Prevalence of Depression among Patients with Type 2 Diabetes Mellitus and its associated Clinical Factors
Introduction. Type 2 diabetes mellitus has been linked to depression. However, this has been largely unrecognized and untreated. There are no current data available in the Philippine setting of the prevalence of the disease.
Objective. The objective of the study was to determine the prevalence of depression among adult Filipino patients with type 2 diabetes mellitus and investigate the different clinical factors associated with it.
Methodology. This is a single-center, analytic cross-sectional study conducted at a tertiary hospital, with 476 patients aged above 18 years old diagnosed with type 2 Diabetes Mellitus included. The Physicians Health Questionnaire 9 (PHQ-9) with a score of >5 was used to make a diagnosis of depression.
Results. Prevalence of depression among patients with type 2 diabetes mellitus was 19.9%. Factors associated with increased odds of depression were having a post-graduate degree (p-value=0.012), presence of retinopathy (p-value=0.018), and higher MMA Score (lower adherence) (p-value=0.000).
Conclusion. Depression is prevalent among Filipino patients with type 2 diabetes mellitus. An integrated approach by the attending physicians and psychiatrists is required for the effective management of these patients.
Shera AS, Jawad F. Basil A. Diabetes related knowledge, attitude and practices of family physicians in Pakistan. J Pak Med Assoc.2002;52(10):465-70. PMID: 12553676.
Tovilla-Zárate C, Juárez-Rojop I, Peralta Jimenez Y, et al. Prevalence of anxiety and depression among outpatients with type 2 diabetes in the Mexican population. PloS One. 2012;7(5):e36887. PMID: 22629339. PMCID: PMC3356343. https://doi.org/10.1371/journal.pone.0036887.
Bartoli F, Carrà G, Crocamo C., et al. Association between depression and neuropathy in people with type 2 diabetes: A meta‐analysis. Int J Geriatr Psychiatry. 2016;31(8):829-36. PMID: 26729627. https://doi.org/10.1002/gps.4397.
Al-Amer RM, Sobeh MM, Zayed AA, Al-Domi HA. Depression among adults with diabetes in Jordan: Risk factors and relationship to blood sugar control. J Diabetes Complications. 2011;25(4):247-52. PMID:21601482. https://doi.org/10.1016/j.jdiacomp.2011.03.001.
Zhang W, Xu H, Zhao S, et al. Prevalence and influencing factors of co-morbid depression in patients with type 2 diabetes mellitus: A general hospital based study. Diabetol Metab Syndr. 2015;7:60. PMID: 26167205. PMCID: PMC4499190. https://doi.org/10.1186/s13098-015-0053-0.
Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care. 2003;26(10):2822-8. PMID:14514586. https://doi.org/10.2337/diacare.26.10.2822.
Engum A, Mykletun A, Midthjell K, Holen A, Dahl AA. Depression and diabetes: A large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes. Diabetes Care. 2005;28(8):1904-9. PMID: 16043730.
Kroenke K, Spitzer RL, Williams JB. The PHQ‐9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13. PMID: 11556941. PMCID: PMC1495268. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.
Moon SJ, Lee WY, Hwang JS, Hong YP, Morisky DE. Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8. PloS One. 2017;12(11):e0187139. PMID: 29095870. PMCID: PMC5667769.
Garabiles MR, Lao CK, Yip P, Chan EWW, Mordeno I, Hall BJ. Psychometric validation of PHQ–9 and GAD–7 in Filipino migrant domestic workers in Macao (SAR), China. J Pers Assess. 2019:30:1-12. PMID: 31361153. https://doi.org/10.1080/00223891.2019.1644343.
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91. PMID: 17695343.
Perlas AP, Briones-Querijero MM, Abcede D, et al. The prevalence of psychiatric disorders among the chronically-ill medical patients in selected tertiary hospitals in the Philippines. Philipp J Psychiatry. 2004;28:17-24. PCHRDPC050267.
Nieva SJD, Capellan MLD, Montano CN. Prevalence and risk factors for depression among Filipino adults with diabetes mellitus type 2 at the Makati Medical Center Outpatient Department. Philipp J Int Med. 2017;55(2):1-10. https://www.pcp.org.ph/images/PJIM/PJIM_2017_Vol55_No2/Final_Layout_2016029_Prevalence_and_Risk_Factors_for_Depression_Among_Filipino_Adults.pdf.
Varma P, Kant R. Mishra PP. Depression in type 2 diabetes
mellitus: A cross-sectional study in tertiary teaching hospital in India.J Diab Endocrinol Assoc Nepal. 2018;2(1):24-8. https://doi.org/10.3126/jdean.v2i1.21196.
Al-Ghandi AA. A high prevalence of depression among
diabetic patients at a teaching hospital in Western Saudi Arabia. Neurosciences (Riyadh). 2004;9(2):108-12. PMID: 23377362.
Sweileh WM, Abu-Hadeed HM, Al-Jabi SW, Zyoud SH. Prevalence of depression among people with type 2 diabetes mellitus: A cross-sectional study in Palestine. BMC Public Health. 2014;14(1):163. PMID: 24524353. PMCID: PMC3929146. https://doi.org/10.1186/1471-2458-14-163.
Salinero-Fort MA, Gómez-Campelo P, San Andrés-Rebollo FJ, et al. Prevalence of depression in patients with type 2 diabetes mellitus in Spain (the DIADEMA Study): Results from the MADIABETES cohort. BMJ Open. 2018;8(9): e020768. PMID: 30249627. PMCID:PMC6157517. https://doi.org/10.1136/bmjopen-2017-020768.
Calvín JLR, Gaviria AZ, Ríos MM. Prevalence of depression in type 2 diabetes mellitus 2. Revista Clínica Española (English ed).2015;215(3):156-64. https://doi.org/10.1016/j.rce.2014.10.010.
Champaneri S, Wand GS, Malhotra SS, Casagrande SS, Golden SH. Biological basis of depression in adults with diabetes. Curr Diab Rep. 2010;10(6):396-405. PMID: 20878274. https://doi.org/10.1007/s11892-010-0148-9.
Sadeghi A, Hami J, Razavi S, Esfandiary E, Hejazi Z. The effect of diabetes mellitus on apoptosis in hippocampus: Cellular and molecular aspects. Int J Prev Med. 2016;7:57. PMID: 27076895. PMCID: PMC4809120. https://doi.org/10.4103/2008-7802.178531.
Pickup JC. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care. 2004;27(3):813-23. PMID: 14988310. https://doi.org/10.2337/diacare.27.3.813.
Laake JP, Stahl D, Amiel SA, et al. The association between depressive symptoms and systemic inflammation in people with type 2 diabetes: Findings from the South London Diabetes Study. Diabetes Care. 2014;37(8):2186-92. PMID: 24842983. https://doi.org/10.2337/dc13-2522.
Gold SM, Dziobek I, Sweat V, et al. Hippocampal damage and memory impairments as possible early brain complications of type 2 diabetes. Diabetologia. 2007;50(4):711-9. PMID: 17334649. https://doi.org/10.1007/s00125-007-0602-7.
Jacobson AM, Samson JA, Weinger K, Ryan CM. Diabetes, the brain, and behavior: Is there a biological mechanism underlying the association between diabetes and depression? Int Rev Neurobiol. 2002;51:455-79. PMID: 12420367.
Brummett BH, Boyle SH, Ortel TL, Becker RC, Siegler IC, Williams RB. Associations of depressive symptoms, trait hostility, and gender with C-reactive protein and interleukin-6 response following emotion recall. Psychosom Med. 2010;72(4):333-9. PMID: 20190126. PMCID:PMC2869533. https://doi.org/10.1097/PSY.0b013e3181d2f104.
Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: The search for shared mechanisms. Lancet Diabetes Endocrinol. 2015;3(6):461-71. PMID: 25995124. https://doi.org/10.1016/S2213-8587(15)00134-5.
Copyright (c) 2019 Journal of the ASEAN Federation of Endocrine Societies
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to firstname.lastname@example.org or email@example.com.
A written agreement shall be emailed to the requester should permission be granted.