Prevalence, Severity and Determinants of Depression in Patients with Type 2 Diabetes Mellitus

摘要

Patients with Type 2 Diabetes Mellitus (T2DM) are at higher risk to develop depression.Depression in turn adversely affects glycaemic control and increases the risk of diabetes-related complications and mortality.There is a large variation among Indian studies on prevalence of depression in T2DM and associated risk factors.Aim: To assess the prevalence, severity, and determinants of depression among patients with T2DM.Materials and Methods: The study was conducted at a Tertiary Care Hospital during February 2018-February 2019, in North-Indian state of Uttarakhand.Study subjects were patients with T2DM, age >18 years.Based on exclusion and inclusion criterias, a total sample of 290 patients were studied.Presence of depression was assessed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.Hamilton Depression Rating Scale (HAM-D) was used to estimate the severity of depression.Unpaired t-test and Mann-Whitney U test were used to compare continuous variables between subjects with and without depression.Chi-Square test was used to analyse categorical data.Binary logistic regression analysis was used to study the association between likelihood of depression and predictor variables.Results: Among 290 (155 males and 135 females, mean age of all subjects 58.2±11.08 years) study subjects with T2DM, 64 (22.1%) were found to have depression using DSM-5 criteria.Out of these 64 patients with depression, 46 were detected to have mild depression, 14 moderate depression and 4 severe depression using HAM-D scale.Subjects with T2DM and depression had: higher proportion of females (62.5% vs.42.0%; p-value 0.004); lower literacy level (53.1% vs.67.3%; p-value 0.037); higher frequency of diabetic retinopathy (85.9% vs.62.8%; p-value <0.001) and diabetic kidney disease (43.8% vs.27.4%; p-value 0.013); higher Fasting Plasma Glucose (FPG) (217.7±94.62 vs.190.0±76.45 mg/dL; p-value 0.040); and lower haemoglobin (10.8±2.49 vs.11.7±2.37 gm/dL; p-value 0.010) compared to the subjects without depression.On binary logistic regression analysis, female gender (OR 2.457, 95% CI 1.368- 4.413, p-value 0.003) and diabetic retinopathy (OR 3.842, 95% CI 1.788-8.255, p-value 0.001) remained significantly associated with likelihood of depression.Conclusion: Depression was present in one-fifth of the study subjects with T2DM.Majority of them had mild depression.Female gender and diabetic retinopathy were associated with increased likelihood of depression.