Depression and diabetes in a rural community in Pakistan

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Abstract

Aims

To determine the prevalence of depression amongst subjects with diabetes and associated risk factors in a rural area of Pakistan.

Methods

One thousand two hundred and ninety rural individuals aged 20 years and above were randomly included in the study. Fasting plasma glucose (FPG), BMI, WHR were recorded. Depression was assessed by Montgomery-Asberg Depression Rating Scale (MADRS).

Results

The prevalence of depression was 5.4% (95% CI: 4.2–6.6), slightly higher amongst women compared to men. Depression prevalence was 14.7% (6.6–22.8) amongst those with diabetes as opposed to 4.9 (3.7–6.1) amongst those without diabetes. Age, gender, and diabetes were independent risk factors for depression, while obesity had a protective effect.

Conclusions

A relatively low prevalence of depression were recorded amongst the rural inhabitants, while a high prevalence was observed amongst diabetic subjects in Pakistan. This may suggest that psychiatric intervention may be required both for improved care and for primary prevention of diabetes.

Introduction

Depression, an increasing health threat, has been found to frequently co-exist with diabetes, hyperglycaemia and diabetes-related complications [1], [2], [3]. Adults with depression have a 37% increased risk of developing type 2 diabetes [4]. Further evidence suggests that depression yields a negative impact on glycaemic control [2], [5]. Conversely, studies have indicated that better glycaemic control in subjects with type 2 diabetes lead to fewer physical symptoms, better mood, and well being [6].

The diabetes prevalence is increasing worldwide, and World Health Organization (WHO) predicts that in 2025 there will be 300 million people with this disease [7], [8]. Highest increase in the prevalence of T2D is predicted to occur in South Asian countries and migrants in the west from this part of the globe. Diabetes is highly prevalent amongst Pakistanis in the Western Europe [9] and Pakistan will rank as the fourth highest diabetic populous country in the world by 2025 [7]. A study from Norway showed that women form South Asian, mainly Pakistanis, had almost a 10-fold higher prevalence of diabetes than their western counterparts [10].

One study from Bangladesh has shown that the co-existence of diabetes and depression is highly prevalent and that depression was found to remain as an important independent risk factor for diabetes [11].

The association of depression and diabetes has been found by several [12], but the validity of these findings between different cultures and communities remains to be shown. To our knowledge, data on depression in South Asia is inadequately addressed and far less in type 2 diabetes patients. Previous studies on depression and diabetes, which was largely conducted in the western culture, may underestimate the risk of depression in eastern communities.

The epidemiology of depression in Pakistan is inadequately investigated. To the best of our knowledge, data on the prevalence of depression amongst diabetes population in Pakistan is almost non-existent. We therefore examined the state of depression in subjects with diabetes in a rural population in Pakistan. Furthermore, the risk factors for the condition were also assessed.

Section snippets

Research design and methods

The study was conducted during the months of March to July 2006. The subjects were enrolled from an area called Kharian, about 150 km south of the capital Islamabad from where most of the Pakistani migrants in Norway originate. Villages that had experienced considerable emigration to Europe and America were excluded from the survey to secure rural life style in Pakistan.

Participants were recruited by cluster sampling from 44 villages. The methods of the survey were described in details elsewhere

Data analysis and statistical methods

All statistical analyses were done using SPSS 12.0. The prevalence rates were determined by simple percentages and were presented with 95% Confidential Intervals. Logistic regressions were performed to adjust for potential confounding factors in the assessment of risk factors. All tests performed were two tailed.

Results

The mean age of the subjects was 44 years. Subjects either with diabetes or depression or both had significantly higher age compared to the healthy subjects. The prevalence of depression was 5.4% (Table 1). Amongst those with diabetes, the prevalence of depression was almost three times higher compared to the entire cohort. On the other hand, the prevalence of diabetes was three-fold higher in the depressed subjects compared to the entire sample.

The risk of having depressive symptom score more

Discussion

We found a relatively low prevalence of depression (5.8%) in this population compared to the previous studies in Pakistan where the prevalence of anxiety and depressive disorders was as high as 34% [17]. A resent paper showed also a very high prevalence of depression amongst rural dwellers in Northern-Pakistan which demonstrated that 60% of the women and 45% of the men had depressive symptoms [18]. A study in two villages in India showed a depression prevalence (7.4%) which was comparable with

Conclusion

The higher rate of depression in diabetes patients is an important finding, as depression has a negative impact on quality of life, and because depression leads to poor glycaemic control [2], [5], [6]. The combination of the two diseases also lead to an increase in health cost [22], this will be an important consideration as the prevalence of diabetes is estimated to rise in Asia where the economic burden of disease might become unbearable. The co-occurrence of depression and other mental

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