BackgroundDiabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, Malaysia.MethodsThe study was cross sectional in design and carried out in 12 randomly selected primary care government clinics in the Klang Valley, Malaysia. A total of 2508 eligible consenting respondents participated in the study. The Depression, Anxiety and Stress Scale (DASS) 21 questionnaire was used to measure depression, anxiety and stress symptoms. Data was analyzed using the SPSS version 16 software using both descriptive and inferential statistics.ResultsThe prevalence of depression, anxiety and stress symptoms among Type II diabetics were 11.5%, 30.5% and 12.5% respectively. Using multiple logistic regression, females, Asian Indians, marital status (never married, divorced/widowed/separated), a family history of psychiatric illness, less than 2 years duration of diabetes and current alcohol consumption were found to be significant predictors of depression. For anxiety, unemployment, housewives, HbA1c level of more than 8.5%, a family history of psychiatric illness, life events and lack of physical activity were independent risk factors. Stress was significantly associated with females, HbA1c level of more than 8.5%, presence of co-morbidity, a family history of psychiatric illness, life events and current alcohol consumption. For depression (adjusted OR 2.8, 95% CI 1.1; 7.0), anxiety (adjusted OR 2.4, 95% CI 1.1;5.5) and stress (adjusted OR 4.2, 95% CI 1.8; 9.8), a family history of psychiatric illness was the strongest predictor.ConclusionWe found the prevalence of depression, anxiety and stress symptoms to be high among Type II diabetics, with almost a third being classified as anxious. Screening of high risk Type II diabetics for depression, anxiety and stress symptoms in the primary care setting is recommended at regular intervals.

Depression among adolescents has been recognized as a major public health issue. The objective of this study was to determine the prevalence and correlates of depression among school-going adolescents in Malaysia. Data from the Malaysia Global School-based Health Survey (GSHS) 2012 were analyzed with additional data from the validated DASS21 (Depression, Anxiety, and Stress) questionnaire. The study revealed that 17.7% of respondents had depressive symptoms. Multivariate analysis further showed that feeling lonely (adjusted odds ratio [aOR] = 2.99; 95% CI = 2.57-3.47), Indian ethnicity (aOR = 2.00; 95% CI = 1.63-2.44), using drugs (aOR = 1.85; 95% CI = 1.21-2.82), and being bullied (aOR = 1.79; 95% CI = 1.60-1.99) were significantly associated with depressive symptoms. Lack of parental supervision, alcohol use, and tobacco use were also significant risk factors. Addressing depressive symptoms among adolescents may have implications for managing their risks of being bullied and substance use. This study also highlights the need to further investigate depressive symptoms among adolescents of Indian ethnicity.

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The present cross sectional study was carried out on 787 type 2 diabetic subjects from tertiary health care hospitals to identify the prevalence and predictors of depression in diabetes. Depression was tested using Patient Health Questionnaire-9. Of the study participants, 199 (25.29%) met the criteria for mild to moderate depression, 252 (32.02%) were severely depressed and 336 (42.69%) were clinically non-depressed. The prevalence of depression was 65.02 % in women, which is 1.87 fold higher (p < 0.0001) than men (49.87%). Depression was observed to be strongly associated with advancing age >30 years (p < 0.05), low income (p = 0.0001), sedentary life style (p = 0.001), Plasma levels of low density lipoproteins (LDL) >100 mg/dl and triglycerides (TG) >150 mg/dl (p < 0.05), drinking alcohol (p < 0.001), statin use (p < 0.001), BMI >35-39.9 kg m(-2) (p = 0.018), WHR >0.9 cm (p < 0.0001), Glucose levels >125 mg/dl (p < 0.0001) and duration of diabetes 2-4 years (p = 0.003). In multivariate logistic regression model, risk factors such as, being a woman, duration of diabetes ≥10 years, BMI ≥30 kg m(-2), LDL >100 mg/dl, TG >150 mg/dl and sedentary life style emerged as independent predictors of depression in diabetes. In the present study, 86.4 % diabetic subjects were not diagnosed for depression prior participation. In conclusion, the present study revealed that higher prevalence of depression in diabetes was evident in population of Punjab, especially in women and majority of these patients remain undiagnosed for depression.

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