The Screening of Comorbid Depressive Disorders and Associated Risk Factors in Adult Patients with Type 2 Diabetes

Objective: Elevated depressive symptoms and disorders affect one in five patients with diabetes. Current guidelines recommend screening depression in the diabetic population. Turkey has the highest (13.7%) prevalence of diabetes in Europe. However, there are limited data about the prevalence of depressive disorders among diabetic patients in Turkey. We aim to investigate the prevalence of a comorbid depressive disorder in Type 2 diabetic patients who were referred to the Endocrinology outpatient unit of a tertiary hospital. Material and Methods: All the Type 2 diabetic patients admitted to our endocrinology department were consecutively included in the study. Their sociodemographics, concomitant diseases and medications, macro and microvascular complications, lifestyle and personal habits, and treatment regimens were obtained by a specifically designed questionnaire. Laboratory data were obtained from the hospital records. The Patient Health Questionnaire-9 (PHQ-9), a depression screening tool, was used as a screening method for depression. Patients with a score of 10 or above determined high risk for depressive disorder according to PHQ-9. The scores were re-evaluated by a psychiatrist to minimize the false negative and positive results. Result: A total of 460 patients with Type 2 diabetic were enrolled in this crosssectional study. 18.9% (n=87) of the participants were found to have depressive disorders according to the psychiatric evaluation done after the PHQ-9 questionnaire. Patients with depressive disorders were predominantly female (69.0% vs. 55.5%; p=0.022), younger (57.2 +/- 10.5 vs. 60.0 +/- 9.5; p=0.014), had higher HbAlc (8.51 +/- 2.51 vs. 7.98 +/- 2.05; p=0.042), total cholesterol (205.6 +/- 44.2 vs. 194.2 +/- 46.0; p=0.045), LDL-cholesterol (123.1 +/- 37.8 vs. 113.1 +/- 35.4; p=0.026) and non-HDL-cholesterol (158.5 +/- 41.61 vs. 146.6 +/- 42.7; p=0.024). These patients had frequent neuropathy (37.3% vs. 19.0%, p=0.001), they were less likely to perform exerdse (31.8% vs. 53.1%; p<0.001) while smoke in excess (31.4% vs. 14.3%; p<0.001). The analysis showed that female gender (OR=4.4; 95% CI=1.6-12.8; p=0.005) and smoking (OR=7.6; 95% CI=2.8-20.5, p<0.001) are independent determinants of a depressive disorder. Conclusion: Approximately one-fifth of diabetic patients had a depressive disorder, and their metabolic parameters were worse than those without a depressive disorder. Therefore, to assess a diabetic patient from all aspects, screening for depressive disorder should be made an indispensable part of the evaluation process.