Association between diabetes mellitus and depressive symptoms in the Brazilian population

Abstract

OBJECTIVE: To determine the prevalence of current depressive symptoms in people with diabetes mellitus and their association with the disease. METHODS: Data were collected from the Brazilian National Health Survey (Pesquisa Nacional de Saúde – PNS), a cross-sectional, population-based study conducted in 2013. Study participants were selected by simple random cluster sampling in three stages: census tracts, households, and residents aged ≥ 18 years. The presence of diabetes was self-reported, whereas the presence of current depressive symptoms was determined by the Patient Health Questionnaire–9 (PHQ-9) and mean scores of this questionnaire were calculated for the variables assessed. Tobit regression was used to evaluate variation in these individuals. RESULTS: Of the 60,202 interviewees, 6.03% (n = 3,636) reported diabetes mellitus. The disease was more frequent in female, older, widowed, obese and with incomplete elementary education. Depression symptoms were mild-to-moderately severe in 22% of the diabetics. The severity of current depressive symptoms was higher in individuals that were female (PHQ-9 mean = 3.35), older adults (PHQ-9 mean = 3.01), indigenous (PHQ-9 mean = 3.46), separated/divorced (PHQ-9 mean = 3.13), widowed (PHQ-9 mean = 3.39), obese (PHQ-9 mean = 3.13) and with incomplete primary education (PHQ-9 mean = 3.21). Higher severity of depressive symptoms was associated with the use of insulin and with coma (PHQ-9 mean = 8.32), limb amputation (PHQ-9 mean = 7.55), circulatory problems (PHQ-9 mean = 6.94), infarction (PHQ-9 mean = 6.83), diabetic foot (PHQ-9 mean = 6.62), and kidney problems (PHQ-9 mean = 6.68). The severity of current depressive symptoms was associated with diabetes severity and degree of limitation in activities of daily living (PHQ-9 mean = 10.62).

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“…The data described in the literature shows a co-prevalence of diabetes and depression ranging from 17.6 to 21% [39,40]. In Brazil, the prevalence of depression in patients with diabetes, in usual situations, appears to be similar to that found in other countries, reaching 22% in the most recently published study [41]. Considering the current scenario, a study by Huang et al in China showed a prevalence of anxiety and depression in the general population of 35% and 20%, respectively [42].…”

Depressive Symptoms among Patients with Diabetes in Qatar: Frequency and Potential Determinants

“…An examination of impact of using insulin on developing major depressive disorder among people with type 2 diabetes, found a higher prevalence of depression among patients using insulin [ 10 ]. Another study found a higher severity of depression among patients with diabetes who use insulin [ 17 ]. These gaps in the results may be due to differences in doses and types of combinations with other diabetes medications.…”

“…The final total PHQ-9 score indicates the severity of depressive symptoms. A score of 0–4 indicates no or minimal depression, 5–9 points equates to mild depression, 10–14 points highlights there being moderate depression, and 15–19 points is indicative of severe depression [ 17 ]. A PHQ-9 score of ≥10 was used to define an incidence of the depressive symptoms.…”

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“…Por exemplo, a percepção de um baixo nível de qualidade de vida é encontrada em indivíduos com altos níveis de sintomas depressivos. Nesse sentido, a melhora ou a redução nos sintomas da depressão proporcionaria uma melhora na qualidade de vida (Briganti et al, 2019;Zanoveli et al, 2016;Lopez et al, 2011).…”