Prevalence, Severity and Determinants of Depression in Patients with Type 2 Diabetes MellitusCorrespondence Address :
Associate Professor, Department of General Medicine, Himalayan Institute of
Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun,
Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) are at higher risk to develop depression. Depression in turn adversely affects glycaemic control and increases the risk of diabetes-related complications and mortality. There is a large variation among Indian studies on prevalence of depression in T2DM and associated risk factors.
Aim: To assess the prevalence, severity, and determinants of depression among patients with T2DM.
Materials and Methods: The study was conducted at a Tertiary Care Hospital during February 2018-February 2019, in North-Indian state of Uttarakhand. Study subjects were patients with T2DM, age >18 years. Based on exclusion and inclusion criterias, a total sample of 290 patients were studied. Presence of depression was assessed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Hamilton Depression Rating Scale (HAM-D) was used to estimate the severity of depression. Unpaired t-test and Mann-Whitney U test were used to compare continuous variables between subjects with and without depression. Chi-Square test was used to analyse categorical data. Binary logistic regression analysis was used to study the association between likelihood of depression and predictor variables.
Results: Among 290 (155 males and 135 females, mean age of all subjects 58.2±11.08 years) study subjects with T2DM, 64 (22.1%) were found to have depression using DSM-5 criteria. Out of these 64 patients with depression, 46 were detected to have mild depression, 14 moderate depression and 4 severe depression using HAM-D scale. Subjects with T2DM and depression had: higher proportion of females (62.5% vs. 42.0%; p-value 0.004); lower literacy level (53.1% vs. 67.3%; p-value 0.037); higher frequency of diabetic retinopathy (85.9% vs. 62.8%; p-value <0.001) and diabetic kidney disease (43.8% vs. 27.4%; p-value 0.013); higher Fasting Plasma Glucose (FPG) (217.7±94.62 vs. 190.0±76.45 mg/dL; p-value 0.040); and lower haemoglobin (10.8±2.49 vs. 11.7±2.37 gm/dL; p-value 0.010) compared to the subjects without depression. On binary logistic regression analysis, female gender (OR 2.457, 95% CI 1.368-4.413, p-value 0.003) and diabetic retinopathy (OR 3.842, 95% CI 1.788- 8.255, p-value 0.001) remained significantly associated with likelihood of depression.
Conclusion: Depression was present in one-fifth of the study subjects with T2DM. Majority of them had mild depression. Female gender and diabetic retinopathy were associated with increased likelihood of depression.
Diagnostic and Statistical Manual of Mental Disorders, Diabetic kidney disease, Diabetic retinopathy, Fifth Edition, Hamilton Depression Rating Scale
Date of Submission: Aug 31, 2020
Date of Peer Review: Oct 16, 2020
Date of Acceptance: Nov 24, 2020
Date of Publishing: Jan 01, 2021
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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