Prevalence and independent risk factors of depression in Chinese patients with type 2 diabetes: a systematic review and meta-analysis

Abstract

BackgroundStudies of the prevalence of depression in patients with type 2 diabetes in China have reported inconsistent findings. The purpose of this study was to assess the prevalence and independent risk factors of depression in patients with type 2 diabetes in China. MethodsWe did a systematic review and meta-analysis of papers published in PubMed (1980–2016), Embase (1980–2016), China National Knowledge Infrastructure (1999–2016), and Wanfang Medical database (1998–2016). We selected population-based, cross-sectional studies investigating the prevalence of depression in patients with type 2 diabetes in China. We used a random-effects meta-analysis to pool the prevalence and relative risks (RR) with 95% CIs. This study was registered at PROSPERO, number CRD42016039795. Findings26 studies published between May, 2003, and February, 2016, were included. The studies included 66 475 patients with type 2 diabetes in China. A meta-analysis of six studies comparing the depression prevalence in diabetes patients and healthy controls suggested that type 2 diabetes was associated with a doubled risk of depression in Chinese people (RR 2·06; 95% CI 1·46–2·92; p<0·0001). The overall prevalence of depression in people with type 2 diabetes in China was 28·9% (95% CI 20·5–39·1; 66 475 participants from 26 studies). There was heterogeneity in the prevalence of depression and meta-regression analysis suggested the heterogeneity was mainly attributable to differences in the methods used to assess depression. Meta-analysis of data by gender suggested that the prevalence of depression in men was 23·0% (95% CI 12·2–39·1; 24 390 participants from 11 studies), while the prevalence rate of depression in women was 27·8% (95% CI 17·1–41·9; 37 416 participants from 12 studies). Meta-analysis of data for risk factors of depression found several independent risk factors of depression in patients with type 2 diabetes: female sex (RR 1·53, 95% CI 1·16–2·02; p=0·0025), comorbidities (RR=3·57, 95% CI 2·08–6·13; p<0·0001), diabetic complications (RR 2·11, 95% CI 1·32–3·39; p=0·002), per 1 year increment in diabetes duration (RR 1·10, 95% CI 1·03–1·17; p=0·0049), high concentrations of HbA1c (RR 1·44, 95% CI 1·11–1·88; p=0·0068), and use of insulin (RR 2·08, 95% CI 1·28–3·37; p=0·0030). InterpretationWe found a high prevalence of depression in Chinese patients with type 2 diabetes. Patients with diabetes and depression should receive more attention than at present in the medical settings of China and effective interventions to decrease depression risk in patients with diabetes are needed. FundingNational Natural Science Foundation of China (number 81471004).