Depression and suicidal ideation among individuals with type-2 diabetes mellitus, a cross-sectional study from an urban slum area of Karachi, Pakistan

Background

Suicidal thoughts and depression are associated with patients with diabetes, especially patients with low socioeconomic backgrounds and prolonged illness.

Objective

We aimed to estimate suicidal thoughts and depression among patients with type 2 diabetes (T2D) in the slums of Karachi.

Methods

This cross-sectional study was conducted across 38 locations in the slums of Karachi to understand depression, suicidal thoughts, and other supporting factors of depression associated with T2D. The three-item Oslo Social Support Scale, the Patient Health Questionnaire-9 (PHQ-9) scale, and the Ask Suicide Screening Questions were used to screen the patients.

Results

A total of 504 study participants were interviewed, with a response rate of 98%. The prevalence of depression among patients with diabetes was 30.83%, and suicidal ideation was 20.39%. In the final multivariate analysis, being socioeconomically poor, physically disabled, and having poor social support were independent predictors of depression.

Conclusion

Diabetes, low socioeconomic level, a lack of social support, and physical disability were all linked to depression. Therefore, trained health providers should conduct an early depression-focused routine screening for patients with diabetes.

The relationship between depression and metabolic control parameters in type 2 diabetic patients: A cross-sectional and feasibility interventional study

BACKGROUND

Substantial evidence supports a bidirectional relationship between diabetes and clinical depression. However, little is known about the effect of treating one condition on the control of the other. Thus, this study aimed to determine the prevalence of depression among Type II diabetes mellitus (T2DM) patients and to assess the efficacy and feasibility of escitalopram treatment of depression on their metabolic control parameters.

METHODS

T2DM patients attending primary care clinics in the North of Jordan were enrolled in a cross-sectional study during the period from February to December 2019 (n = 157). Depressive symptoms were screened utilising the patient health questionnaire-9 (PHQ-9) tool. Metabolic control was assessed by measurement of glycated haemoglobin (HbA1c), triglycerides, cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Patients with moderate to severe depressive symptoms by PHQ-9 (n = 58) were interviewed by a psychiatrist to confirm a clinical diagnosis of depression. Eligible depressed patients were administered escitalopram 10 mg orally once daily for 3 months (n = 12). Thereafter, depressive symptoms and metabolic control measures were reassessed.

RESULTS

The prevalence of moderate to severe depressive symptoms among T2DM patients, according to PHQ-9, was 36.94%, while the prevalence of clinical depression based on interview was 7.64%. Baseline PHQ-9 scores correlated significantly with baseline levels of HbA1c, HDL, cholesterol and triglycerides. Escitalopram treatment intervention resulted in significant improvement of PHQ-9 scores without significantly improving any of the metabolic control measures.

CONCLUSION

The relationship between depression and T2DM in the context of metabolic syndrome is plausible. However, our results show that escitalopram treatment may not be associated with significant improvement in metabolic control parameters among these patients. Our study has laid the groundwork for future randomised clinical trials with larger sample size and longer follow-up.

Nutrition quality of life associated with affective functioning among Omani patients with type 2 diabetes from primary health care

Diabetes requires challenging lifelong dietary management, affects quality of life and heightens the impact of affective functioning. The aim of this study was to investigate the relationship between Nutrition Quality of Life (NQOL) and affective functioning in a sample of Omani patients with type 2 diabetes. A sample of 149 adults with type 2 diabetes was conveniently recruited from seven Primary Health Centers (PHCs) during follow-up visits. Data were gathered via face-to-face interviews. Pearson correlation and χ² test of independence were applied to examine associations at P < 0⋅05. Most patients had poor glycemic control (71⋅1 %), BMI ≥ 25 kg/m² (85⋅2 %) and central obesity (75⋅8 %), and moderate (54⋅4 %) and poor (32⋅9 %) level of NQOL. Based on the Hospital Anxiety and Depression Scale (HADS), 16⋅1 and 23⋅5 % of the sample endorsed the presence of anxiety and depression, respectively. A significant negative correlation was found between NQOL and HADS (r −0⋅590, P = 0⋅000), anxiety (r −0⋅597, P = 0⋅000) and depression (r −0⋅435, P = 0⋅000). There was a significant association between NQOL and HADS, χ² (2) = 38⋅21, P < 0⋅01 that was large, Cramer's V = 0⋅51. Also, there were significant associations (P < 0⋅01) between NQOL and HADS when controlling for HbA1c, BMI, waist circumference and HMNT that were moderately to largely strong, Cramer's V = 0⋅43–0⋅55. There is an evident association between NQOL and affective functioning in adults with type 2 diabetes. Further research is recommended to confirm these relationships and to guide intervention programmes at PHCs to help improve the general quality of life of such patients.

Prevalence of depression and its associated factors among patients with diabetes mellitus at Tirunesh-Beijing general hospital, Addis Ababa, Ethiopia

BACKGROUND

Depression is one of the common and overwhelming mental disorder in diabetic patients. A little is known about the prevalence and associated factors of depression among diabetic patients at general hospitals. Therefore, this study aimed to assess the prevalence and associated factors of depression among patients with diabetes mellitus at Tirunesh-Beijing General Hospital, Addis Ababa, Ethiopia.

METHODS

An institution-based cross-sectional study was conducted from February 8 to April 8, 2019. A systematic random sampling technique was used to select 403 participants. Depression was assessed by using patient health questionnaire-9 (PHQ-9). Oslo 3 social support scale was used to assess social support. The data were entered into Epidata version 3.1 and analyzed by the statistical package for social science version 23 software. We computed bivariate and multivariate binary logistic regressions to assess factors associated with depression. Statistical significance was declared at P-value < 0.05.

RESULTS

A total of 403 study participants were interviewed with a response rate of 99%. The prevalence of depression among diabetic patients was 21.3%. In the final multivariate analysis, diagnosed with type II diabetes mellitus, being physically disabled and having poor social support were independent predictors of depression.

CONCLUSIONS

Type II diabetes mellitus, poor social support and physical disability were factors associated with depression. An early depression-focused regular screening for diabetic patient should be carried out by trained health professionals. Linkage with mental health service providers also needs to be considered. Clinicians needs to give emphasis to diabetic patients with physically disable and poor social support.

Psychosocial and clinical factors associated with depression among individuals with diabetes in Bahir Dar City Administrative, Northwest Ethiopia

BACKGROUND

In a context of the potential epidemic nature of both diabetes mellitus (DM) and depression had negative effects in cases of disability and mortality. Coexisting depression had been linked to morbidity and mortality in people with diabetes. Therefore, this study aimed to identify psychosocial and clinical factors associated to develop depression symptoms in diabetes patients.

METHODS

A systematic institution based cross-sectional study design was conducted from 1st March to 8th April 2016 among adult diabetes patent. Depression status was assessed by the Patient Health Questionnaire-9 (PHQ-9). Data were analyzed by logistic regression and at P < 0.05 with 95% CI was considered statistically significant.

RESULT

A total of 416 patients were included in this studied. Based on PHQ-9, self- reported depression symptom was 29.3% [95% CI 25.2, 33.4]. In the performed statistical evaluation, patients whose age was between 45 and 54 years old (AOR = 3.88; 95% CI 1.36, 11.08); being female (AOR = 2.43; 95% CI 1.29, 4.58); who has poor social support (AOR = 6.08; 95% CI 2.98, 12.40); and who has high fear of kidney problems secondary to DM (AOR = 6.12; 95% CI 1.75, 21.23) were statistically associated with depressive symptoms in diabetes patients.

CONCLUSION

This study demonstrated that complication fears, social support, being female and sexual dysfunction were found significantly associated with co-morbid depression in diabetes. Therefore, availed a social network of family and friends; providing diabetes education to address the patient's fear of complications; and considered a sexual function is an integral part of overall health in diabetic patients.

The prevalence of comorbid depression in patients with diabetes: A meta-analysis of observational studies

Depression is one of the most common psychiatric disorders in patients with diabetes, which can exacerbate and accelerate adverse diabetes complaints by reducing self-care behaviors and medication adherence. The purpose of this study is to estimate the prevalence of depression in Iranian patients with diabetes. The search was conducted in the databases of Scientific Information Database (SID), MagIran, PubMed, Scopus, Web of Science, and Google Scholar. The following keywords and their possible combinations were used: depressive disorder, major depressive disorder, dysthymic disorder, diabetes mellitus and Iran. Heterogeneity between studies was examined with I². The data were analyzed using the meta-analysis method and random-effects model with Stata version 11.0. The analysis of 37 selected articles with a total sample size of 7849 indicated that the overall prevalence of depression in Iranian patients with diabetes was 54% (95% CI: 47.32-60.70). In addition, the prevalence of depression in women (56.25%; 95% CI: 48.83-63.68) was higher than that of men (41.05%; 95% CI: 32.74-49.36). The results showed that there was no relationship between the prevalence of depression and publication year (0.249), sample size (p = 0.529), and mean age of the subjects (p = 0.330). More than half of the patients with diabetes suffer from depression. Identification and treatment of these patients can be an important step in controlling and delaying the diabetes complication.

Prevalence and factors affecting the level of depression, anxiety, and stress in hospitalized patients with a chronic disease

PURPOSE

To report the prevalence of psychological/mental disorders and determine the factors associated with them in hospitalized patients with chronic diseases.

DESIGN AND METHODS

This was as cross-sectional study. One hundred and fifty patients were randomly selected from one hospital having at least one chronic disease.

FINDINGS

The rate of depression, anxiety, and stress in our sample were 21.3%, 61.3%, and 48.7%, respectively. Benign prostate hypertrophy, dysthyroidism, avoidance of thoughts and feelings as a coping mechanism, and a longer hospital stay were associated with higher depression. Hypertension, female gender, and a higher education level were associated with higher anxiety. Female gender and a longer stay in hospital were predictors of stress.

PRACTICE IMPLICATIONS

Hospitalized patients with chronic illnesses have high levels of psychological distress, showing the importance of getting psychological counseling in these settings.

The prevalence of depression and anxiety in Iranian patients with diabetes mellitus: A systematic review and meta-analysis

INTRODUCTION

This study aims to estimate the prevalence of depression and anxiety among Iranian patients with diabetes mellitus (DM) through meta-analysis.

METHODS

This is a systematic review article based on MOOSE and PRISMA guidelines. Review of the literature was done using databases including Magiran, Barakat Knowledge Network System, SID, RICST, IranDoc, PubMed/Medline, Science Direct, Embase, Scopus, Cochrane Library, Web of Science and the Google Scholar search engine without time limit until December, 2018. Heterogeneity between studies was assessed using Cochran's Q test and I² index. Data were analyzed using Comprehensive Meta-Analysis (CMA) software version 2 according to a random-effects model. P-values less than 0.05 were considered as the significance level.

RESULTS

The analysis consisted of 44 studies including 10,349 Iranian patients with DM. The prevalence of depression was estimated to be 61.8% (95% confidence interval [CI]: 56.6-66.7). The lowest and highest prevalence of depression based on regions was in the North (56.7% [95%CI: 44.9-67.8]) and the East (64.2% [95%CI: 30.7-87.9]), respectively. The depression prevalence in females and males was 63.9% (95%CI: 54.0-72.8) and 46.3% (95%CI: 36.4-56.4), respectively, The prevalence of mild, moderate, severe and highly severe depression was estimated to be 24.4% (95%CI: 21.0-28.2), 19.1% (95%CI: 15.2-23.9), 11.4% (95%CI: 8.6-14.9), and 4.6% (95%CI: 3.4-6.1), respectively. In eight studies, the prevalence of anxiety in Iranian patients with DM was estimated to be 64.5% (95%CI: 42.0-82.1).

CONCLUSIONS

Depression and anxiety are more prevalent among Iranian patients with DM compared with developed countries. Therefore, regular psychiatric consultation is required for the early diagnosis and treatment of depression and anxiety in these patients.

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.

Association between depression with glycemic control and its complications in type 2 diabetes

AIMS

This study aims to determine the association between depression with glycemic control (HbA1c) and its complications.

MATERIALS AND METHODS

This was a cross-sectional study that included 514 diabetic patients. The patients were randomly selected from among all type 2 diabetes patients referred to health and medical centers in Khorramabad town (Iran). Two questionnaires used for data collection. The first questionnaire included demographic information, diabetes and its complications and the second questionnaire was Beck Depression Inventory (BDI-II) which was used to assess depression. The stata software version 14 was used for data analysis. Then, for evaluate the association between depression with glycemic contol and its complications, Univariate and multiple logistic regression analysis were employed.

RESULTS

The prevalence of depression in diabetic patients under study was 46.3% and for female and male was 49.6 and 36.8%; respectively. The results showed that 48.6% of diabetic patients did not have appropriate glycemic control status (HbA1c > 8). There was no significant association between glycemic control expressed as HbA1c levels and depression (OR: 1.11, 95% CI: 0.87-1.57). By contrast, sex (OR: 2.03, CI 95%: 1.03-3.99), residence (OR: 1.92, 95% CI: 1.28-2.91) and sexual complications (OR: 5.54, 95% CI: 1.07-27.87) have a significant statistical association with depression.

CONCLUSION

The study highlights the high prevalence of depression in diabetic patients. However, there was no significant association between depression and glycemic control. The implementation of mental health screening for rapid diagnosis and timely treatment of depression seems essential in diabetic patients.

Why Early Psychological Attention for Type 2 Diabetics Could Contribute to Metabolic Control

Background and aims: Type 2 Diabetes Mellitus (T2DM) is currently a public health emergency that requires inter- and multidisciplinary medical services. The principal aim of the present work was to review the basic factors related to the possible advantages of providing early psychological attention to T2DM patients as a coadjuvant for achieving adequate metabolic control.

Material and methods: A literature review was conducted to explore the interaction between stress and depression and the relation of both to the ability of T2DM patients to effectively manage their disease. Results: It was found that stress is one of the factors linked to the etiology of depression, which is a disorder with high prevalence in diabetic patients. Consequently, an inter- and multidisciplinary approach to treating diabetic patients was developed. One of the main focuses of this approach is early psychological attention, starting shortly after the initial diagnosis.

Conclusions: The ability to create consciousness among health care professionals about the importance of early psychological attention for T2DM patients under an inter- and multidisciplinary strategy could possibly improve pharmacological adherence, metabolic control, the quality of life and the life expectancy of patients, as well as save economic resources for patient families and health institutions.

Illness Perception and Depressive Symptoms among Persons with Type 2 Diabetes Mellitus: An Analytical Cross-Sectional Study in Clinical Settings in Nepal

Background. This study aimed to assess the relationship between illness perception and depressive symptoms among persons with diabetes. Method. This was an analytical cross-sectional study conducted among 379 type 2 diabetic patients from three major clinical settings of Kathmandu, Nepal. Results. The prevalence of depressive symptoms was 44.1% (95% CI: 39.1, 49.1). Females (p < 0.01), homemakers (p < 0.01), 61-70 age group (p = 0.01), those without formal education (p < 0.01), and people with lower social status (p < 0.01) had significantly higher proportion of depressive symptoms than the others. Multivariable analysis identified age (β = 0.036, p = 0.016), mode of treatment (β = 0.9, p = 0.047), no formal educational level (β = 1.959, p = 0.01), emotional representation (β = 0.214, p < 0.001), identity (β = 0.196, p < 0.001), illness coherence (β = -0.109, p = 0.007), and consequences (β = 0.093, p = 0.049) as significant predictors of depressive symptoms. Conclusion. Our study demonstrated a strong relationship between illness perception and depressive symptoms among diabetic patients. Study finding indicated that persons living with diabetes in Nepal need comprehensive diabetes education program for changing poor illness perception, which ultimately helps to prevent development of depressive symptoms.

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.

Contributions of diabetic macro-vascular complications and hip fracture to depression onset in elderly patients with diabetes: an 8-year population-based follow-up study

OBJECTIVE

To prospectively examine the roles of diabetic macro-vascular complications and hip fracture in association with depression onset in Taiwan's elderly diabetic population.

METHODS

A representative sample of elderly diabetic patients (n=144,216) identified in 2000 were linked to National Health Insurance claims (2000-2007) to ascertain the diagnoses of depression in both outpatient and inpatient settings. The person-year approach with Poisson assumption was used to estimate the hazard rates. Using Cox proportional hazard regression model, we evaluated the relative risk of depression in relation to diabetic macro-vascular complications and hip fracture. The additive effects from the above medical conditions were also assessed.

RESULTS

The 8-year cumulative risk of depression was 5.08%, representing an incidence density of 8.40 per 1000 patient-years. Hazard ratio (HR) with 95% confidence interval (CI) for the elderly diabetes associated with cardiovascular disease (CVD), hip fracture, and lower extremity amputation was 1.13 (1.04-1.23), 1.10 (0.91-1.34), and 1.25 (0.95-1.65), respectively. Additionally, we found that the more the complications or hip fracture, the higher the risk of depression onset in elderly diabetes.

CONCLUSION

The increased number of diabetic macro-vascular complications and hip fracture is significantly associated with a higher risk of depression onset in elderly diabetes. Future studies should be conducted to assess the feasibility and cost-effectiveness of intensive depression screening program in elderly diabetes suffering from macro-vascular complications and hip fracture.