Depressive Disorders Among Adult Persons with Diabetes in Michigan

BACKGROUND:   The association of cardiovascular and kidney disease with diabetes is well known. However, depression, another common condition among persons with diabetes (PWD), may create additional challenges for disease management. We report the prevalence of depression among Michigan adults by diabetes status. For PWD, the association between depression and various risk/preventive factors is also assessed.

METHODS:   The 2011 Michigan Behavioral Risk Factor Survey (MiBRFS) included questions regarding depression, diabetes, behavioral risk factors and preventive care practices. Respondents were asked if they have ever been told by a doctor, nurse, or other health professional that they had diabetes or depression. Preventive care practice was defined as report of having an annual eye examination, annual foot examination, and biannual A1C measurements. Demographic subpopulations were compared for differences on both depression and diabetes status. Data were analyzed using SAS-Callable SUDAAN. Weighted prevalence estimates and Wald’s chi-square values were determined.

RESULTS:   In 2011, 10.0% of Michigan adults reported diagnosed diabetes. PWD were 43.4% more likely to have reported ever being told that they had depression than Michigan adults without diabetes (28.4% vs. 19.8%). Females with (33.0%) and without diabetes (24.7%) reported a higher prevalence of depression than their male counterparts (PWD: 23.8% and persons without diabetes: 14.4%). PWD also reported a higher prevalence of depression than persons without diabetes within both the non-Hispanic White (28.6% vs. 20.7%) and non-Hispanic Black (23.2% vs. 13.7%) populations. Among PWD, adults with depression were 17.5% more likely to be obese as their non-depressed counterparts (68.4% vs. 58.2%, p = 0.02). Furthermore, PWD with depression were more likely to report current cigarette smoking than PWD without depression (30.8% vs. 14.1%). The prevalence of inadequate fruit/vegetable consumption, no leisure-time physical activity, and preventive care practice were similar among adult PWD with and without depression.

CONCLUSIONS:   The prevalence of depression was significantly higher among those with diabetes compared to those without diabetes regardless of gender or racial/ethnic group. Some behavioral risk factors and preventive care practices were uniformly poor for PWD, regardless of depression status. Others (obesity and smoking) were higher among PWD with depression than those without the condition. Depression may further complicate the ability of PWD to manage their health. Therefore, diabetes education and self-management programs and primary care providers may need to further address signs of depression among PWD.