Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries: results from the INTERPRET-DD prospective study

Abstract

Aims To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries. Methods People with type 2 diabetes treated in out-patient settings aged 18–65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of ‘upset’) between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables. Results In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS. Conclusion This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.

Comorbidity Between Recent Diagnosis of Type 2 Diabetes and Non-Psychotic Psychiatric Disorders: Metabolic Characteristics and Clinical Correlates

“…This information is consistent with previous data about the higher prevalence of depressive, anxiety, and eating disorders in females compared with males in the general population. Several studies, 3 , 37–39 including a collaborative study in 14 countries reported that among T2D patients, women had increased odds of major depressive disorder than men (OR=1.96). 37 Also, a systematic literature review identified a different prevalence of BED according to sex (0–9.8% for women and 0–0.5%for men).…”

“…Several studies, 3 , 37–39 including a collaborative study in 14 countries reported that among T2D patients, women had increased odds of major depressive disorder than men (OR=1.96). 37 Also, a systematic literature review identified a different prevalence of BED according to sex (0–9.8% for women and 0–0.5%for men). 36 …”

Bi-directional Mendelian randomization and multi-phenotype GWAS show causality and shared pathophysiology between depression and type 2 diabetes

“…Diabetes distress, the psychological burden caused by dealing with having diabetes and having to care for it, has indeed been linked to depression 31 . However, a large international longitudinal study of 14 countries has shown that only depressive symptoms rather than MDD were predicted by diabetes distress one year after diagnosis 32 .…”

Depression in disabling medical conditions – current perspectives

“…Another 11-year cohort study examining risk factors for depression in type 2 diabetic patients (N = 50 590) suggests that depression is strongly associated with severity of disease progression, regardless of other potential covariates such as demographic status, comorbidities, or medication compliance (43). A multicentre European study carried out in 12 countries with type 2 diabetic patients also found that being female and less physically active significantly increases the risk of having major depressive disorder (44). Finally, a cohort study with 3240 patients suggested that being female and younger are risk factors for clinical depression associated with diabetes (45).…”