High Prevalence of Depressive Symptoms in Patients With Type 1 and Type 2 Diabetes in Developing Countries: Results From the International Diabetes Management Practices Study

Abstract

Depression is common in people with diabetes, but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS). RESEARCH DESIGN AND METHODSIDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the 9-item Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms. RESULTSOf 9,865 patients eligible for analysis, 2,280 had type 1 and 7,585 had type 2 diabetes (treatment: oral glucose-lowering drugs [OGLD] only, n 5 4,729; OGLDs plus insulin, n 5 1,892; insulin only, n 5 964). Depressive symptoms (PHQ-9 score $5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs-only, 36.6% for OGLDs-plus-insulin, and 46.7% for insulin-only subgroups. Moderate depressive symptoms (PHQ-9 score 10-19) were observed in 8-16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms. In type 1 diabetes and in the type 2 diabetes OGLDs-only group, depression was associated with poor glycemic control. CONCLUSIONSDepressive symptoms are common in patients with diabetes from developing countries, calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction.

Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1)

“…The prevalence of depression found in this study through the SCID-I is low in comparison with the estimates of some authors, who place the prevalence of depression in patients with T1D at around 30% [ 12 , 14 , 21 ]. Perhaps, for this reason, the positive predictive value (PPV) is not very high in any of the three scales, although it is high enough to assure that the DID-1 confirms the disease.…”

“…When assessing differences in DID-1 scores as a function of sample characteristics, we found that women scored worse than men on both the total scale score and the seven factors. These results are consistent with previous results and those found in the general population and in the population with diabetes, with a higher prevalence of depression in women [ 14 , 35 ]. With regard to complications, significant differences were found between those with physical illness and those without.…”

“…Therefore, given that the risk of developing T1D is not only higher but is also increasing [ 14 , 15 ], the need to detect depression in people with T1D is a priority, which makes the evaluation of depression in these people essential.…”

Factors Associated with Depressive Symptoms in Korean Adults with Diabetes Mellitus: A Cross-Sectional Study

“…Conversely, this study's prevalence of depressive symptoms was relatively lower than previous studies conducted with diabetic adults in other countries. An international crosssectional study conducted with the PHQ-9 in 21 developing countries reported moderate to severe depressive symptoms in 10.2% and 11.1% in adults with type 1 and type 2 diabetes, respectively [8]. In Indonesia, a cross-sectional survey using the PHQ-9 identified that 11.6% of adults with diabetes exhibited depressive symptoms (PHQ-9 score ≥ 10) [36].…”

“…A meta-analysis of 39 studies showed that the likelihood of depression in people with diabetes was twice that of people without diabetes [7]. Approximately 10-20% of people with diabetes experience depressive symptoms and are more likely to have a moderate to severe form of depression [8][9][10][11]. The high burden of diabetes complications and diabetes itself can increase the risk of depressive symptoms.…”