A systematic review and meta-analysis to compare the prevalence of depression between people with and without Type 1 and Type 2 diabetes

Published:November 19, 2021DOI:https://doi.org/10.1016/j.pcd.2021.11.001

      Highlights

      • Prevalence of depression was higher in people with Type 1 and Type 2 diabetes compared with those without diabetes.
      • Depression prevalence in people with diabetes did not significantly differ between methods of depression assessment.
      • Prevalence of depression in people with diabetes was higher in studies set in specialist care.
      • Effective chronic disease management is vital, including managing depression in specialist care settings.

      Abstract

      Aims

      Diabetes can significantly impact quality of life and mental health. However, inconsistencies have been reported in the prevalence of depression in those with Type 1 and Type 2 diabetes, and those without. Systematic reviews also included studies without adequate control subjects. We update existing literature, by comparing depression prevalence between individuals with and without Type 1 and Type 2 diabetes.

      Methods

      A systematic review and meta-analysis. We searched MEDLINE, EMBASE and PSYCHINFO, from January 1985 to August 2021. Studies were excluded if they failed to have an adequate control group, specified type of diabetes, or reported depression prevalence by type of diabetes.

      Results

      44 studies were selected for inclusion. The prevalence of depression was significantly higher in people with Type 1 (22% vs 13%, OR = 2.10 (95% CI: 1.23, 3.52)), or Type 2 diabetes (19% vs 11%, OR = 1.76 (1.55, 2.01)) compared to those without diabetes. There was no association between study effect size and mean age or gender. Findings did not significantly differ between methods of depression assessment. Prevalence of depression in people with diabetes was higher in studies carried out in specialist care (36%, OR = 3.14 (2.12, 4.63)) compared to those in community or primary care (12%, OR = 1.51 (1.35, 1.70) and in low- and middle-income countries (OR = 2.58 (1.91, 3.50) compared to countries with high income economies (OR = 1.59 (1.39, 1.82)).

      Conclusions

      Depression prevalence remains significant in those with type 1 and type 2 diabetes. Effective chronic disease management in people with diabetes is important, particularly screening and managing depression and diabetes distress in specialist care settings.

      Abbreviations:

      PHQ (Patient Health Questionnaire), CES-D (Center for Epidemiological Studies-Depression), DIS (Diagnostic Interview Schedule)

      Keywords

      To read this article in full you will need to make a payment
      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abdoli S.
        • Hardy L.R.
        • Hall J.
        The complexities of “struggling to live life”: the experiences of adults with T1DM living in Appalachia.
        Diabetes Educ. 2017; 43: 206-215
        • Harding K.A.
        • Pushpanathan M.E.
        • Whitworth S.R.
        • et al.
        Depression prevalence in Type 2 diabetes is not related to diabetes–depression symptom overlap but is related to symptom dimensions within patient self-report measures: a meta-analysis.
        Diabet. Med. 2019; 36: 1600-1611
        • Roy T.
        • Lloyd C.E.
        Epidemiology of depression and diabetes: a systematic review.
        J. Affect. Disord. 2012; 142: S8-21
        • Khaledi M.
        • Haghighatdoost F.
        • Feizi A.
        • Aminorroaya A.
        The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies.
        Acta Diabetol. 2019; 56: 631-650
        • Wang F.
        • Wang S.
        • Zong Q.Q.
        • et al.
        Prevalence of comorbid major depressive disorder in Type 2 diabetes: a meta-analysis of comparative and epidemiological studies.
        Diabet. Med. 2019; 36: 961-969
        • Buchberger B.
        • Huppertz H.
        • Krabbe L.
        • et al.
        Symptoms of depression and anxiety in youth with type 1 diabetes: a systematic review and meta-analysis.
        Psychoneuroendocrinology. 2016; 70: 70-84
        • Johnson B.
        • Eiser C.
        • Young V.
        • Brierley S.
        • Heller S.
        Prevalence of depression among young people with Type 1 diabetes: a systematic review.
        Diabet. Med. 2013; 30: 199-208
        • Alzoubi A.
        • Abunaser R.
        • Khassawneh A.
        • et al.
        The bidirectional relationship between diabetes and depression: a literature review.
        Korean J. Fam. Med. 2018; 39: 137
        • Champaneri S.
        • Wand G.S.
        • Malhotra S.S.
        • Casagrande S.S.
        • Golden S.H.
        Biological basis of depression in adults with diabetes.
        Curr. Diab. Rep. 2010; 10: 396-405
        • van Dooren F.E.
        • Nefs G.
        • Schram M.T.
        • et al.
        Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis.
        PLoS One. 2013; 8e57058
        • Farooqi A.
        • Khunti K.
        • Abner S.
        • et al.
        Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: a systematic review and meta-analysis.
        Diabetes Res. Clin. Pract. 2019; 156107816
        • Grey M.
        • Whittemore R.
        • Tamborlane W.
        Depression in type 1 diabetes in children: natural history and correlates.
        J. Psychosom. Res. 2002; 53: 907-911
        • Fisher L.
        • Hessler D.M.
        • Polonsky W.H.
        • et al.
        Prevalence of depression in Type 1 diabetes and the problem of over-diagnosis.
        Diabet. Med. 2016; 33: 1590-1597
        • Lu M.C.
        • Juan C.Y.
        • Koo M.
        • Lai N.S.
        Higher incidence of psychiatrist-diagnosed depression in Taiwanese female school-age children and adolescents with type 1 diabetes: a nationwide, population-based, retrospective cohort study.
        J. Child Adolesc. Psychopharmacol. 2017; 27: 281-284
        • Ali S.
        • Stone M.A.
        • Peters J.L.
        • Davies M.J.
        • 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
        • Nouwen A.
        • Winkley K.
        • Twisk J.
        • et al.
        Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis.
        Diabetologia. 2010; 53: 2480-2486
        • Rotella F.
        • Mannucci E.
        Diabetes mellitus as a risk factor for depression. A meta-analysis of longitudinal studies.
        Diabetes Res. Clin. Pract. 2013; 99: 98-104
        • Barnard K.D.
        • Skinner T.C.
        • Peveler R.
        The prevalence of co-morbid depression in adults with Type 1 diabetes: systematic literature review.
        Diabet. Med. 2006; 23: 445-448
        • Gendelman N.
        • Snell-Bergeon J.K.
        • McFann K.
        • et al.
        Prevalence and correlates of depression in individuals with and without type 1 diabetes.
        Diabetes Care. 2009; 32: 575-579
        • Gonzalez J.S.
        • Fisher L.
        • Polonsky W.H.
        Depression in diabetes: have we been missing something important?.
        Diabetes Care. 2011; 34: 236-239
        • Drukker M.
        • Weltens I.
        • van Hooijdonk C.F.M.
        • Vandenberk E.
        • Bak M.
        Development of a methodological quality criteria list for observational studies: the observational study quality evaluation.
        Front Res Metr Anal. 2021; 6675071https://doi.org/10.3389/frma.2021.675071
        • Hippisley-Cox J.
        • Coupland C.
        • Pringle M.
        • Crown N.
        • Hammersley V.
        Married couples’ risk of same disease: cross sectional study.
        BMJ. 2002; 325: 636
        • Harlow S.D.
        • Linet M.S.
        Agreement between questionnaire data and medical records. The evidence for accuracy of recall.
        Am. J. Epidemiol. 1989; 129: 233-248
      1. datahelpdesk.worldbank.org (Internet). World Bank Country Classification. 2021. (Accessed 1 July 2021). Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.

        • Altman D.G.
        Practical Statistics for Medical Research.
        CRC press, 1990
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Egger M.
        • Smith G.D.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Wells G.A.
        • Shea B.
        • O’Connell D.
        • et al.
        Newcastle–Ottawa Scale (NOS) for Assessing the Quality if Nonrandomized Studies in Meta-analyses.
        2009
        • Higgins J.P.
        • Thomas J.
        • Chandler J.
        • et al.
        Cochrane Handbook for Systematic Reviews of Interventions.
        John Wiley & Sons, 2019
        • Modesti P.A.
        • Reboldi G.
        • Cappuccio F.P.
        • et al.
        ESH Working Group on CV Risk in Low Resource Settings. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis.
        PLoS One. 2016; 11e0147601
        • Alshabanat A.
        • Zafari Z.
        • Albanyan O.
        • Dairi M.
        • FitzGerald J.M.
        Asthma and COPD overlap syndrome (ACOS): a systematic review and meta analysis.
        PLoS One. 2015; 10e0136065
        • Yeh T.L.
        • Lei W.T.
        • Liu S.J.
        • Chien K.L.
        A modest protective association between pet ownership and cardiovascular diseases: a systematic review and meta-analysis.
        PLoS One. 2019; 14e0216231
        • Rodríguez-Saldaña J.
        • Morley J.E.
        • Reynoso M.T.
        • et al.
        Diabetes mellitus in a subgroup of older Mexicans: prevalence, association with cardiovascular risk factors, functional and cognitive impairment, and mortality.
        J. Am. Geriatr. Soc. 2002; 50: 111-116
        • Siddiqui S.
        • Jha S.
        • Waghdhare S.
        • Agarwal N.B.
        • Singh K.
        Prevalence of depression in patients with type 2 diabetes attending an outpatient clinic in India.
        Postgrad. Med. J. 2014; 90: 552-556
        • Xuan L.
        • Zhao Z.
        • Jia X.
        • et al.
        Type 2 diabetes is causally associated with depression: a Mendelian randomization analysis.
        Front. Med. 2018; 12: 678-687
        • Leedom L.
        • Meehan W.P.
        • Procci W.
        • Zeidler A.
        Symptoms of depression in patients with type II diabetes mellitus.
        Psychosomatics. 1991; 32: 280-286
        • Thomas J.
        • Jones G.
        • Scarinci I.
        • Brantley P.
        A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses.
        Diabetes Care. 2003; 26: 2311-2317
        • Golden S.H.
        • Lazo M.
        • Carnethon M.
        • et al.
        Examining a bidirectional association between depressive symptoms and diabetes.
        JAMA. 2008; 299: 2751-2759
        • Robinson N.
        • Fuller J.H.
        • Edmeades S.P.
        Depression and diabetes.
        Diabet. Med. 1988; 5: 268-274
        • Maraldi C.
        • Volpato S.
        • Penninx B.W.
        • et al.
        Diabetes mellitus, glycemic control, and incident depressive symptoms among 70-to 79-year-old persons: the health, aging, and body composition study.
        Arch. Intern. Med. 2007; 167: 1137-1144
        • Anderson R.J.
        • Freedland K.E.
        • Clouse R.E.
        • Lustman P.J.
        The prevalence of comorbid depression in adults with diabetes: a meta-analysis.
        Diabetes Care. 2001; 24: 1069-1078
        • Elamoshy R.
        • Bird Y.
        • Thorpe L.
        • Moraros J.
        Risk of depression and suicidality among diabetic patients: a systematic review and meta-analysis.
        J. Clin. Med. 2018; 7: 445https://doi.org/10.3390/jcm7110445
        • Delisle V.C.
        • Beck A.T.
        • Ziegelstein R.C.
        • Thombs B.D.
        Symptoms of heart disease or its treatment may increase Beck Depression Inventory Scores in hospitalized post-myocardial infarction patients.
        J. Psychosom. Res. 2012; 73: 157-162
        • Fisher L.
        • Gonzalez J.S.
        • Polonsky W.H.
        The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision.
        Diabet. Med. 2014; 31: 764-772
        • Pouwer F.
        • Beekman A.T.
        • Nijpels G.
        • et al.
        Rates and risks for co-morbid depression in patients with Type 2 diabetes mellitus: results from a community-based study.
        Diabetologia. 2003; 46: 892-898
        • Brown L.C.
        • Majumdar S.R.
        • Newman S.C.
        • Johnson J.A.
        Type 2 diabetes does not increase risk of depression.
        CMAJ. 2006; 175: 42-46
        • Icks A.
        • Kruse J.
        • Dragano N.
        • et al.
        Heinz Nixdorf Recall Study Investigator Group. Are symptoms of depression more common in diabetes? Results from the Heinz Nixdorf Recall study.
        Diabet. Med. 2008; 25: 1330-1336
        • Mezuk B.
        • Johnson-Lawrence V.
        • Lee H.
        • et al.
        Is ignorance bliss? Depression, antidepressants, and the diagnosis of prediabetes and type 2 diabetes.
        Health Psychol. 2013; 32: 254
        • Engum A.
        • Mykletun A.
        • Midthjell K.
        • Holen A.
        • Dahl A.A.
        Depression and diabetes: a large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes.
        Diabetes Care. 2005; 28: 1904-1909
        • Nichols G.A.
        • Brown J.B.
        Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes.
        Diabetes Care. 2003; 26: 744-749
        • Wilson S.
        • Delaney B.C.
        • Roalfe A.
        • et al.
        Randomised controlled trials in primary care: case study.
        BMJ. 2000; 321: 24-27
        • Leone T.
        • Coast E.
        • Narayanan S.
        • de Graft Aikins A.
        Diabetes and depression comorbidity and socio-economic status in low and middle income countries (LMICs): a mapping of the evidence.
        Global. Health. 2012; 8: 1
        • Aschner P.
        • Ilkova H.
        • Lavalle F.
        • et al.
        High prevalence of depressive symptoms in patients with type 1 and type 2 diabetes in developing countries: results from the international diabetes management practices study.
        Diabetes Care. 2021; https://doi.org/10.2337/dc20-2003
      2. International Diabetes Federation: The IDF Diabetes Atlas.
        5th edition. International Diabetes Federation, Brussels2011
        • Li C.
        • Ford E.S.
        • Zhao G.
        • et al.
        Prevalence and correlates of undiagnosed depression among US adults with diabetes: the Behavioral Risk Factor Surveillance System, 2006.
        Diabetes Res. Clin. Pract. 2009; 83: 268-279
        • Degmečić D.
        • Bačun T.
        • Kovač V.
        • et al.
        Depression, anxiety and cognitive dysfunction in patients with type 2 diabetes mellitus—a study of adult patients with type 2 diabetes mellitus in Osijek, Croatia.
        Coll. Antropol. 2014; 38: 711-716
        • Petrak F.
        • Herpertz S.
        Treatment of depression in diabetes: an update.
        Curr. Opin. Psychiatry. 2009; 22: 211-217
        • Owens-Gary M.D.
        • Zhang X.
        • Jawanda S.
        • et al.
        The importance of addressing depression and diabetes distress in adults with type 2 diabetes.
        J. Gen. Intern. Med. 2019; 34: 320-324
        • Barnard K.
        • Peveler R.C.
        • Holt R.I.
        Antidepressant medication as a risk factor for type 2 diabetes and impaired glucose regulation: systematic review.
        Diabetes Care. 2013; 36: 3337-3345
        • Chen P.C.
        • Chan Y.T.
        • Chen H.F.
        • Ko M.C.
        • Li C.Y.
        Population-based cohort analyses of the bidirectional relationship between type 2 diabetes and depression.
        Diabetes Care. 2013; 36: 376-382
        • Aarts S.
        • Van den Akker M.
        • van Boxtel M.P.
        • et al.
        Diabetes mellitus type II as a risk factor for depression: a lower than expected risk in a general practice setting.
        Eur. J. Epidemiol. 2009; 24: 641-648
        • Chireh B.
        • Li M.
        • D’Arcy C.
        Diabetes increases the risk of depression: a systematic review, meta-analysis and estimates of population attributable fractions based on prospective studies.
        Prev. Med. Rep. 2019; 14100822https://doi.org/10.1016/j.pmedr.2019.100822