Abstract
BackgroundAdults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetes-related distress (DD). Low socioeconomic level is associated with increased risk of poor self-management, treatment difficulties and psychological distress. The goals of this study were to document the frequency of major depressive disorder (MDD), high depressive symptoms and high DD, to assess levels of empowerment and to determine the association with each of these measures and glycemic control in a low-income Brazilian sample of adults with T1D.MethodsIn a cross-sectional study, inclusion criteria were age > 18 years and diagnosis of T1D > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, severe diabetes-related complications and pregnancy. Diagnoses of MDD were made using interview-based DSM-5 criteria. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The Diabetes Distress Scale (DDS) assessed DD. Empowerment levels were evaluated by the Diabetes Empowerment Scale short form (DES-SF). Glycemic control was measured by HbA1c. The latest lipid panel results were recorded. Number of complications was obtained from medical records.ResultsOf the 63 T1D patients recruited, 36.5% were male, mean age was 31.5 (± 8.9), mean number of complications was 1 (± 1.1), and mean HbA1c was 10.0% (± 2). Frequency of MDD was 34.9% and 34.9% reported high depressive symptoms. Fifty-seven percent reported clinically meaningful DD. High diabetes regimen distress and low empowerment were associated to HbA1c (p = 0.003; p = 0.01, respectively). In multivariate analyses, lower empowerment levels were associated to higher HbA1c (beta − 1.11; r-partial 0.09; p value 0.0126). MDD and depressive symptoms were not significantly correlated with HbA1c in this expected direction (p = 0.72; p = 0.97, respectively).ConclusionsThis study showed high rates of MDD, high depressive symptoms and high DD and low levels of empowerment in this low income population. Empowerment and diabetes regimen distress were linked to glycemic control. The results emphasize the need to incorporate the psychological and psychosocial side of diabetes into strategies of care and education for T1D patients.
Highlights
Adults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetesrelated distress (DD)
The goals of this study were [1] to document the frequency of clinical depression, depression symptoms and DD, [2] to assess levels of empowerment, and [3] to determine the association between each of these measures and glycemic control in this low resource, Brazilian population of adults with T1D
The current study found a high frequency of major depressive disorder (MDD), high depressive symptoms, high DD, and low levels of empowerment in this population of low socioeconomic sample (SES) T1D adults seen in a tertiary care center in Brazil
Summary
Adults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetesrelated distress (DD). Low socioeconomic level is associated with increased risk of poor self-management, treatment difficulties and psychological distress. Abundant evidence has shown that adults with type 1 diabetes (T1D) have a high risk for developing clinical depression and elevated depressive symptoms [1,2,3,4,5]. Living with T1D, the exhaustive demands of daily self-management and dealing with the possibility of developing chronic complications are associated with an increased risk of psychological distress [10, 11]. Low socioeconomic level is significantly associated with increased risk of poor self-management, treatment difficulties and psychological problems [12,13,14]
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