Type 2 (DM2) diabetes mellitus and depression are two very prevalent diseases in the general population;In our country, the prevalence of the first is estimated at 13.8%, and around 10.5% of the Spanish population has suffered some episode of depression throughout its life.
Between them a bidirectional association has been described: people with diabetes could present depression as a result of the psychological stress of disease itself, its chronic character and associated comorbidity.
On the other hand, depression and antidepressant treatments have been considered an important risk factor for developing DM2.The mechanisms that underlie this relationship are not yet clear, and deserve greater research.
In this study that the authors are discussed as a primary objective to know the prevalence of diagnosed and hidden depression in people with DM2, as well as another series of secondary objectives, such as knowing the degree of metabolic control of the patients studied (with and without depression), Assess the differences between the different groups and evaluate whether there is any relationship with the prescribed treatment or the presence of comorbidity.
It is a descriptive, transverse and multicenter study conducted in patients with DM2 assisted in primary care in Spain.Data collection was carried out by reviewing the computerized medical history and a directed interview conducted to the patient by means of the PHQ-9 questionnaire, self-administered, useful for the diagnosis of depression and establishing its severity.
411 patients with an average age of 70.8 years participated in the study, of which 53.8% were women.The prevalence of depression, taking into account the diagnostic criteria of the PHQ-9 test, was 29.2%, of which 17% knew the diagnosis of depression and 12.2% did not know (score ≥10 without a diagnosisprevious).Depression was more frequent in women than in men (43.4%prevalence; 95%confidence interval [IC]: 34.5-52,3), in widows (33.3%; 95%CI: 95%:27.9-38.7) and in patients with hypothyroidism (12.5%; 95%CI: 8.7-16,3).In this study, the presence of other cardiovascular risk factors, age, metabolic control, diabetes -related complications, antidiabetic treatment or the number of drugs were not associated with the presence of depression, despite the fact thatAlmost 28% of patients were being treated with insulin.
These results do not agree with what is published in other studies, in which patients with depression have a higher prevalence of complications of diabetes (retinopathy, nephropathy, neuropathy, macrovascular complications and sexual dysfunction), with respect to patients who have no depression.Depressive symptoms in patients with DM2 have greater impact on the quality of life than microvascular complications, heart failure and the number of drugs used.Recently published clinical practice guides begin to recommend the realization of a screening of depressive symptoms in people with diabetes.
In conclusion, this study provides relevant information on depression in patients with DM2 in a specific sociocultural environment and a health system different from that related to data published to date;In fact, most of these studies were carried out in the United States.Approximately one third of patients with DM2 assisted in primary care in Spain have depression, of which an important proportion had not previously been diagnosed.Primary care is the best scenario where a wide approach to diabetic patients could be carried out, including the detection of depression withvalidated and simple instruments, such as the self-administered test PHQ-9.This can be particularly important in patients with the highest risk of depression, such as women, widows or those with other chronic pathologies.
Cols-Sagarra C, López-Simarro F, Alonso-Fernández M, Mancera-Romero J, Pérez-Unanua MP, Mediavilla-Abravo JJ;Work Group of Diabetes Semergen (Spanish Society of Primary Care Physicians).Prevalence of Depression in Patients With Type 2 Diabetes Attended in Primary Care in Spain.Prim Care Diabetes.2016 [PII: S1751-9918 (16) 00026-7;DOI: 10.1016/J.PCD.2016.02.003] [EPUB AHEAD OF PRINT] PMID: 27025441.