The association between diabetes and depressive symptoms varies by quality of diabetes care across Europe

Abstract

BackgroundDepressive symptoms are more common in adults with diabetes and may arise from the physical and psychosocial burden of disease. Better quality of diabetes care may be associated with a reduced disease burden and fewer depressive symptoms.MethodsThis cross-sectional study included 34 420 participants from 19 countries in the European Social Survey Round 7 (2014–2015). Countries were grouped into quartiles based on their quality of diabetes care as measured in the Euro Diabetes Index 2014. Individual-level depressive symptoms were measured using the 8-item Center for Epidemiologic Studies—Depression Scale. Negative binomial regression was used to compare the number of depressive symptoms between adults with and without diabetes in each quartile of diabetes care quality. Analyses included adjustment for covariates and survey weights.ResultsIn countries with the highest quality of diabetes care, having diabetes was associated with only a 3% relative increase in depressive symptoms (95% CI 1.00–1.05). In countries in the second, third and fourth (lowest) quartiles of diabetes care quality, having diabetes was associated with a 13% (95% CI 1.08–1.17), 13% (1.08–1.19) and 22% (1.14–1.31) relative increase in depressive symptoms, respectively.ConclusionThe association between diabetes and depressive symptoms appears stronger in European countries with lower quality of diabetes care. Potential pathways for this association include the financial aspects of diabetes care, access to services and differential exposure to the social determinants of heath. Further research is needed to unpack these mechanisms and improve the quality of life of people with diabetes across Europe.

Glycaemic status and depressive symptoms among adults in Germany: results from the German Health Interview and Examination Survey for Adults (DEGS1)

“…Effective diabetes management and depressive symptoms appear inter‐connected. In a large study including over 30 000 participants from 19 European countries, the association between diabetes and depressive symptoms appears stronger in countries with lower quality of diabetes care . Associations between knowledge of diabetes diagnosis and depressive symptoms and health‐related quality of life are moderated by sociodemographic factors and social support and depressive symptoms among people with Type 2 diabetes may be attributed to health‐related quality of life, rather than to glucose metabolism .…”

Epidemiology of undiagnosed depression in people with diabetes mellitus: a comparative analysis of Ireland, England and the USA

“…This was surprising, given the overall quality of diabetes care in England compared with other countries. 16 33 34 Possible population and healthcare professional factors should be examined to better understand the increased odds of undiagnosed depression among people with diabetes in England. Results from the USA were consistent with the limited available evidence that diabetes is associated with increased access to depression diagnosis.…”

“…15 Specifically, in countries scoring in the highest quartile, having diabetes was associated with a 3% relative increase in depressive symptoms (95% CI 1.00 to 1.05) compared with a 22% (1.14–1.31) relative increase in countries scoring within the lowest quartile of diabetes care quality. 16 The authors suggested related pathways for this association may include financial aspects of diabetes care, access to services and differential exposure to social determinants of health. These findings suggest that improved quality of diabetes care may reduce some of the psychological burden associated with living with diabetes.…”

“…These findings suggest that improved quality of diabetes care may reduce some of the psychological burden associated with living with diabetes. 16 Countries vary in the extent to which psychosocial care is integrated into diabetes care. 17 In 2012, approximately 70% of diabetes health professionals surveyed in the UK indicated major improvements were needed in the provision of psychological support and care compared with approximately 50% of US counterparts.…”

Information, Motivation and Behavioural Factors in Influencing Diabetes Self-Care: A Conceptual Paper

“…Depression among women workers may be associated to burden of having diabetes while maintaining a career which might affects their daily life. Likewise, responsibility to family and children may afflict women in managing diabetes (Aliaga, 2006;Graham, Thomson & Bambra, 2018).…”