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 so-ciodemographics, 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 psy-chiatrist to minimize the false negative and positive results. Result: A total of 460 patients with Type 2 diabetic were enrolled in this cross-sectional 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 HbA1c (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 exercise (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.