Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries: results from the INTERPRET-DD prospective study.

Cathy E Lloyd ,B Mankovsky,Andrzej Kiejna ,David M Ndetei ,Santosh K Chaturvedi ,Golam Rabbani ,А Е Бобров ,Umberto Valentini ,Е Г Старостина ,Thummala Kamala ,Karsten Müssig ,Edoardo Mannucci ,М.v Shevchuk ,Helal Uddin Ahmed ,Silver Bahendeka ,Andrzej Kokoszka ,Karen Van Dam ,Lorenzo Burti ,Giovanni De Girolamo ,Arie Nouwen ,Victoria Mutiso ,Norman Sartorius ,A.a Khan ,Adriana Álvarez ,Martin Heinze ,Rizwan Taj ,Wolfgang Gäebel ,Mónica Guinzbourg ,Nebojša Lalić ,S Srikanta ,Dušica Lečić-Toševski ,Olivera Vuković ,Tomasz Gondek ,Wolfgang Wölwer

doi:10.1017/s2045796020000438

Abstract

To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries. People with type 2 diabetes treated in out-patient settings aged 18-65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of 'upset') between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables. In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS. This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.

Highlights

It is well-known that the prevalence of both diabetes and mental health problems is increasing rapidly, with a greater risk for depression in people with diabetes compared to those without (Nouwen, 2010; 2015; Lloyd et al, 2012; Roy and Lloyd, 2012; Mommersteeg et al, 2013; Salinero-Fort et al, 2018)
The treating physician or diabetologist in the diabetes clinic invited individuals to participate in the study
Diabetes distress scores were higher in participants compared to non-participants (17.9 ± 18.4 v. 16.1 ± 18.3; Mann–Whitney test p < 0.05), and the number of complications was higher in participants than non-participants (1.05 ± 1.38 v. 0.81 ± 1.04; p < 0.001); PHQ-9 scores did not differ significantly between those who participated in the follow-up and those who did not

Summary

Introduction

It is well-known that the prevalence of both diabetes and mental health problems is increasing rapidly, with a greater risk for depression in people with diabetes compared to those without (Nouwen, 2010; 2015; Lloyd et al, 2012; Roy and Lloyd, 2012; Mommersteeg et al, 2013; Salinero-Fort et al, 2018). The combination of diabetes and depression has a far greater impact on well-being compared with depression and other comorbid diseases (Moussavi et al, 2007). There is evidence that depression can be treated successfully with both psychological and pharmacological interventions in people with diabetes (van der Feltz-Cornelis et al, 2010; Nicolau et al, 2013); more research is required to clarify which factors predict the onset of this condition. There are extra challenges given that emotional distress may be present in people with diabetes due to difficulties with the sometimes overwhelming requirements of self-management which can, in turn, impact on and be influenced by depression (van der Feltz-Cornelis et al, 2010; Baumeister et al, 2012; Petrak et al, 2015). We aimed to identify specific risk factors for the onset of diagnosed depression as well as depressive symptoms in this cohort of individuals with type 2 diabetes

Methods

Results

Conclusion