Sujoy Majumdar1, Binayak Sinha2, Biswajit Ghosh Dastidar3, Kalyan Kumar Gangopadhyay4, Samit Ghoshal5, Jagat Jyoti Mukherjee6, Anirban Mazumdar7, Subir Ray8, Samir Dasgupta9, Kingshuk Bhattacharjee10. 1. Senior Consultant, Department of Diabetes and Endocrinology. Peerless Hospital and B K Roy Research Centre, Kolkata, India, Hon Head, Department of Diabetology, G D Hospital and Diabetes Institute, Kolkata, India. Electronic address: prestwichcentre@gmail.com. 2. Senior Consultant Endocrinologist, Department of Endocrinology, AMRI Hospitals, Kolkata, India. Electronic address: binayak.sinha@gmail.com. 3. Senior Consultant Physician, Woodlands Hospital, Kolkata, India. Electronic address: biswa.dasti@gmail.com. 4. Senior Consultant Endocrinologist, Department of Diabetes and Endocrinology, Peerless Hospital and B K Roy Research Centre, Kolkata, India, Calcutta Medical Research Institute, Kolkata, India. Electronic address: jaykal69@hotmail.com. 5. Senior Consultant Diabetologist, Nightingale Hospital, Kolkata, India. Electronic address: ramdasghosal@gmail.com. 6. Senior Consultant Endocrinologist, Department of General Medicine, Division of Endocrinology, Apollo Gleneagles Hospital, Kolkata, India. Electronic address: jjmukh@gmail.com. 7. Hon Prof and Head, Department of Diabetes and Endocrinology, KPC Medical College and Hospital, Kolkata, India. Electronic address: dranirbanmazumdar@gmail.com. 8. Senior Consultant Endocrinologist, Department of Medicine, Division of Endocrinology, Apollo Gleneagles Hospital, Kolkata, India. Electronic address: subirray@gmail.com. 9. Senior Consultant Diabetologist, Ruby General Hospital, Kolkata, India. Electronic address: sdasgupta@gmail.com. 10. Consultant Physician, Department of Medical Sciences, SJJT University, Jaipur, India. Electronic address: khbh@novonordisk.com.
Abstract
OBJECTIVES: Depression is common in diabetes and has significant impact on health outcomes. Suicidal ideation also forms a part of the spectrum of diabetes and coexistent depression. To assess the predictors of depression as well as its prevalence in Type 2 Diabetes Mellitus (T2DM) patients, we conducted a cross sectional study entitled "DEPression in DIABetes" (DEPDIAB). MATERIAL AND METHODS: A cohort of consecutive 1371 T2DM patients from Eastern India suffering from diabetes greater than 1 year was assessed in a cross- sectional survey in 9 different hospitals and medical polyclinics in Kolkata, India for depression by administering the 9-item PHQ - 9 and Beck depression scales. Socioeconomic status was assessed by the "Revised Kuppuswamy and B G Prasad socio-economic scales for 2016", a validated scoring system for assessing the socioeconomic status of Indian patients. RESULTS: In our study 836 patients (60.9%) were male and 535 (39.02%) were female. 56 patients (4.1%) met the criteria for major depression and 494 patients (36.16%) for minor depression. No sign of depression was found in 816 patients (59.74%). Depression was strongly associated with younger age (18-40 years vs. > 60 years)[OR-2.09; 95% CI 1.11-3.96], female sex [OR-1.31;95% CI 1.11-2.01],low socioeconomic status[OR-2.69; 95% CI 1.34-3.79], poor compliance [OR 5.05; 95% CI 2.79-8.13], hypoglycemia [HR 1.466; 95% CI 1.076 -1.999]and difficulty in managing day-to-day activities[HR 4.648; 95% CI 3.450 - 6.262] Suicidal ideation was detected in 201 patients (14.8%). Among patients who had repeated attacks of hypoglycemia (> 1 episode per month), 22% experienced suicidal ideation. This was significantly higher than in patients who had not suffered from hypoglycemia (12%) (p < 0.0001). Patients with HbA1C of 7% or lower experienced statistically significantly lesser suicidal ideation than patients with a higher HbA1C (12% vs. 16.8% {p = 0.016}). Suicidal ideation did not correlate with BMI, FPG or insulin usage. CONCLUSIONS: We found a high prevalence of depression in T2DM patients in Eastern India. Younger age, female sex, lower socio-economic status, poor compliance, hypoglycemia, and difficulty in managing day to day activities emerged as significant predictors of depression in this study. Recurrent episodes of hypoglycemia were an independent risk factor for suicidal ideation in patients with depression. Depression was not significantly associated with co morbidities associated with T2D and surprisingly insulin usage was not associated with increased depression.
OBJECTIVES:Depression is common in diabetes and has significant impact on health outcomes. Suicidal ideation also forms a part of the spectrum of diabetes and coexistent depression. To assess the predictors of depression as well as its prevalence in Type 2 Diabetes Mellitus (T2DM) patients, we conducted a cross sectional study entitled "DEPression in DIABetes" (DEPDIAB). MATERIAL AND METHODS: A cohort of consecutive 1371 T2DM patients from Eastern India suffering from diabetes greater than 1 year was assessed in a cross- sectional survey in 9 different hospitals and medical polyclinics in Kolkata, India for depression by administering the 9-item PHQ - 9 and Beck depression scales. Socioeconomic status was assessed by the "Revised Kuppuswamy and B G Prasad socio-economic scales for 2016", a validated scoring system for assessing the socioeconomic status of Indian patients. RESULTS: In our study 836 patients (60.9%) were male and 535 (39.02%) were female. 56 patients (4.1%) met the criteria for major depression and 494 patients (36.16%) for minor depression. No sign of depression was found in 816 patients (59.74%). Depression was strongly associated with younger age (18-40 years vs. > 60 years)[OR-2.09; 95% CI 1.11-3.96], female sex [OR-1.31;95% CI 1.11-2.01],low socioeconomic status[OR-2.69; 95% CI 1.34-3.79], poor compliance [OR 5.05; 95% CI 2.79-8.13], hypoglycemia [HR 1.466; 95% CI 1.076 -1.999]and difficulty in managing day-to-day activities[HR 4.648; 95% CI 3.450 - 6.262] Suicidal ideation was detected in 201 patients (14.8%). Among patients who had repeated attacks of hypoglycemia (> 1 episode per month), 22% experienced suicidal ideation. This was significantly higher than in patients who had not suffered from hypoglycemia (12%) (p < 0.0001). Patients with HbA1C of 7% or lower experienced statistically significantly lesser suicidal ideation than patients with a higher HbA1C (12% vs. 16.8% {p = 0.016}). Suicidal ideation did not correlate with BMI, FPG or insulin usage. CONCLUSIONS: We found a high prevalence of depression in T2DM patients in Eastern India. Younger age, female sex, lower socio-economic status, poor compliance, hypoglycemia, and difficulty in managing day to day activities emerged as significant predictors of depression in this study. Recurrent episodes of hypoglycemia were an independent risk factor for suicidal ideation in patients with depression. Depression was not significantly associated with co morbidities associated with T2D and surprisingly insulin usage was not associated with increased depression.