Abstract
SummaryObjectiveTo compare depressive symptomatology as assessed by two frequently used measures, the Beck Depression Inventory (BDI‐1A) and Patient Health Questionnaire (PHQ‐9).MethodsInvestigators conducted a cross‐sectional secondary analysis of data collected as part of the follow‐up observational phase of the Look AHEAD study. Rates of agreement between the BDI‐1A and PHQ‐9 were calculated, and multivariable logistic regression was used to examine the relationship between differing depression category classifications and demographic factors (ie, age, sex, race/ethnicity) or comorbidities (ie, diabetes control, cardiovascular disease).ResultsA high level of agreement (κ = 0.47, 95% CI (0.43 to 0.50)) was found in the level of depressive symptomatology between the BDI‐1A and PHQ‐9. Differing classifications (minimal, mild, moderate, and severe) occurred in 16.8% of the sample. Higher scores on the somatic subscale of the BDI‐1A were significantly associated with disagreement as were having a history of cardiovascular disease, lower health‐related quality of life, and minority racial/ethnic classification.ConclusionsEither the BDI‐1A or PHQ‐9 can be used to assess depressive symptomatology in adults with overweight/obesity and type 2 diabetes. However, further assessment should be considered in those with related somatic symptoms, decreased quality of life, and in racial/ethnic minority populations.
Highlights
Depression is 60% more common in individuals with type 2 diabetes than in the general population and is associated with numerous poor health behaviors including physical inactivity and higher dietary fat intake.[1,2] Individuals suffering from depression are at increased risk of adverse cardiovascular outcomes in addition to workplace absenteeism, unemployment, and disability.[3-5]
To gain understanding of differences found based on BDI1A score, a refined multivariable logistic regression analysis was conducted using the cognitive and somatic subscales of the Beck Depression Inventory (BDI)-1A modeling the probability of differing classifications between the BDI1A and PHQ-9
Comparisons revealed a high level of agreement (83%) between measures (κ=0.47) in the classification of depressive symptoms. These results are similar to those found in studies that have compared the BDI-1A and PHQ-9 in other disease states with kappa's ranging from 0.24 to 0.64.29-32 the BDI-1A has historically been considered the optimal measure of depressive symptoms, the PHQ-9 is briefer and available at no cost, which may be advantageous to many healthcare providers and those working with resource-limited populations
Summary
Depression is 60% more common in individuals with type 2 diabetes than in the general population and is associated with numerous poor health behaviors including physical inactivity and higher dietary fat intake.[1,2] Individuals suffering from depression are at increased risk of adverse cardiovascular outcomes in addition to workplace absenteeism, unemployment, and disability.[3-5]. Depression is 60% more common in individuals with type 2 diabetes than in the general population and is associated with numerous poor health behaviors including physical inactivity and higher dietary fat intake.[1,2]. Individuals suffering from depression are at increased risk of adverse cardiovascular outcomes in addition to workplace absenteeism, unemployment, and disability.[3-5]. Depression increases the activation of the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, and proinflammatory cytokines, resulting in elevated serum glucose levels.[6]. Only half of patients with diabetes and major depression are recognized as depressed by their primary care provider.[7]. This may relate to these conditions’ overlapping symptoms including fatigue, appetite changes, and decreased libido.[8,9]. This may relate to these conditions’ overlapping symptoms including fatigue, appetite changes, and decreased libido.[8,9] Brief and easy-to-administer screening questionnaires for individuals with diabetes are critical to improve surveillance of depression.[10]
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