Psychiatric–Medical ComorbidityThe effect of major depression on preventive care and quality of life among adults with diabetes☆,☆☆,
Introduction
Diabetes is a chronic metabolic disease that affects approximately 7.8% of the United States population or 23.6 million people [1]. It is well documented that diabetes is associated with significant medical and psychiatric comorbidity, decreased mortality and increased health care utilization and cost [1]. There are also ample data demonstrating that depression is significantly higher among individuals with diabetes relative to the general population [2]. Although the direction of the relationship between diabetes and depression is unclear (i.e., whether depression is a consequence or a risk factor for diabetes), approximately 30% of adults with diabetes have comorbid clinical depression [3], [4], [5]. The link between depression and diabetes is particularly noteworthy in light of consistent findings that the presence of depression is associated with poor metabolic control, higher complication rates, increased health care use and cost, diminished quality of life, increased disability and lost productivity, and increased risk of death [3], [6], [7], [8], [9], [10], [11], [12], [13], [14].
To date, a number of studies have examined the association between depression and diabetes-specific self-care behaviors and found that depression has an adverse impact on a wide range of patient-initiated self-care activities. More specifically, depression among adults with diabetes is associated with decreased medication adherence [15], [16], [17], [18], decreased diabetes knowledge [19] and decreased adherence to dietary and physical activity recommendations [17], [18], [20], [21]. There are also data to show that even minor depression has a significant negative impact on diabetes-specific self-care behaviors and provider quality of care [22]. Although the link between depression and diabetes-specific health care behaviors is well documented, there is little extant data on how depression affects a broader range of preventive care practices in this population. In addition, although there is ample data to suggest that depression has a negative impact on quality-of-life indices such as physical, mental and social functioning [13], [14], [23], [24], few studies have examined the relationship between depression and variables such as perceived health status, life satisfaction and social support.
Therefore, the purpose of the current study was to examine the effect of depression on general preventive care behaviors and broader quality-of-life indices in a national sample of adults with diabetes. This study used data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) national survey [25] to determine whether a broad range of preventive care behaviors (i.e., not drinking excessively and receiving age-appropriate screenings for breast, cervical, prostrate and colorectal cancers) and quality-of-life indices (i.e., perceived health status, physical and mental health functioning, life satisfaction and social support) differed by depression status (i.e., major depression vs. no major depression). We hypothesized that individuals with major depression would be less likely to engage in general preventive health practices and to endorse poorer quality of life than individuals without major depression after controlling for relevant confounding variables.
Section snippets
Study setting and sample
We analyzed data from the 2006 BRFSS. The BRFSS is a state-based, random-digit-dialing telephone survey of the United States adult population sponsored by the Centers for Disease Control and Prevention [25]. The BRFSS uses a complex design involving stratification, clustering and multistage sampling to yield nationally representative estimates.
Demographic and socioeconomic characteristics
The BRFSS provides information on a wide range of demographic and background characteristics. For the purposes of the current study, we created four age
Results
The 2006 BRFSS sample included 351,968 adults who responded “yes” or “no” to the question about diabetes. Of this number, 35,834 had diabetes which represented a weighted proportion of 8.1% of the sample. Our final sample was composed of 16,754 participants with diabetes who had data on the PHQ-8. The prevalence of major depression in the study sample was 14.7%. The highest prevalence of major depression by racial/ethnic group was among individuals who identified themselves as “Other” (19.1%)
Discussion
The current study examined the relationship between depression status, general preventive health practices and quality-of-life indicators among adults with diabetes. Similar to other studies demonstrating an association between depression and decreased adherence to diabetes-specific preventive care practices, the present study findings suggest that depression is also linked to decreased compliance with preventive health practices that are not diabetes specific. To our knowledge, this is the
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Cited by (39)
Diabetes and Mental Health
2023, Canadian Journal of DiabetesDiabetes and Mental Health
2018, Canadian Journal of DiabetesCitation Excerpt :Both symptom measures (e.g. self-report measures of various symptoms) and methods to arrive at psychiatric diagnoses (e.g. structured interviews leading to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition [DSM-5 diagnoses] (30) have been assessed. Given that the person with diabetes is directly responsible for 95% of diabetes management (31), identifying significant psychological reactions in diabetes is important since depressive symptoms are a risk factor for poor diabetes self-management (32–34) and outcomes, including early mortality (35,36). Individuals with serious mental illnesses, particularly those with depressive symptoms or syndromes, and people with diabetes share reciprocal susceptibility and a high degree of comorbidity (Figure 1).
The association of minor and major depression with health problem-solving and diabetes self-care activities in a clinic-based population of adults with type 2 diabetes mellitus
2017, Journal of Diabetes and its ComplicationsCitation Excerpt :Prior research has also found that MDD in individuals with T2DM is associated with worse self-care practices. In a study using data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) national survey, which included a depression module based on PHQ-8 and a self-reported diagnosis of diabetes, individuals with T2DM and MDD were shown to participate in fewer general preventive self-care behaviors (i.e., not drinking excessively and receiving timely screenings for breast, cervical, prostate, and colorectal cancers) than their non-depressed counterparts.11 While our study looked more specifically at diabetes-related self-care activities in individuals with T2DM and MDD or MinDD, our results support the prior findings that comorbid MDD in T2DM leads to worse self-care.
Diabète et santé mentale
2013, Canadian Journal of DiabetesCitation Excerpt :Tant les méthodes d’évaluation des symptômes (p. ex., auto-évaluation des symptômes de la dépression ou de l’anxiété) que les méthodes pour le diagnostic de la maladie mentale (p. ex., entretiens structurés pouvant mener à un diagnostic fondé sur les critères du DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, quatrième édition] (42)) ont été étudiées. Étant donné que les diabétiques endossent 95 % de la prise en charge de la maladie (65) et que la dépression constitue un facteur de risque d’une mauvaise autogestion (66–68) et d’un pronostic défavorable (y compris le décès précoce (69,70)), il est crucial de repérer les syndromes dépressifs. On a rapporté que le trouble dépressif majeur est sous-diagnostiqué chez les personnes diabétiques (71).
Validity of the short-form five-item Problem Area in Diabetes questionnaire as a depression screening tool in type 2 diabetes mellitus patients
2023, Journal of Diabetes Investigation
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This work represents work supported by the use of facilities at the Charleston, SC HSR&D Funded Center for Disease Prevention and Health Interventions for Diverse Populations (REA 08-261).
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Dr. Grubaugh and Dr. Ellis are both supported by a career development award (CDA2 #07-015-2 and CDA #07-012-3, respectively) from the Veterans Health Administration Health Services Research and Development program.
The Psychiatric–Medical Comorbidity section will focus on the prevalence and impact of psychiatric disorders in patients with chronic medical illness as well as the prevalence and impact of medical disorders in patients with chronic psychiatric illness.