Highlights
- •Over one in four adults with diabetes have depressive symptoms.
- •Rates of depression among persons with diabetes have remained stable from 2005 to 2016.
- •Risk factor control among diabetic adults has not improved in over a decade.
Abstract
Aims
We examined changes in the prevalence of elevated depressive symptoms among US adults
with diabetes, prediabetes, and normal glycemic status during 2005–2016.
Methods
We analyzed data from 32,676 adults in the 2005–2016 National Health and Nutrition
Examination Surveys. We defined diabetes as self-reporting a physician diagnosis of
diabetes or A1C ≥ 6.5% [48 mmol/mol], and prediabetes as A1C 5.7–6.4% [39–46 mmol/mol].
We used the 9-item Patient Health Questionnaire (PHQ-9) score ≥ 10 or antidepressant
use to define ‘clinically significant depressive symptoms’ (CSDS) and PHQ-9 score
≥ 12 as ‘Major Depressive Disorder’ (MDD). We calculated prevalence age-standardized
to the 2000 US census and used logistic-regression to compute adjusted odds of CSDS
and MDD for 2005–2008, 2009–2012, and 2015–2016. We analyzed the prevalence of A1C
≥ 9.0% [75 mmol/mol], systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure
≥ 90 mmHg, non-HDL cholesterol ≥ 130 mg/dL, and current smoking among adults with
diagnosed diabetes by depressive status.
Results
The prevalence of CSDS increased among individuals with normal glycemic status from
15.0% (13.5–16.2) to 17.3% (16.0–18.7) (p = 0.03) over 2005–2016. The prevalence of
CSDS and MDD remained stable among adults with prediabetes (~ 16% and 1%, respectively)
and diabetes (~ 26% and ~3%). After controlling for glycemic, sociodemographic, economic,
and self-rated health variables, we found 2-fold greater odds of CSDS among unemployed
individuals and 3-fold greater odds among those with fair/poor self-rated health across
all survey periods. Cardiometabolic care targets for adults with diagnosed diabetes
were stable from 2005 to 2016 and similar across depressive status.
Conclusions
One-fourth of adults with diabetes have comorbid CSDS; this prevalence remained stable
over 2005–2016 with no change in diabetes care. At the population level, depression
does not appear to impact diabetes care, but further research could explore subgroups
that may be more vulnerable and could benefit from integrated care that addresses
both conditions.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Primary Care DiabetesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Centers for Disease Control and Prevention, 2017. National Diabetes Statistics Report, 2017. 2017, Department of Health and Human Services: Atlanta, GA, USA.
- Prevalence of and trends in diabetes among adults in the United States, 1988-2012.JAMA. 2015; 314: 1021-1029
Centers for Disease Control and Prevention, 2020. National Diabetes Statstics Report, 2020. 2020, Department of Health and Human Services: Atlanta, GA, USA.
- Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States.Int. J. Methods Psychiatr. Res. 2012; 21: 169-184
- The prevalence of comorbid depression in adults with diabetes: a meta-analysis.Diabetes Care. 2001; 24: 1069-1078
- Relationship of depression and diabetes self-care, medication adherence, and preventive care.Diabetes Care. 2004; 27: 2154-2160
- Association of depression and diabetes complications: a meta-analysis.Psychosom. Med. 2001; 63: 619-630
- Depression predicts all-cause mortality: epidemiological evaluation from the ACCORD HRQL substudy.Diabetes Care. 2012; 35: 1708-1715
- Depression and all-cause and coronary heart disease mortality among adults with and without diabetes.Diabetes Care. 2005; 28: 1339-1345
- Depression and risk of mortality in individuals with diabetes: a meta-analysis and systematic review.Gen. Hosp. Psychiatry. 2013; 35: 217-225
- Depression and diabetes: impact of depressive symptoms on adherence, function, and costs.Arch. Intern. Med. 2000; 160: 3278-3285
- Association of socio-economic status with diabetes prevalence and utilization of diabetes care services.BMC Health Serv. Res. 2006; 6: 124
- Socioeconomic position predicts long-term depression trajectory: a 13-year follow-up of the GAZEL cohort study.Mol. Psychiatry. 2013; 18: 112-121
- Prevalence of depression among adults aged 20 and over: United States, 2013–2016.NCHS Data Brief. 2018;
- Economic downturns and population mental health: research findings, gaps, challenges and priorities.Psychol. Med. 2011; 41: 1343-1348
- Mental health outcomes in times of economic recession: a systematic literature review.BMC Public Health. 2016; 16: 115
- Depression in the US population during the time periods surrounding the great recession.J. Clin. Psychiatry. 2015; 76: e499-e504
Centers for Disease Control and Prevention. 2014. National Health and Nutrition Examination Surveys. 2014; Available from: 〈http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm〉.
Centers for Disease Control and Prevention.2007. Analytic Note Regarding 2007-2010 Survey Design Changes and Combining Data Across other Survey Cycles. Available from: 〈http://www.cdc.gov/nchs/data/nhanes/analyticnote_2007–2010.pdf〉.
Centers for Disease Control and Prevention. 2013. NHANES Response Rates and Population Tools. 2013; Available from: 〈http://www.cdc.gov/nchs/nhanes/response_rates_cps.htm〉.
- The PHQ-9: validity of a brief depression severity measure.J. Gen. Intern. Med. 2001; 16: 606-613
- Depression among people with type 2 diabetes mellitus, US National Health and Nutrition Examination Survey (NHANES), 2005-2012.BMC Psychiatry. 2016; 16: 88
- Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis.J. Gen. Intern. Med. 2007; 22: 1596-1602
Services, C..f.M.a.M. DM-2 (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%). 2019; Available from: 〈https://qpp.cms.gov/docs/QPP_quality_measure_specifications/Web-Interface-Measures/2019_Measure_DM2_CMSWebInterface_UPDATED.pdf〉.
Services, U.S.D.o.H.a.H.. Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey: questionnaires, datasets, and related documentation [survey operations manuals, interview and exam manuals online]. Available from: 〈https://wwwn.cdc.gov/nchs/nhanes/default.aspx〉.
- The comorbidity of diabetes mellitus and depression.Am. J. Med. 2008; 121: S8-S15
- Depressive states among adults with diabetes: findings from the National Health and Nutrition Examination Survey, 2007-2012.Diabetes Res. Clin. Pract. 2017; 127: 80-88
- Secular changes in U.S. Prediabetes prevalence defined by hemoglobin A1c and fasting plasma glucose: National Health and Nutrition Examination Surveys, 1999-2010.Diabetes Care. 2013; 36: 2286-2293
- Prevalence of prediabetes and abdominal obesity among healthy-weight adults: 18-year trend.Ann. Fam. Med. 2016; 14: 304-310
- Impact of business cycles on US suicide rates, 1928-2007.Am. J. Public Health. 2011; 101: 1139-1146
- Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder.Arch. Gen. Psychiatry. 1990; 47: 1112-1117
- Self-reported health and adult mortality risk: an analysis of cause-specific mortality.Soc. Sci. Med. 2004; 59: 1297-1306
- Self-rated health and mortality: a review of twenty-seven community studies.J. Health Soc. Behav. 1997; 38: 21-37
- Collaborative care for patients with depression and chronic illnesses.N. Engl. J. Med. 2010; 363: 2611-2620
Article info
Publication history
Published online: March 08, 2022
Accepted:
March 2,
2022
Received in revised form:
January 8,
2022
Received:
June 27,
2021
Identification
Copyright
© 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
