reviewed 48 studies from 1,091 references. We found that this research has been conducted primarily in middle-income countries, including India (n = 8), Mexico (n = 8), Brazil (n = 5), and China (n = 5). There was variation in prevalence of comorbid depression across studies, but these differences did not reveal regional differences and seemed to result from study sample (e.g., urban vs rural and clinical vs population-based samples). Fifteen depression inventories were administered across the studies. We concluded that despite substantial diabetes burden in LMICs, few studies have reviewed comorbid depression and diabetes. Our review suggests depression among people with diabetes in LMICs may be higher than in HICs. Evidence from these 48 studies underscores the need for comprehensive mental health care that can be integrated into diabetes care within LMIC health systems.

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

BACKGROUND

Diabetes 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.

METHODS

A 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).

RESULTS

The 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 10 mmHg 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).

CONCLUSIONS

Depression 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.

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

INTRODUCTION

This paper reviews the most up-to-date epidemiological evidence of the relationship between depression and diabetes, and considers the risk factors for the development of depression and the consequences of depression in diabetes with an emphasis on international and cross-cultural data. The difficulties that researchers face when epidemiological studies require assessment of psychological phenomena, such as depression, across different cultural settings are explored.

METHODS

Relevant papers were sought on the epidemiology of diabetes and depression in people with diabetes by undertaking a literature search of electronic databases including MEDLINE, Psych-INFO, CINAHL and EMBASE. These papers were assessed by the authors and a narrative review of the relevant literature was composed.

RESULTS

Systematic reviews of the prevalence of depression in people with diabetes have focused on studies conducted in English speaking countries and emerging data suggest that there may be international variations in prevalence and also in how symptoms of depression are reported. There appears to be a bi-directional relationship between depression and diabetes, with one influencing the other; however, research in this area is further complicated by the fact that potential risk factors for depression in people with diabetes often interact with each other and with other factors. Further research is needed to elucidate the causal mechanisms underlying these associations.

LIMITATIONS

Data from non-English speaking countries remain scarce and so it is difficult to come to any firm conclusions as to the international variation in prevalence rates of co-morbid diabetes and depression in these countries until further research has been conducted.

CONCLUSION

It is important to take a culture-centered approach to our understanding of mental health and illness and consider the key issues related to the development of culturally sensitive depression screening tools. In order to come to any firm conclusions about the international variation in prevalence of co-morbid diabetes and depression, issues of culture and diversity must be taken into account prior to conducting international epidemiological studies.

Association of depression and its relation with complications in newly diagnosed type 2 diabetes

INTRODUCTION

The prevalence of major depressive disorders is higher among persons with diabetes compared to the general population. These associations may be related to the increased risk of depressive symptoms in individuals with diabetes, increased risk of type 2 diabetes (T2DM) in individuals with depressive symptoms, or both.

OBJECTIVES

To study the association of depression with diabetes and its complications in newly diagnosed type 2 diabetes in eastern UP.

MATERIAL AND METHODS

Sixty cases and an equal number of age- and sex-matched controls were assessed for depression, diabetes complications, and a demography profile.

RESULTS

Depression was found in 26 (43.34%) cases, while it was present in only eight (13.33%) controls (P = 0.002). Depression correlated with the level of hyperglycemia at presentation, as measured by fasting and postprandial blood glucose (FBG and PPBG) values. The presence of diabetic nephropathy was significantly associated with depression, while the prevalence of other complications of diabetes (retinopathy and dyslipidemia), although higher among those with depression, was not statistically significant. The level of HbA1c was 8.56 ± 1.66 in the depressed versus 8.04 ± 1.88 in the non-depressed diabetics (P = 0.26).

CONCLUSIONS

The association of depression with diabetes and its complications in newly diagnosed type 2 diabetics was highlighted in our subpopulation and emphasized the need for integrated health services. The prevalence of depression was higher among them compared to controls. The chances of becoming depressed increased as the diabetes complications worsened.

Correlates of anxiety and depression among patients with type 2 diabetes mellitus

CONTEXT

Research has established the relation between diabetes and depression. Both diabetes and anxiety/depression are independently associated with increased morbidity and mortality.

AIMS

The present study aims at assessing the prevalence of anxiety/depression among outpatients receiving treatment for type 2 diabetes.

SETTINGS AND DESIGN

The study was conducted in the endocrinology outpatient department of an urban tertiary care center.

MATERIALS AND METHODS

The instruments used included a semi-structured questionnaire, HbA1c levels, fasting blood glucose and postprandial blood glucose, Brief Patient Health Questionnaire, and Hospital Anxiety and Depression Scale (HADS).

STATISTICAL ANALYSIS USED

Analysis was carried out using the SPSS version 16.0. Pearson's correlation coefficient was calculated to find out the correlations. ANOVA was carried out for the in between group comparisons.

RESULTS

There was a significant correlation between the HADS-Anxiety scale and Body Mass Index (BMI) with a correlation coefficient of 0.34 (P = 0.008). Also, a significant correlation existed between HADS-Depression scale and BMI (correlation coefficient, 0.36; P = 0.004). Significant correlation were observed between the duration of daily physical exercise and HADS-Anxiety (coefficient of correlation, -0.25; P = 0.04) scores. HADS-Anxiety scores were found to be related to HbA1c levels (correlation-coefficient, 0.41; P = 0.03) and postprandial blood glucose levels (correlation-coefficient, 0.51; P = 0.02).

CONCLUSIONS

Monitoring of biochemical parameters like HbA1c and postprandial blood glucose levels and BMI could be a guide to development of anxiety in these patients. Also, physical exercise seems to have a protective effect on anxiety in those with type 2 diabetes mellitus.

Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors

BACKGROUND

Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes.

METHODS

We conducted a cross-sectional, multi-center study in four out-patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and depression, while adjusting for confounding variables.

RESULTS

Overall, 57.9% (95% CI = 54.7%, 61.2%) and 43.5% (95% CI = 40.3%, 46.8%) study participants had anxiety and depression respectively. Factors found to be independently associated with anxiety were physical inactivity, having hypertension and ischemic heart disease. For depression, being female, of older age, having hypertension and ischemic heart disease were significantly associated. Metabolic components found to be independently associated with both anxiety and depression were systolic blood pressure, fasting blood glucose and fasting blood triglycerides. Body mass index was independently associated with depression but not with anxiety.

CONCLUSION

This study identified that a large proportion of adults with diabetes had anxiety and/or depression, and identified factors associated with these entities. These results alert clinicians to identify and treat anxiety and depression as common components of diabetes care. Additional studies are needed to establish the directional nature of this relationship and to test interventions.

Prevalence of depression in relation to glucose intolerance in urban south Indians--the Chennai Urban Rural Epidemiology Study (CURES-76)

BACKGROUND

This study investigated the association between depression and glucose intolerance in urban residents of southern India.

METHODS

Subjects were recruited from the Chennai Urban Rural Epidemiology Study, carried out on a representative sample of 26,001 subjects recruited from Chennai city in southern India. Subjects with known diabetes were excluded (n = 1,498). Of the remaining 24,503 subjects, fasting capillary blood glucose (FBG) estimation were available for 23,787 subjects (response rate, 97.1%) in whom depression was assessed using a validated instrument, the Patient Health Questionnaire-12. Subjects with FBG values ≥126 mg/dL were termed as subjects with newly diagnosed diabetes (NDD), those with values between 100 and 125 mg/dL as having impaired fasting glucose (IFG), and those with <100 mg/dL as having normal fasting glucose (NFG).

RESULTS

The overall prevalence of depression was 14.3% (3391 of 23,787 subjects), and an increasing prevalence of depression was seen with increasing grades of glucose intolerance: NFG (13.1%), IFG (15.7%), and NDD (19.7%) (trend χ(2) = 57.1, P < 0.001). The prevalence of depression was higher in females at all grades of glucose intolerance. Risk for depression was higher among NDD subjects compared to NFG subjects (odds ratio = 1.12, 95% confidence interval 1.03-1.22, P = 0.01) and IFG subjects (odds ratio 1.21, 95% confidence interval 1.02-1.44, P = 0.03) and also for IFG compared to NFG subjects (odds ratio = 1.12, 95% confidence interval 1.02-1.21, P = 0.01) after adjusting for age, gender, body mass index, hypertension, and socioeconomic status.

CONCLUSION

The prevalence of depression increases with increasing grades of glucose intolerance and is highest among those with diabetes.

Diabesity: an overview of a rising epidemic

'Diabesity' is the term for diabetes occurring in the context of obesity. In this review, we will overview the latest epidemiological data available describing the rising prevalence, health impact and economic impact of diabesity. We will also outline the measures required to slowdown this newly evolving epidemic. The global prevalence of diabetes in 2010 was 284 million people worldwide constituting around 6.4% of the world population, which is higher than was projected in earlier studies. Furthermore, the projections for 2030 show the prevalence to reach 439 million individuals comprising ~7.7% of the world population. The burden of diabetes on the world economy has been rising steadily in the last decade to reach $376 billion in 2010 and is expected to reach $490 billion in 2030. Diabesity represents a substantial economic burden as reflected by diabetes and obesity consuming 14 and 5.7% of the USA's total health expenditure, respectively, representing the highest known expenditure on diabesity worldwide. When costs associated with being overweight were also included, the upper limit of obesity expenditure rises to 9.1% of the USA's total healthcare expenditure. The highest recorded expenditure on diabetes alone was in Saudi Arabia consuming 21% of the country's total health expenditure, with no data available about the health expenditure on obesity. The health impact of diabesity is substantial to include long-term diabetic complications, reduction in health-related functioning, reduction of quality of life and reduced overall life expectancy. Long-term complications include myocardial infarction, cerebrovascular stroke and end-stage renal disease. Also recent advances have found that there is an association between chronic stress, depression and sleeping troubles to both diabetes and obesity. This century is the unprecedented diabetogenic era in human history. It is thus urgent to take steps including screening, prevention and early management in an attempt to control this evolving epidemic of diabesity.