Prevalence of co-morbid depression in out-patients with type 2 diabetes mellitus in Bangladesh

Tapash Roy, Cathy E Lloyd, Masuma Parvin, Khondker Galib B Mohiuddin, Mosiur Rahman, Tapash Roy, Cathy E Lloyd, Masuma Parvin, Khondker Galib B Mohiuddin, Mosiur Rahman

Abstract

Background: Little is known about the prevalence of depression in people with diabetes in Bangladesh. This study examined the prevalence and factors associated with depression in out-patients with Type 2 diabetes in Bangladesh.

Methods: In this cross-sectional study a random sample of 483 diabetes out-patients from three diabetes clinics in Bangladesh was invited to participate. Of them 417 patients took part. Depressive symptoms were measured using previously developed and culturally standardized Bengali and Sylheti versions of the World HealthOrganization-5 Well Being Index (WHO-5) and the Patient Health Questionairre-9 (PHQ-9) with predefined cut-off scores. Data was collected using two different modes; e.g. standard assisted collection and audio questionnaire methods. Associations between depression and patient characteristics were explored using regression analysis.

Results: The prevalence of depressive symptoms was 34% (PHQ-9 score ≥ 5) and 36% (WHO-5 score < 52) with audio questionnaire delivery method. The prevalence rates were similar regardless of the type (PHQ-9 vs. WHO-5) and language (Sylheti vs. Bengali) of the questionnaires, and methods of delivery (standard assisted vs. audio methods). The significant predictors of depressive symptoms using either the PHQ-9 or WHO-5 questionnaires were; age, income, gender, treatment intensity, and co-morbid cardiovascular disease. Further, depression was strongly associated with poor glycaemic control and number of co-morbid conditions.

Conclusions: This study demonstrated that depression prevalence is common in out-patients with type 2 diabetes in Bangladesh. In a setting where recognition, screening and treatment levels remain low, health care providers need to focus their efforts on diagnosing, referring and effectively treating this important disease in order to improve service delivery.

Figures

Figure 1
Figure 1
Flow participants through research study.

References

    1. Palinkas LA, Wingard DL, Barrett-Connor E. Chronic illness and depressive symptoms in the elderly: a population-based study. J Clin Epidemiol. 1990;43:1131–1141. doi: 10.1016/0895-4356(90)90014-G.
    1. Ali S, Stone M, Peters J, Davies M, Khunti K. The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006;23:1165–1173. doi: 10.1111/j.1464-5491.2006.01943.x.
    1. Barnard K, Skinner T, Peveler R. The prevalence of co-morbid depression in adults with type 1 diabetes: systematic literature review. Diabet Med. 2006;23:445–448. doi: 10.1111/j.1464-5491.2006.01814.x.
    1. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of co-morbid depression in adults with diabetes. Diabetes Care. 2001;6:1069–1078.
    1. Lustman PJ, Anderson RJ, Freedland KE, De Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000;23:934–942. doi: 10.2337/diacare.23.7.934.
    1. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025. Diabetes Care. 1998;21:1414–1431. doi: 10.2337/diacare.21.9.1414.
    1. Khunti K, Kumar S, Brodie J. Executive summary, diabetes UK and South Asian health foundation recommendations on diabetes research priorities for British South Asians. London: Diabetes UK; 2009.
    1. Patel V, Pereira J, Coutinho L, Fernandes R, Fernandes J, Mann A. Poverty, psychological disorder and disability in primary care attenders in Goa, India. Br J Psychiatry. 1998;171:533–536.
    1. Asghar S, Hussain A, Ali S, Khan A, Magnusson A. Prevalence of depression and diabetes: a population-based study from rural Bangladesh. Diabet Med. 2007;24:872–877.
    1. Zahid N, Asghar S, Claussen B, Hussain A. Depression and diabetes in a rural community in Pakistan. Diabetes Res Clin Pract. 2008;79:124–127. doi: 10.1016/j.diabres.2007.07.006.
    1. Muhammad Gadit AA, Mugford G. Prevalence of depression among households in three capital cities of Pakistan: need to revise the mental health policy. PLoS One. 2007;2:e209. doi: 10.1371/journal.pone.0000209.
    1. Raval A, Dhanaraj E, Bhansali A, Grover S, Tiwari P. Prevalence & determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian J Med Res. 2010;132:195–200.
    1. Lloyd CE, Sturt J, Johnson MRD, Mughal S, Collins G, Barnett AH. Development of alternative modes of data collection in South Asians with type 2 diabetes. Diabet Med. 2008;25(4):455–462. doi: 10.1111/j.1464-5491.2008.02401.x.
    1. Lloyd CE, Roy T, Begum S, Mughal S, Barnett AH. Measuring psychological wellbeing in South Asians with diabetes; a qualitative investigation of the PHQ-9 and the WHO-5 as potential screening tools for measuring symptoms of depression. Diabet Med. 2012;29(1):140–147. doi: 10.1111/j.1464-5491.2011.03481.x.
    1. Spitzer RL, Kroenke K, Williams JB. The patient health questionnaire primary care study group. Validation and utility of a self-report version of the PRIME-MD: the PHQ primary care study. JAMA. 1999;282:1737–1744. doi: 10.1001/jama.282.18.1737.
    1. Lowe B, Kroenke K, Herzog W, Grafe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the PHQ-9. J Affect Dis. 2003;81:61–66.
    1. Roy T, Lloyd CE, Pouwer F, Holt RIG, Sartorius N. Screening Tools used for measuring depression among people with type 1 and type 2 diabetes: a systematic review. Diabet Med. 2012;29(2):164–175. doi: 10.1111/j.1464-5491.2011.03401.x.
    1. Newnham EA, Hooke GR, Page AC. Monitoring treatment response and outcomes using the World Health Organization's wellbeing index in psychiatric care. J Affect Disord. 2010;122(1–2):133–138.
    1. Pouwer F, Geelhoed-Duijvestijn PH, Tack CJ, Bazelmans E, Beekman AJ, Heine RJ. et al.Prevalence of comorbid depression is high in out-patients with type 1 or type 2 diabetes mellitus. Results from three out-patient clinics in the Netherlands. Diabet Med. 2010;27(2):217–224. doi: 10.1111/j.1464-5491.2009.02903.x.
    1. Bech P, Olsen LR, Kjoller M, Rasmussen NK. Measuring well-being rather than absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five Well-being scale. Int J Methods Psychiatr. Res. 2003;12:85–91. doi: 10.1002/mpr.145.
    1. Reddy P, Ford D, Dunbar JA. Improving the quality of diabetes care in general practice. Aust J Rural Health. 2010;18(5):187–193. doi: 10.1111/j.1440-1584.2010.01152.x.
    1. Shim RS, Baltrus P, Ye J, Rust G. Prevalence, treatment, and control of depressive symptoms in the United States: results from the National Health and Nutrition Examination Survey (NHANES), 2005–2008. J Am Board Fam Med. 2011;24(1):33–38. doi: 10.3122/jabfm.2011.01.100121.
    1. Holt RIG, Phillips DIW, Jameson KA, Cooper C, Dennison EM, Peveler RC. The relationship between depression and diabetes mellitus: findings from the Hertfordshire Cohort study. Diabet Med. 2009;26:641–648.
    1. Golden SH, Lazo M, Carnethon M, Bertoni AG, Schreiner PJ, Diez Roux AV. Examining a bidirectional association between depressive symptoms and diabetes. JAMA. 2008;299(23):2751–2759. doi: 10.1001/jama.299.23.2751.
    1. Engum A. The role of depression and anxiety in onset of diabetes in a large population-based study. J Psychosom Res. 2007;62(1):31–38. doi: 10.1016/j.jpsychores.2006.07.009.
    1. Lloyd CE CE, Dyer PH, Barnett AH. Prevalence of symptoms of depression and anxiety in a diabetes clinic population. Diabet Med. 2000;17((3):198–202.
    1. Richardson LK, Egede LE, Mueller M, Echols CL, Gebregziabher M. Longitudinal effects of depression on glycemic control in veterans with type 2 diabetes. Gen Hosp Psychiatry. 2008;30:509–514. doi: 10.1016/j.genhosppsych.2008.07.001.
    1. De Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a metaanalysis. Psychosom Med. 2001;63:619–630.
    1. Dickerson F, Brown CH, Fang L, Goldberg RW, Kreyenbuhl J, Wohlheiter K. et al.Quality of life in individuals with serious mental illness and type 2 diabetes. Psychosomatics. 2008;49:109–114. doi: 10.1176/appi.psy.49.2.109.
    1. Nouwen A, Nefs G, Caramlau I, Connock M, Winkley K, Lloyd CE. et al.Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: a systematic review and meta-analysis of the European Depression in Diabetes (EDID) research consortium. Diabetes Care. 2011;34(3):752–762. doi: 10.2337/dc10-1414.
    1. Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K. et al.Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010;53(12):2480–2486. doi: 10.1007/s00125-010-1874-x.
    1. Talbot F, Nouwen A. A review of the relationship between depression and diabetes in adults: is there a link? Diabetes Care. 2000;23:1556–1562. doi: 10.2337/diacare.23.10.1556.
    1. Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care. 2008;31(12):2383–2390. doi: 10.2337/dc08-0985.
    1. Simmons D, Gamble GD, Foote S, Cole DR, Coster G. The New Zealand diabetes passport study: a randomized controlled trial of the impact of a diabetes passport on risk factors for diabetes-related complications. Diabet Med. 2004;21:214–217. doi: 10.1111/j.1464-5491.2004.01047.x.
    1. Phillips LS, Branch WT, Cook CB. et al.Clinical inertia. Ann Intern Med. 2001;135:825–834.
    1. Rubin RR, Ciechanowski P, Egede LE, Lin EH, Lustman PJ. Recognizing and treating depression in patients with diabetes. Curr Diab Rep. 2004;4:119–125. doi: 10.1007/s11892-004-0067-8.
    1. Pouwer F, Snoek FJ, van der Ploeg HM, Adèr HJ, Heine RJ. Monitoring of psychological well-being in outpatients with diabetes: effects on mood, HbA(1c), and the patient's evaluation of the quality of diabetes care: a randomized controlled trial. Diabetes Care. 2001;24(11):1929–1935. doi: 10.2337/diacare.24.11.1929.
    1. Pouwer F, Tack CJ, Geelhoed-Duijvestijn PH, Bazelmans E, Beekman AT, Heine RJ. et al.Limited effect of screening for depression with written feedback in outpatients with diabetes mellitus: a randomised controlled trial. Diabetologia. 2011;54(4):741–748. doi: 10.1007/s00125-010-2033-0.
    1. Pouwer F. Should we screen for emotional distress in type 2 diabetes mellitus? Nat Rev Endocrinol. 2009;5(12):665–671. doi: 10.1038/nrendo.2009.214.
    1. Morgan MAJ, Dunbar J, Reddy P. Collaborative care. The role of practice nurses. Aust Fam Physician. 2009;38(11):925–926.

Source: PubMed

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