Original researchCorrelates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study
Introduction
Depression is a common co-morbid condition among adults with diabetes with prevalence estimates ranging from 8.3% to over 30% – as much as three times higher than in non-diabetic populations [1], [2], [3], [4], [5]. Depression has been associated with worse diabetes-related outcomes including poorer glycemic control, other cardiovascular disease risk factors, a greater diabetes symptom burden and poorer quality of life [6], [7], [8], [9]. Patients with diabetes and co-morbid depression have been found to be at an increased risk of death from all causes, including those unrelated to diabetes [10], [11], [12]. Depression has been associated with suboptimal self-care and poor treatment adherence, thus contributing to adverse outcomes [13], [14], [15], [16]. Co-morbid depression also results in higher utilization for both medical and mental health care, and higher health care costs [15], [17], [18]. Furthermore, previous studies have shown that co-morbid depression may often be unrecognized and untreated in individuals with diabetes [19], [20], [21]. With emerging evidence that depression treatment improves patient outcomes [22], [23], [24], [25], it is important to clarify which diabetes patients are at risk for depression, and the relationships between depression, quality of care and outcomes for diabetes.
Estimates of the prevalence of co-morbid depression with diabetes vary widely. A number of methodological factors affecting these estimates have been identified, including differences in depression measures, population size and characteristics, study design and the inclusion of confounding variables [1], [2], [26]. These methodological issues are further compounded in studies of outcomes associated with co-morbid depression. Health systems factors can directly and indirectly affect quality of care for diabetes, depression and associated outcomes [27], [28], [29], but have received very little attention. Few previous diabetes studies have been designed to include sufficient diversity in patient characteristics and health system factors, as well as an adequate sample size, to assess the independent association of a broad range of patient characteristics and outcomes associated with depression.
The Translating Research Into Action for Diabetes (TRIAD) study, with nearly 12,000 diabetes patients varying in age, race/ethnicity and socioeconomic position, receiving care under many different health care plans across the U.S., offers the opportunity to better elucidate the relationships of depression with patient characteristics, quality, and outcomes. The three specific aims of this diabetes study were to measure the association of co-morbid depression with: (1) patient characteristics; (2) outcomes; and (3) diabetes-related quality of care.
Section snippets
Methods
The main objective of the TRIAD study was to measure quality of care and outcomes among a diverse population of people with diabetes receiving care under varying managed health care systems located throughout the U.S. The TRIAD study design, key hypotheses and sampling frame have been described elsewhere [30]. Six centers (Pacific Health Research Institute, Hawaii; University of California, Los Angeles; Kaiser Permanente Northern California; University of Michigan; Indiana University; and the
Sample characteristics
The mean age of the 8790 TRIAD study follow-up participants was 61.8 years, 53% were female, and more than 90% had type 2 diabetes. Mean duration of diabetes was 13.5 years. Among study participants, 44% were white, non-Hispanic, 16% were Asian/Pacific Islander, 16% were Hispanic, 15% were African American and 9% belonged to other racial or ethnic groups.
Unadjusted results
Unadjusted results showed an overall rate of major depression (PHQ score >10) of 18% (Table 1). Depression rates were highest among women,
Depression prevalence and important correlates
Methodological issues associated with previous studies have resulted in large differences in estimates of co-morbid depression prevalence rates, as well as conflicting results about the impact of depression upon outcomes. The most frequently identified issues are limited sample size, the use of different measures of depression, the lack of a control group, and the failure to adequately include important confounding variables [1], [26]. Health system factors in particular have received very
Conclusions
While there are many previous studies of diabetes and co-morbid depression, the results of this study are based on the largest and most diverse sample of patients and health care systems ever undertaken. The TRIAD study sampling design, and the collection of comprehensive covariate data, enabled the independent assessment of a broad range of correlates and outcomes associated with depression.
The strong association of socioeconomic status and co-morbid depression was clear. The association of
Conflict of interest
Two co-authors have served as consultants for pharmaceutical companies (Herman – Amylin Pharmaceuticals, Eli Lilly and Company, GlaxoSmithKline, Merck and Co., Sanofi-Aventis; and Marrero – Eli Lilly and Company, Sun Pharmaceuticals). Two have received grants (Karter – an unrestricted grant to study therapy effectiveness from Novartis; and Herman – Sanofi-Aventis). Dr. Herman has also received honoraria from several pharmaceutical companies and Dr. Ettner and Bair have served on pharmaceutical
Acknowledgements
This study was jointly funded by Program Announcement number 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases.
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding organizations.
Significant contributions to this study were made by members of the Translating Research Into Action for Diabetes (TRIAD) Study
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Depression among patients with type 2 diabetes mellitus: Evidence from the Northeast region of Vietnam
2021, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :Nevertheless, Chaudhry et al. (2010) disagree with this point of view and commented that mode of treatment of diabetes (oral vs injectable) has nothing to do with the symptoms of depression in diabetic patients. In addition to the differences in measurement standards, sample size, and population characteristics [52,58], other potential explanations may be due to the influence of confounding factors, such as benefit structure, co-pay amounts, and management of diabetes in hospital and home [59–61]. There are the definitions of the class of an individual that tend to be based on economic resources, on education and on occupation status; or on attitudes, self-perception, and mindset.
Screening for depression in diabetes in an Indian primary care setting: Is depression related to perceived quality of life?
2020, Primary Care DiabetesCitation Excerpt :Currently, 80% of people with diabetes live in low- and middle-income countries out of which only 50% receive some form of care [2]. Prevalence of depression in patients with diabetes is three times the rates in non-diabetic population which further complicates the healthcare needs of this population [3]. Depression is known be both cause as well as effect of diabetes and often adversely affects self-management, glycemic control, long term complications, healthcare utilization and quality of life [2].
Prevalence of depression in patients with type 2 diabetes attended in primary care in Spain
2016, Primary Care DiabetesCitation Excerpt :As a result, performing a study stratified by age seems mandatory. Depression has been associated with a poor metabolic and cardiovascular risk factors control [6–8,23]. In our study no significant differences were found in HbA1c, lipid profile, blood pressure and body mass index according to the presence of depression.
The PHQ-9 versus the PHQ-8 - Is item 9 useful for assessing suicide risk in coronary artery disease patients? Data from the Heart and Soul Study
2012, Journal of Psychosomatic ResearchCitation Excerpt :It has been argued that patient care may even be improved when access is limited to unsolicited diagnostic information, which is easily misinterpreted and not likely to benefit patients [31]. Consistent with this, a growing number of published studies have used the PHQ-8 rather than the PHQ-9, including studies of pregnant women [37], breast cancer survivors, [38] arthritis patients [14], pulmonary arterial hypertension patients [39], diabetes patients [40–42], HMO patients [43] Veterans Affairs patients [17] and general population samples [44,45]. Two studies [17,19] have compared continuous PHQ-8 and PHQ-9 scores and, consistent with the results of the present study, reported correlations of > 0.99.
Association between depression with glycemic control and its complications in type 2 diabetes
2019, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :However, the results of present research showed that 48.6% of patients did not have appropriate glycemic control status (HbA1c > 8) and also the prevalence of depression in this group was higher than other groups with lower HbA1c. Generally, many studies have supported the idea that depression in diabetic patients can be associated with weak self-care behaviors, insufficient control of glycemic and reduced physical function and as a result increase in HbA1c [47–49]. Therefore, attention to the relationship between HbA1c levels and depression can be important in diabetic patients.
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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.