Psychosocial factors contributing to persistent depressive symptoms in type 2 diabetic patients: a Croatian survey from the European Depression in Diabetes Research Consortium

Abstract

Objective The study was aimed at exploring a 1-year course of depression in persons with type 2 diabetes and analysing demographic, disease-related, and psychological variables that may predict persistent depressive symptoms. Patients and methods One hundred patients from a randomly selected sample of 470 outpatients were found to be suffering from severe depressive symptoms. They were followed and re-examined for depression after 1 year. Baseline depression was assessed by the Center for Epidemiologic Studies—Depression scale (CES-D) and a face-to-face diagnostic interview relying on the DSM-IV. Nonparametric tests for between-group differences were used to compare patients who recovered from depression with those who still suffered from severe depressive symptoms. Multiple logistic regression was used to determine predictors of depression persistence. Results Seventy-nine of 100 patients with baseline depression scores indicative of severe depression were reached at 1-year follow-up. Among them, 53% were shown to have improved depressive symptoms to CES-D <16, while 47% continued to suffer from severe depressive disturbances (CES-D ≥16). Logistic regression analysis indicated that psychosocial variables predicted persistently elevated depressive symptoms better than demographic and diabetes-related ones. Clinical depression at baseline (OR=3.8, CI 1.31–10.98, P=.01), diabetes-related distress (OR=3.3, CI 1.01–10.98, P=.05), and social and physical quality-of-life aspects (OR=0.92, CI 0.88–0.97, P=.0005 and OR=0.94, CI 0.90–0.98, P=.002, respectively) were shown to be independent predictors of 1-year depression outcomes. Conclusions Severity of baseline depression, a degree to which depression disrupted the patients' quality of life, and concomitant emotional problems related to diabetes were shown to be associated with persistently elevated depressive symptoms.