Elsevier

General Hospital Psychiatry

Volume 32, Issue 6, November–December 2010, Pages 563-569
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
The effect of major depression on preventive care and quality of life among adults with diabetes,☆☆,

https://doi.org/10.1016/j.genhosppsych.2010.08.002Get rights and content

Abstract

Objective

To examine the association between major depression and preventive care practices and quality-of-life indices among adults with diabetes.

Methods

Data from 16,754 participants with diabetes in the 2006 Behavioral Risk Factor Surveillance Survey were examined. Multiple logistic regression was used to assess the independent association between the presence of major depression and a range of (1) preventive care behaviors and (2) quality-of-life indices, after accounting for relevant covariates.

Results

With regard to preventive care practices, women with major depression were less likely to have received a mammogram in the past 2 years [OR 0.60 (95% CI 0.45–0.79) for women age 40 years and older and OR 0.52 (95% CI 0.37–0.71) for women age 50 and older] relative to their counterparts without major depression. With regard to quality-of-life indices, individuals with major depression were less likely to perceive their health as good [OR 0.24 (95% CI 0.19–0.31)], to report being satisfied with life [OR 0.10 (95% CI 0.07–0.14)] and to report receiving needed social support [OR 0.29 (95% CI 0.22–0.38)] relative to individuals without major depression. Individuals with major depression were also more likely to report one or more poor physical and poor mental health days in the past 30 days [OR 4.36 (95% CI 3.33–5.72) and OR 9.77 (95% CI 7.81–12.22), respectively] than those without major depression.

Conclusions

Major depression in adults with diabetes is associated with decreases in a wide range of quality-of-life indices as well as preventive self-care practices that were not entirely limited to diabetes-specific disease management.

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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    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).

    ☆☆

    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.

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