Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries: Results from the INTERPRET-DD prospective study

Abstract

Abstract Aims. To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries. Methods. People with type 2 diabetes treated in out-patient settings aged 18–65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of ‘upset’) between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables. Results. In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for theWHO-5, PAID and PHQ-9 were poorer in those withincidentMDD comparedwiththosewhohadneverhad adiagnosis ofMDD.Regression analyses demonstrated that higher PHQ-9, lowerWHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score,WHO-5, PAID and CSS. Conclusion. This study demonstratesthe importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in peoplewith type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.