The Association Between Depressive Symptoms, Access to Diabetes Care, and Glycemic Control in 5 Middle-income Countries

Objective: The relationship between depression, diabetes, and access to diabetes care is established in high-income countries (HICs) but not in middle-income countries (MICs), where contexts and health-systems differ and may impact this relationship. In this study we investigate access to diabetes care for individuals with and without depressive symptoms in MICs. Research Design and Methods: We analyzed pooled data from nationally representative household surveys across Brazil, Chile, China, Indonesia, and Mexico. Validated survey tools (CESD-R-10, CESD-9, CIDI-SF, PHQ-9) identified participants with depressive symptoms. Diabetes, defined per WHO PEN guidelines, included self-reported medication use and biochemical data. The primary focus was on tracking diabetes care progression through stages: (1) diagnosis, (2) treatment, and (3) glycemic control. Descriptive and multivariable logistic regression analyses, accounting for gender, age, education, and BMI, examined diabetes prevalence and care continuum progression. Results: The pooled sample included 18,301 individuals aged 50 and above; 3,309 (18.1%) had diabetes, and 3,934 (21.5%) exhibited depressive symptoms. Diabetes prevalence was insignificantly higher among those with depressive symptoms (28.9%) compared to those without (23.8%, p=0.071). Co-occurrence of diabetes and depression was associated with increased odds of diabetes detection (OR 1.398, p<0.001) and treatment (OR 1.344, p<0.001), but not with higher odds of glycemic control (OR 0.913, p=0.377). Conclusions: In MICs, individuals aged 50 years and older with diabetes and depression showed heightened diabetes identification and treatment probabilities, unlike patterns seen in HICs. This underscores the unique interplay of these conditions in different income settings.