Diabetes and depression comorbidity and socio-economic status in low and middle income countries (LMICs): a mapping of the evidence

Ernestina Coast,Shilpa Narayanan,Ama De Graft Aikins,Tiziana Leone

doi:10.1186/1744-8603-8-39

Ernestina Coast, Shilpa Narayanan + Show 2 more

Open Access

https://doi.org/10.1186/1744-8603-8-39

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Abstract

Non-communicable diseases account for more than 50% of deaths in adults aged 15–59 years in most low income countries. Depression and diabetes carry an enormous public health burden, making the identification of risk factors for these disorders an important strategy. While socio-economic inequalities in chronic diseases and their risk factors have been studied extensively in high-income countries, very few studies have investigated social inequalities in chronic disease risk factors in low or middle-income countries. Documenting chronic disease risk factors is important for understanding disease burdens in poorer countries and for targeting specific populations for the most effective interventions. The aim of this review is to systematically map the evidence for the association of socio-economic status with diabetes and depression comorbidity in low and middle income countries. The objective is to identify whether there is any evidence on the direction of the relationship: do co-morbidities have an impact on socio-economic status or vice versa and whether the prevalence of diabetes combined with depression is associated with socio-economic status factors within the general population. To date no other study has reviewed the evidence for the extent and nature of this relationship. By systematically mapping the evidence in the broader sense we can identify the policy and interventions implications of existing research, highlight the gaps in knowledge and suggest future research. Only 14 studies were found to analyse the associations between depression and diabetes comorbidity and socio-economic status. Studies show some evidence that the occurrence of depression among people with diabetes is associated with lower socio-economic status. The small evidence base that considers diabetes and depression in low and middle income countries is out of step with the scale of the burden of disease.

Highlights

Global burden of diabetes, depression and comorbidities Diabetes causes 4.6 million deaths per year, accounting for 8.2% of global all-cause mortality, and it is estimated that 366 million adults have diabetes [1]
52 items were screened for inclusion on the basis of a review of their full text, after which a total of just 14 studies were selected for inclusion in the mapping
The main reason for exclusion at this stage was that an association between depression-diabetes comorbidity and socio-economic status (SES) was not sought or diabetes and depression cases were considered as separate diseases in two different populations rather than as a comorbidity (e.g.: diabetic patients with depression or viceversa) in a specific group of people

Summary

Introduction

Depression and comorbidities Diabetes causes 4.6 million deaths per year, accounting for 8.2% of global all-cause mortality, and it is estimated that 366 million adults have diabetes [1]. The global mortality burden of diabetes is not evenly distributed, with low and middle income countries carrying a disproportionate burden. The age distribution of adults with diabetes differs by country. In this study we look at the copresence of diabetes and depression regardless of whether diabetes or depression is the primary disorder. The identification of co-morbidities is fundamental in order to understand whether the primary disorder or disease might either cause or affect the secondary one and to understand any association between the two

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