Prevalence of depression in patients with type 2 diabetes mellitus in Irish primary care and the impact of depression on the control of diabetes

Depression and glycaemic control among adult patients with type 2 diabetes: a cross-sectional study in a comprehensive specialised hospital, Jigjiga, Ethiopia

OBJECTIVES

The primary objective of this study was to evaluate the prevalence of depression and its sociodemographic predictors, clinical predictors and glycaemic control among adult patients with type 2 diabetes at Sheik Hassan Yabare Comprehensive Specialized Hospital (SHYCSH), Jigjiga, Ethiopia.

DESIGN

A hospital-based cross-sectional study was conducted.

SETTING

Patients with type 2 diabetes mellitus (T2DM) at Sheik Hassan Yabare Comprehensive Specialized Hospital, for chronic follow-up from 3 October 2022 to 13 November 2022.

PARTICIPANTS

Randomly selected 278 patients with T2DM age 18 years and older, with a duration of 1 year or more since diagnosis, who had a diabetic follow-up at SHYCSH.

MAIN OUTCOME MEASURES

Depression was assessed using the Patient Health Questionnaire.

RESULTS

A total of 263 participants were included, with a response rate of 94.6%. Of the respondents, 134 (51%) were male, making up more than half of the total. The overall prevalence of depression was 47.1% (95% CI 41.1 to 53.2). Depression was further classified, as follows, based on its severity: the majority (66 or 25.1%) had mild depression, followed by 44 (16.7%) with moderate depression, 9 (3.4%) with moderately severe depression and 5 (1.9%) with severe depression. A multivariable logistic regression analysis indicated that poor glycaemic control (adjusted OR (AOR)=1.93; 95% CI 1.05 to 3.53), DM complications (AOR=2.02; 95% CI 1.09 to 3.74) and DM duration of 6-10 years since diagnosis (AOR=2.29; 95% CI 1.21 to 4.34) were independently associated with depression.

CONCLUSIONS

Our study revealed a significant burden of depression among patients with T2DM receiving follow-up care at the hospital. Glycaemic control, the presence of complications and a longer duration of diabetes were identified as predictors of depression. Therefore, concerned stakeholders should work to improve blood sugar control and promote healthy behaviour, particularly among those with complications or who have been sick for an extended period of time.

Are adults diagnosed with type 2 diabetes at a greater risk of developing depression? Integrative literature review

BACKGROUND

The aim of this integrative literature review was to investigate the prevalence of depression in adults diagnosed with type 2 diabetes within Europe and to examine the link between adults with type 2 diabetes and the risk of developing depression.

METHODS

An integrative literature review using the databases CINAHL, Medline and PsycInfo to retrieve the most relevant articles on adults with type 2 diabetes and the risk of developing depression.

RESULTS

Gender, age and socio-economic status may increase the risk of an adult with type 2 diabetes developing depression.

CONCLUSION

Adults with type 2 diabetes are at a greater risk of developing depression, and factors such as age, gender and socio-economics also play a role in predicting whether a person with type 2 diabetes will develop depression. Screening tools such as Patient Health Questionnaire-2 (PHQ-2) may be used to assess for depression within GP surgeries at the time of diagnosis with type 2 diabetes.

The Impact of and Interaction between Diabetes and Frailty on Psychosocial Wellbeing and Mortality in Ireland

Frailty in middle-aged and older adults is associated with diabetes-related complications. The impact of and interaction between diabetes and frailty on psychosocial wellbeing and mortality in Ireland for adults aged ≥50 years were assessed using data from the Survey of Health, Ageing and Retirement in Europe. Measures included diabetes status (self-reported), frailty phenotype (≥3/5 criteria), low self-rated health (“fair” or “poor”), depression screening (EURO-D index score ≥4), and low quality of life (QoL) (CASP-12 index score < 35). Among the 970 participants, those with diabetes (n = 87) were more likely to be frail (23% vs. 8%; p < 0.001), have low self-rated health (46% vs. 19%; p < 0.001), depression (25% vs. 17%; p = 0.070), and low QoL (25% vs. 18%, p = 0.085). Adjusting for diabetes, age and sex, frailty independently predicted low self-rated health (OR: 9.79 (5.85–16.36)), depression (9.82 (5.93–16.25)), and low QoL (8.52 (5.19–13.97)). Adjusting for frailty, age and sex, diabetes independently predicted low self-rated health (2.70 (1.63–4.47)). The age-sex adjusted mortality hazard ratio was highest for frailty with diabetes (4.67 (1.08–20.15)), followed by frailty without diabetes (2.86 (1.17–6.99)) and being non-frail with diabetes (1.76 (0.59–5.22)). Frailty independently predicts lower self-reported wellbeing and is associated with reduced survival, underpinning its role as an integral part of holistic diabetes care.

Prevalence and risk factors of depressive symptoms among dialysis patients with end-stage renal disease (ESRD) in Khartoum, Sudan: A cross-sectional study

Background

Depression is the most common prevalent psychiatric condition among patients with chronic kidney disease (CKD), and especially during dialysis. This study aimed to evaluate depression symptoms in Sudanese patients with end-stage renal diseases (ESRD) who undergo hemodialysis.

Methods

This is a case finding, hospital-based study recruited 75 patients on dialysis in Khartoum, Sudan. Data were analyzed by statistical package for social science (SPSS, version 23).

Results

The percentage of depression symptoms that satisfies the criteria for the diagnosis of major depression disorders in patients with ESRD undergoes dialysis was 68%. The new patients who undergo dialysis for less than 1 year had more depression symptoms (66.7%) than those on dialysis for 2-3 years (21.6%) or more than 3 years with a percentage of11.8%. Chi-square test showed significant associations between depression and age, the duration of dialysis, signs of significant weight loss when no dieting, and when the clinical symptoms related to distress or social or functional impairment (P = 0.016, 0.000, 0.004, and 0.000, respectively). Logistic regression test showed that age and duration of dialysis were significantly associated with depression with (odds ratios [OR]: 0.724, 0.211).

Conclusion

More than two-thirds of patients on dialysis have depressive symptoms. Risk factors associated with depression in Sudanese patients on dialysis were age, duration of dialysis, weight loss, and social and functional impairment. Future research is needed in order to assess the benefit of antidepressants in patients on dialysis. Family physicians should be aware of the association between depression and dialysis, in order to provide early treatment and prevent suicide.

Prevalence of Depressive Symptoms in the Elderly Population Diagnosed with Type 2 Diabetes Mellitus

Introduction: A sharp rise in the population of elderly people, who are more prone to somatic and mental diseases, combined with the high prevalence of type 2 diabetes mellitus and diabetes-associated complications in this age group, have an impact on the prevalence of depressive symptoms. Aim of the work: The work of the study was the evaluation of the prevalence of depressive symptoms in the elderly population diagnosed with type 2 diabetes mellitus. Materials and methods: The pilot study was conducted in 2019 among 200 people diagnosed with type 2 diabetes mellitus, aged 65 years and above, receiving treatment in a specialist diabetes outpatient clinic. The study was based on a questionnaire aimed at collecting basic sociodemographic and clinical data and the complete geriatric depression scale (GDS, by Yesavage) consisting of 30 questions. Results: The study involved 200 patients receiving treatment in a diabetes outpatient clinic. The mean age of the study subjects was 71.4 ± 5.0 years. The vast majority of the subjects (122; 61%) were women, with men accounting for 39% of the study population (78 subjects). A statistically significant difference in the GDS (p < 0.01) was shown for marital status, body mass index (BMI), duration of diabetes, and the number of comorbidities. Patients with results indicative of symptoms of mild and severe depression were found to have higher BMI, longer disease duration, and a greater number of comorbidities. There were no statistically significant differences in the level of HbA1c. Conclusions: In order to verify the presence of depressive symptoms in the group of geriatric patients with diabetes mellitus, an appropriate screening programme must be introduced to identify those at risk and refer them to specialists, so that treatment can be promptly initiated. Screening tests conducted by nurses might help with patient identification.

Physical health among patients with common mental health disorders in primary care in Europe: a scoping review

Introduction:

Mental disorders are increasingly common among adults in both the developed and developing world and are predicted by the WHO to be the leading cause of disease burden by 2030. Many common physical conditions are more common among people who also have a common mental disorder. This scoping review aims to examine the current literature about the prevention, identification and treatment of physical problems among people with pre-existing mental health disorders in primary care in Europe.

Methods:

The scoping review framework comprised a five-stage process developed by Arksey & O’Malley (2005). The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Both quantitative and qualitative studies were included, with no restriction on study design.

Results:

The initial search identified 299 studies, with a further 28 added from the hand-search (total n = 327) of which 19 were considered relevant to the review research question and included for full analysis. Depression was the mental health condition most commonly studied (nine studies), followed by depression and anxiety (seven studies), with three studies examining any mental disorder. Eleven studies examined the effects of various interventions to address physical and mental comorbidity, with the most commonly studied intervention being collaborative care.

Conclusions:

With just 19 studies meeting our criteria for inclusion, there is clearly a paucity of research in this area. Further research is essential in order to understand the pathophysiological mechanisms underlying the association between mental disorders and chronic conditions.

Health literacy and depression in women with type 2 diabetes mellitus

OBJECTIVES

The prevalence of diabetes mellitus has recently increased in Taiwan, and depression is common among these patients. Moreover, a lack of health literacy may lead to depression. In this study, we explored the correlation between health literacy and depression in diabetic women.

METHODS

In this cross-sectional study, 152 women with type 2 diabetes mellitus were recruited from the outpatient clinic of a regional teaching hospital in Taiwan. The data were collected through medical records and a self-reported structured questionnaire, which included items on basic attributes, self-rated health status, the Center for Epidemiologic Studies Depression Scale (CES-D), and Chinese Health Literacy Scale for Diabetes (CHLSD). The results were analyzed using descriptive statistical analyses, bivariate correlation tests, and linear regression analyses.

RESULTS

One hundred thirty-five valid questionnaires were obtained. Approximately 20% of the participants had a higher tendency toward depression as per their CES-D score, and the CHLSD results showed that 13.33% had poor health literacy. There was a negative correlation between health literacy and depressive tendencies after adjusting for self-rated health status, economic satisfaction status, employment status, and education level using multivariate linear regression analyses. For each 1-point rise in the CHLSD score, the CES-D score decreased by 0.17 points (z=-2.05, p=0.042).

CONCLUSIONS

A negative correlation was identified between health literacy and depression. Self-rated health status, economic satisfaction, employment status, and higher education level are factors that also affect depressive tendency among diabetic women.

The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies

AIMS

Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies.

METHODS

MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11".

RESULTS

In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%).

CONCLUSION

Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.

Prevalence of Undiagnosed Depression in Patients With Type 2 Diabetes

Introduction: Type 2 Diabetes Mellitus (T2DM) is the most prevalent type of diabetes among adults and constitutes around 90% of all cases. Substantial evidence demonstrates that depression in the context of diabetes is associated with a wide range of adverse consequences such as reduced adherence to the prescribed treatment regimen, lower quality of life, higher fasting glucose and HbA1c levels, and higher health expenditures. Methods: This study was conducted to assess the depression among T2DM patients attending diabetic clinics, primary healthcare centers (PHC), Dubai Health Authority (DHA). Depressive symptoms were assessed by using both Arabic and English version of the Beck Depression Inventory. Results: Out of 1,050 diabetic patients approached, 559 were within our inclusion criteria and agreed to participate in this study (Response rate of 53%). The mainstream of the participants had T2DM for <10 years (393, 70%), were under oral hypoglycemic treatment only (479, 86%), and had good medication adherence (526, 94%). The overall depression prevalence using a cutoff of 16 was 17%. When we assessed the level of depression amongst participants in association with their sociodemographic and clinical characteristics, there was a significant difference between age groups (p < 0.00001); gender (p < 0.0001); nationality (p < 0.00001); educational level (p < 0.00001); and employment status (p < 0.0001). The type of clinic in which the T2DM patients were attending (e.g., diabetes mini-clinic vs. General Family Clinic) was also significantly associated with depression (p < 0.0001). Conclusion: Our results demonstrate that the intensive service being given in a diabetes mini-clinic compared to routine PHC clinics appears to benefit the psychological aspects of T2DM patients in the UAE population resulting in a lower incidence of depression than commonly seen in a diabetic population. We have identified a need for the establishment of these mini-clinics in each PHC clinics; and the development of campaigns and educational programs, both for health care providers and the public to decrease depression in T2DM patients in this region.

Associations between multimorbidity, all-cause mortality and glycaemia in people with type 2 diabetes: A systematic review

Introduction

Type 2 diabetes (T2D) is a major health priority worldwide and the majority of people with diabetes live with multimorbidity (MM) (the co-occurrence of ≥2 chronic conditions). The aim of this systematic review was to explore the association between MM and all-cause mortality and glycaemic outcomes in people with T2D.

Methods

The search strategy centred on: T2D, MM, comorbidity, mortality and glycaemia. Databases searched: MEDLINE, EMBASE, CINAHL Complete, The Cochrane Library, and SCOPUS. Restrictions included: English language, quantitative empirical studies. Two reviewers independently carried out: abstract and full text screening, data extraction, and quality appraisal. Disagreements adjudicated by a third reviewer.

Results

Of the 4882 papers identified; 41 met inclusion criteria. The outcome was all-cause mortality in 16 studies, glycaemia in 24 studies and both outcomes in one study. There were 28 longitudinal cohort studies and 13 cross-sectional studies, with the number of participants ranging from 96–892,223. Included studies were conducted in high or upper-middle-income countries. Fifteen of 17 studies showed a statistically significant association between increasing MM and higher mortality. Ten of 14 studies showed no significant associations between MM and HbA1c. Four of 14 studies found higher levels of MM associated with higher HbA1c. Increasing MM was significantly associated with hypoglycaemia in 9/10 studies. There was no significant association between MM and fasting glucose (one study). No studies explored effects on glycaemic variability.

Conclusions

This review demonstrates that MM in T2D is associated with higher mortality and hypoglycaemia, whilst evidence regarding the association with other measures of glycaemic control is mixed. The current single disease focused approach to management of T2D seems inappropriate. Our findings highlight the need for clinical guidelines to support a holistic approach to the complex care needs of those with T2D and MM, accounting for the various conditions that people with T2D may be living with.

Systematic review registration

International Prospective Register of Systematic Reviews CRD42017079500

Risk of Depression and Suicidality among Diabetic Patients: A Systematic Review and Meta-Analysis

The purpose of this study is to conduct a systematic review and meta-analysis to evaluate the risk of depression and suicidality among diabetic patients.

METHODS

Medline, PubMed, EMBASE, Cochrane library, and Psych INFO were searched for studies published from 2008 onwards. Meta-analysis was conducted to estimate the pooled effect size. Sources of heterogeneity were investigated by subgroup analysis and meta-regression.

RESULTS

In total, 5750 articles were identified and of those, 17 studies on suicidality and 36 on depression were included in this study. Our analysis suggests a positive relationship between diabetes and depression (cohort studies odds ratio (OR) 1.49, 95% confidence interval (CI): 1.36⁻1.64 and cross-sectional studies OR 2.04, 95% CI, 1.73⁻2.42). Pooled OR values for suicidal ideation, attempted suicide, and completed suicide were 1.89 (95% CI: 1.36⁻2.63), 1.45 (95% CI: 1.07⁻1.96), and 1.85 (95% CI: 0.97⁻3.52), respectively. All findings were statistically significant except for completed suicide.

CONCLUSIONS

The increased risk of depression and suicidality in diabetic patients highlights the importance of integrating the evaluation and treatment of depression with diabetes management in primary healthcare settings. Further research in this area is needed.

Comorbidity of depression and diabetes: an application of biopsychosocial model

Background

Type 2 diabetes (T2D) is one of the most psychologically demanding chronic medical illness in adult. Comorbidity between diabetes and depression is quite common, but most studies were based on developed country sample. Limited data exists to document biopsychosocial predictors of depressive symptoms in Ethiopian patients. Therefore, the aim of the study was to describe the association of depressive symptoms and T2D and explore the potential underlying associated biopsychosocial risk factors.

Methods

Institution based cross-sectional study was conducted on 276 patient with T2D at diabetic clinic, Black Lion General Specialized Hospital in Ethiopia. Patients were selected using systematic random sampling technique. Depressive symptoms score, which constructed from a validated nine-item Patient Health Questionnaire (PHQ-9), was an outcome variable. Finally, significant associated factors were identified using multiple linear regression analysis with backward elimination procedure. Statistical Package for Social Science (SPSS) version 22.0 (IBM SPSS Corp.) was used to perform all analysis.

Results

Total of 264 patient data was analyzed with 95.7% response rate. Patients mean (SD) current age and age at diagnosis was 55.9 (10.9) and 43.9 (10.9) years, respectively. Patients waist circumference (mean ± SD) was 98.9 ± 11.1 cm. The average PHQ-9 score was 4.9 (SD 4.1) and fasting blood glucose was 166.4 (SD 73.2). Marital status (divorced), occupation (housewife), diabetic complication (nephropathy), negative life event in the last six months, and poor social support significantly associated with increased mean PHQ-9 score after adjustment for covariates. Whereas not fearing diabetic-related complication and death significantly lower mean PHQ-9 score.

Conclusion

Biopsychosocial variables including marital status, negative life event in the last 6 months, occupation, diabetic complication, and poor social support significantly increase average depressive symptoms score. Evidence-based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms.

Electronic supplementary material

The online version of this article (doi:10.1186/s13033-016-0106-2) contains supplementary material, which is available to authorized users.

Therapeutic effect of vagus nerve stimulation on depressive-like behavior, hyperglycemia and insulin receptor expression in Zucker fatty rats

Depression and type 2 diabetes (T2D) are common comorbid diseases and highly prevalent in the clinical setting with an unclarified mechanism. Zucker diabetic fatty (ZDF, fa/fa) rats natively develop T2D with hyperglycemia and hyperinsulinemia. Here we studied whether ZDF rats also innately develop depression, what a correlation is between depression and T2D, whether insulin receptor (IR) expression is involved in, and whether transcutaneous auricular vagus nerve stimulation (taVNS) would be beneficial in amelioration of the comorbidity. Six week old male ZDF and Zucker lean (ZL, fa/+) littermates were randomly divided into naïve (ZDF, n = 6; ZL, n = 7) and taVNS (ZDF-taVNS, n = 8; ZL-taVNS, n = 6) groups. Once daily 30 min-taVNS sessions were administrated under anesthesia for 34 consecutive days in taVNS groups. Blood glucose levels were tested weekly, and plasma glycosylated hemoglobin (HbAlc) level and immobility time in forced swimming test were determined on day 35 in all groups. The expression of insulin receptor (IR) in various tissues was also detected by immunostaining and Western blot. We found that naïve ZDF rats developed hyperglycemia steadily. These ZDF rats showed a strong positive correlation between longer immobility time and higher plasma HbAlC level. Long term taVNS treatment simultaneously prevented the development of depression-like behavior and progression of hyperglycemia in ZDF rats. The expression of IR in various tissues of naïve ZDF rats is lower than in naïve ZL and long-term taVNS treated ZDF rats. Collectively, our results indicate that in ZDF rats, i) depression and T2D develop simultaneously, ii) immobility time and HbAlc concentrations are highly and positively correlated, iii) a low expression of IR may be involved in the comorbidity of depression and T2D, and iv) taVNS is antidiabetic and antidepressive possibly through IR expression upregulation.