Assessment of depression and its associated factors among patients with type 2 diabetes

Background Patients with diabetes mellitus (DM) have a poorer quality of life in comparison with patients without DM. Any chronic illness will have a negative impact on diabetic patient. In fact, one in every five diabetic patients suffers from co-morbid depression, which can lead to poor management, poor compliance with treatment, and low quality of life. Objectives This study aimed to estimate the prevalence of depression and to identify its associated factors influencing depression among patients with type 2 diabetes mellitus attending an out-patient clinic at a tertiary care hospital in Dhaka, Bangladesh. Methods A cross-sectional study was conducted among 318 type 2 diabetic (T2DM) patients attending a diabetic clinic at a tertiary care hospital during July 2019 to February 2020 in Dhaka, Bangladesh. Depression was assessed among the subjects using Patient Health Questionnaire-9 (PHQ-9); a standardized questionnaire that developed in the United States of America. Demographic, clinical, and diabetes-related information were collected using a semi-structured questionnaire after written informed consent of the patients. Results Of the 318 patients, 72.0% were female. Mean (±SD) age was 48.88 ± 11.51 years and mean duration of diabetes was 7.51 ±6.18 (±SD) years. About one third of the patients (34.9%) had been suffering from diabetes for more than 10 years. The prevalence of depressive illness using the PHQ-9 (score≥5) was found higher among female patients (46.2%) than male patients (17.9%); [P=0.98]. Mean depression score was calculated 6.89±6.08 (±SD). On the other hand, the prevalence of moderate to severe depressive illness using the PHQ-9 (score≥10) was 33.6% (male vs. female: 7.2% vs. 26.4%); [P=0.06]. The most frequent level of depression was a mild depression (30.8%), followed by moderate depression (18.9%), and then moderately severe depression (11.6%). The prevalence of severe depression was only 3.1%; [p=0.12] among study population. Demographic variables that found statistically significant association with depression were older age, urban residency, housewife, widow, lower education level, and low income; [p<0.05]. Among the clinical variables, patients for longer duration of diabetes (≥10 years), those with co-morbid disease, or diabetes related complications, and higher BMI, were all found to be significantly associated with a greater risk for moderate to severe depression; [p<0.05]. Poor glycaemic control (as indicated by HbA1c values > 8.0%), was also revealed as a strong predictor for depression; [p<0.001]. Conclusion Depression was found to be particularly high among the study population. The high prevalence and strong association of depression in individuals with diabetes suggests that depression should be routinely screened for patients with diabetes at the clinics. Since depression could significantly hinder patient’s adherence to treatment, there is an urgent need for early diagnosis and treatment. This calls for the integration of mental health care into the management of diabetes.