Elsevier

Primary Care Diabetes

Volume 10, Issue 5, October 2016, Pages 369-375
Primary Care Diabetes

Original research
Prevalence of depression in patients with type 2 diabetes attended in primary care in Spain

https://doi.org/10.1016/j.pcd.2016.02.003Get rights and content

Highlights

  • Undiagnosed depression (occult depression) is highly prevalent.

  • Antidiabetic drugs are not associated with the presence of depression.

  • Complications related to diabetes are not associated with depression.

  • Performing an active search of depression is recommended in type 2 diabetic patients.

Abstract

Objectives

To estimate the prevalence of known and undiagnosed depression in patients with type 2 diabetes attended in primary care setting in Spain, and to determine the factors associated with the presence of depression.

Methods

This was a cross-sectional and multicenter study performed in a random sample of patients with type 2 diabetes attended in 21 primary care centers. Depressive symptoms were measured with the self-administered Patient Health Questionnaire (PHQ-9).

Results

A total of 411 patients were analyzed (mean age 70.8 (SD 10.3) years; 53.8% women). 29.2% of patients met the diagnostic criteria of depression, of whom 17% had known depression and 12.2% undiagnosed depression (PHQ-9 score ≥10, without a previous diagnosis of depression). Depression was more common in women (43.4%; 95% confidence interval [CI] 34.5–52.3%), widow (33.3%; 95% CI 27.9–38.7%), and hypothyroidism (12.5%; 95% CI 8.7–16.3%). Cardiovascular risk factors, the degree of control, complications related to diabetes, antidiabetic therapy and the number of drugs were not associated with the presence of depression.

Conclusions

The prevalence of depression was high in patients with type 2 diabetes. However, in approximately 40% of patients depression was undiagnosed. The complications related to diabetes and antidiabetic therapy were not associated with the presence of depression.

Introduction

Type 2 diabetes mellitus and depression are two conditions very common in the general population. In Spain, the prevalence of type 2 diabetes is approximately 13% [1] and around 10.5% of the subjects have had at least one depressive episode during their lives [2].

The concomitance of both entities is common. Thus, compared with individuals without diabetes, the risk of depression is almost double in patients with type 2 diabetes [3]. Similarly, patients with type 2 diabetes have a higher risk of developing depression [4]. In Spain the prevalence of depression in patients with type 2 diabetes ranges from 15% to 32% [5], [6]. However, these studies were not performed in primary care setting and were limited to specific geographic areas.

Subjects with type 2 diabetes and depression have a worse glycemic and other cardiovascular risk factors control [7], [8]. This may be associated with a poor self-care, including a lesser physical activity, unhealthy diet or a lesser adherence to medication [9]. Compared with subjects without depression, patients with type 2 diabetes and major depression have a higher risk of either micro and macrovascular complications [10], as well as cognitive impairment [11], regardless the previous medical history or treatments. In addition, patients with diabetes and depression exhibit higher ambulatory care use and fill more prescriptions than their counterparts without depression. In fact, total health care expenditures for diabetics with depression are 4.5 times higher than that for diabetics without depression [12], [13].

On the other hand, different studies have shown that compared with those individuals without depression, in those patients with type 2 diabetes and depression, all-cause mortality is increased by about 50% [8], [14], [15]. Moreover, it has been reported that cardiovascular mortality is increased in women with type 2 diabetes and depression [16].

However, the current prevalence of depression in patients with type 2 diabetes attended in primary care setting in Spain is not well known. This study was designed to estimate the prevalence of known and undiagnosed depression in patients with type 2 diabetes attended in primary care setting in Spain, and to determine the factors associated with the presence of depression.

Section snippets

Patients and methods

This was a multicenter, descriptive and cross-sectional study performed in a random sample of patients with type 2 diabetes attended in 21 primary care centers from 12 out of 17 Autonomous Communities of Spain. The selection of primary care centers was performed by convenience. Patients >35 years old, with an established diagnosis of type 2 diabetes attended in primary care setting in Spain in the last 12 months were included in the study. Patients exclusively attended by specialists, with

Results

A total of 422 patients were initially included in the study, of whom 6 rejected to participate, 2 were exclusively attended by the specialist and 3 patients exhibited language barriers. As a result, 11 patients (2.6%) were excluded from the study, and 411 patients were finally included for the analysis. Mean age was 70.8 (SD 10.3) years and 53.8% of patients were women. The clinical characteristics of the patients were shown in Table 1. Compared with men, women were older, more commonly widow,

Discussion

The results of our study showed that the prevalence of depression in patients with type 2 diabetes was 29.2%, of whom 41.7% had not been previously diagnosed of depression. Although the comparisons with other studies are difficult, since the methodology differs between them, overall, our data are in accordance with those previously reported.

In the systematic review of Roy et al. [3], largely variations in the prevalence of depression were observed between the studies, likely due to the

Limitations

The limitations of this study include those typical of a cross-sectional study and the selection of primary care centers by convenience, and not by randomly selection, including physicians with a particular interest for diabetes. As a result, it would be necessary to perform a prospective study with a control group in primary care centers randomly selected in Spain.

Another limitation of the study is that the diagnostic tool of depression requires methods for the transcultural evaluation to

Conflict of Interest

The authors state that they have no conflict of interest.

Acknowledgements

CCS, FLS, MAF and JMR participated in the design of the study, and drafted the manuscript. MPPU, JJMB, ABG, SMJ made substantial contributions to the conception and design of the study. All authors read and approved the final version of the manuscript.

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    1

    The members of the working group of diabetes SEMERGEN participating in the study are listed in Appendix 1.

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