Indian Write-Ups
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| Prevalence of Co-morbid Depression in Type 2 Diabetes Mellitus Dr. Biplab Bandyopadhyaya MD.DM, Dr Arunanshu Parlal DPM, MD Psychiatry DIABETES, Thyroid and Hormone Care and Manochikitsa Kendra, Raipur |
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| The reason that depression was more prevalent in the uncontrolled than in the controlled studies is unclear. One possibility is that the uncontrolled studies included a higher proportion of individuals recruited from settings with higher prevalences of depression (e.g., physician referrals or university-based clinics). Although similar ORs describing the likelihood of depression were found between the clinical and community studies, the uncontrolled studies comprised almost exclusively of clinic-based samples. Of the (1) community studies in the controlled subset, 8 restricted their samples to older individuals; this further contributes to lower rates of depression in the controlled studies, since depression is less common in older than younger adults. There may also be other unmeasured differences in clinical or functional characteristics that might account for the differences in the controlled and uncontrolled studies. For example, the associations of depression with hyperglycemia and with increased risk of complication described in recent meta-analytic reviews support the hypothesis that the severity of diabetes and/or functional impairment may increase the risk for depression. A difference in the prevalence of depression in type 1 vs type 2 DM could not be established. The ORs from the controlled studies were nearly identical between types, and aggregate estimate of prevalence using controlled and uncontrolled studies, segregated by depression assessment method, also yielded equivalent depression rates. Many of the studies, including some with the largest numbers of patients, did not report the fraction of depressed individuals by type of DM. This omission exemplified a more general failure of many studies to fully characterize the depressed and nondepressed samples. Such information is needed to assess the effects of other factors (e.g., age, socioeconomic status, and severity of diabetes) on the prevalence of depression. In particular, failure to report race or ethnicity is common in the psychosocial literature on DM.
The findings of this review echo the observation first made by Willis in 1684, that depression is associated with diabetes. The complex interaction of physical, psychological, and genetic factors that contribute to this association remain uncertain. Depression may occur secondary to the hardships of depression or the diabetes-related abnormalities in neurohormonal or neurotransmitter function. On the other hand, evidence from prospective studies in the U.S. and Japan indicates that depression doubles the risk of incident type 2 DM independent of its association with other risk factors. In patients with preexisting DM, depression is an independent risk factor for coronary heart disease, and appears to accelerate the presentation of coronary heart disease. Additional studies are needed to identify the behavioral and physiological mechanisms that account for these findings. A significant association between Diabetes complication and depressive symptoms has also been demonstrated.4 Depression was significantly associated with hyperglycemia and may adversely affect the glycemic control and increase the risk of diabetic complication.5 Ciechanovoski et al found that depressive symptom severity was associated with poorer adherence to diet and medication, leads to more functional impairment and higher health cost.6 Screening instruments like Beck’s depression inventory have demonstrated its efficacy in detecting major depression.7.8 |
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Table Depression and Type 2 Diabetes Mellitus
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| In our observation, depression was present in 46.5% of female and 18% of male diabetes patients. Diabetic nephropathy, Diabetic nephropathy and retinopathy patients had significantly higher frequency of getting depressed than DM patients with no micro-vascular complications. Our findings was similar to the studies by de Groot et al4 and Cohen et al11
Standard error of difference in Hba1c level in depressed diabetic patients to non- depressed was significantly higher. Self-rated compliance in DM with depression was poorer than those diabetics who were mentally fit. Number of years from onset of diabetes had a negative impact on depression scale. Above 10 years of presence of diabetes was associated with significantly higher frequency of depression than diabetes of < 6 years duration. Socio-economic status was independent of frequency of depression in diabetes subjects. Coping and course of diabetes depends upon social environment, family support system, doctor patient relationship and economic status of the person. In case any one of the above strings is broken result is inability to respond normally to stress.12 There is need to diagnose and treat depressive illness in Type 2 DM at an early stage before irreversible complication develop. Bibliography:
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