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Year : 2018 | Volume : 6 | Issue : 2 | Page : 83 - 87  


Original Articles
A study to assess prevalence of depression among Diabetic population in rural field practice area of a Medical College in Hyderabad

MD Shoeeb Akram1, Sushma K2

1Assistant Professor, Dept of Community Medicine, MNR Medical College and Hospital, Sangareddy

2Associate Professor, Dept of Community Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad

Corresponding Author:

E-mail address: katkurisushma@gmail.com

Abstract:

Background: Depression and diabetes having bidirectional association and depression being 2 to 3 more common among diabetic population can have profound risk of poor outcome and serious implications.

Objective: To assess the magnitude of depression among diabetic population residing in rural field practice area of a medical college in Hyderabad, as well as to study the association of various socio-demographic factors with depression

Methods: A cross-sectional survey was conducted among 94 adult Population with diabetes residing in the rural field practice area of a medical college in Hyderabad. The sample size was calculated using 4pq/d2 and systemic random sampling was employed. Those who were willing to participate voluntarily were included. The study was conducted for a period of 1 month using a pre-tested and predesigned tool to measure depression and the data collected was analyzed using SPSS 16.0

Results: mean age of the study participants was 58.66+11.517 years, 34% of the study participants with diabetes mellitus were found to have depression, of which most (46.87%) of them were found to be suffering from mild mood disturbances. Marital status was found to be the significant predictor of depression (p<0.05)

Conclusion: Prevalence of depression was high among study Participants, further research is warranted to rule out various risk factors involved and to employ preventive strategies.

Keywords: Depression, Diabetes Mellitus, Rural population, Beck Depression Inventory

Introduction:

According to International Diabetes Federation for South-East Asia, 415 million people have diabetes in the world and 78 million people in the South-East Asia region and it is expected to rise to 140 million by 2040. 1 According to 2015 data India had constituted 69.2 million people living with diabetes. 2 Depression is highly common and serious medical illness with lifetime prevalence ranging from 11% to 15% in low and high income countries. 3 According to DSM-V criteria, a major depressive disorder has the following principal symptoms-either a diminished/irritable mood or having decreased pleasure or interest or having both and at least having four of the following symptoms viz., feelings of guilt or worthlessness, fatigue or loss of energy, concentration problems, suicidal thoughts, weight loss or weight gain, psychomotor retardation or activation, hypersomnia or insomnia lasting for 2 weeks. 4 There are evidences that prevalence of depression is markedly increased in diabetic populations when compared to normo glycemic individuals 5 and the prevalence of depression could be 2 to 3 times higher in diabetic patients (Type 2 and Type 1 patients) when compared to general population. 6 Also there is 60% risk of developing type 2 diabetes mellitus in patients with depression which suggest bidirectional association between diabetes mellitus and depression. 7, 8 Due to paucity of studies related to depression and diabetes in India, the exact burden of the disease is unclear hence we would like to assess the prevalence of depression among diabetic population in rural field practice area of a medical college in Hyderabad.

There is paucity of studies evaluating depression among chronic diseases such as diabetes in rural areas, thus this study paved a way in assessing the magnitude of depression among diabetic population in rural field practice area of a medical college in Hyderabad as well to assess the association of various socio-demographic variables with depression.

Methods:

A cross-sectional study was conducted among adult population with diabetes mellitus aged more than 18 years residing in the rural field practice area of a medical college in Hyderabad. The study was carried out for a period of one month during 2017. Adult population with diabetes Mellitus, irrespective of the type of diabetes, aged 18 years and above and those who consent for the study voluntarily were included as study subjects and those with existing psychiatric illness or on antidepressant medications were excluded from the study.

The prevalence of depression, p among adult population with diabetes was taken as 65.5%.[10] With the precision of 15%, using the above mentioned statistical formula which considers 95% confidence limits, the sample size was estimated to be 94. List of households in the selected area was taken as the sample frame. The systematic random sampling method was used to select the house with sampling interval of 21. The study was approved and ethical clearance was sought from the Institutional ethics committee, after obtaining written consent from the study participants, the data was collected using a pre-designed and pre-tested questionnaire, where information on diabetes was obtained through past clinical records and medications in use.

Information pertaining to depression among diabetics was obtained through a structured questionnaire called Beck Depression Inventory (BDI)9, that includes information on sadness, Pessimism, past failure, loss of pleasure, feeling of guilt, punishment feelings, self dislike, self criticalness, suicidal thoughts or wishes, crying, agitation, loss of interest, indecisiveness, worthlessness, loss of energy, changes in sleeping pattern, irritability, changes in appetite, concentration difficulty, tiredness or fatigue, loss of interest in sex. A score ranges from 1-63, where a score of 1-10 is considered normal, 11-16 as mild mood disturbance, 17-20 as borderline clinical depression, 21-30 as moderate depression, 31-40 as severe depression and a score more than 40 as extreme depression.

Information pertaining to various socio-demographic variables such as age, gender, marital status, occupation, education and socio-economic status using modified BG Prasads classification was obtained.

Analysis was done using the SPSS Version 16.0. Descriptive statistics in terms of Mean (S.D) will be applied for continuous variables and in terms of frequency, percentages and proportions for categorical variables. Categorical variations will be analyzed by the chi-square test using Yates correction for continuity and the Fishers exact test. Continuous variables will be analyzed by the t-test.

Results:

As seen in table 1, majority of the study participants with diabetes mellitus were in the age group of 60 years and above (58.5%) and male gender was dominant among the study group (55.3%). Majority of the study participants were married (94.7%). Majority viz., 62.8% and 64.9% of the study participants were employed and illiterate respectively.

As seen in Table 2 and figure 1, 34% of the study participants with diabetes mellitus were suffering from depression, of which majority were suffering from mild mood disturbances (46.87%), followed by borderline clinical depression (31.25%).

As depicted in table 3, marital status was the only single predictor found to be statistically significantly associated with depression.

Discussion:

The present was conducted to assess the magnitude of depression among the adult males with Diabetes Mellitus, irrespective of its various types and also to study the association of various socio-demographic variables with depression. In our study mean age of the study participants was found to be 58.66+11.517 years. The present study found that 34% of the study participants with diabetes mellitus were suffering from depression and of the study participants with depression most of them were suffering from mild mood disturbances (46.87%) followed by which 31.25, 15.63 and 6.25% were found to be suffering from borderline clinical, moderate and severe depression respectively. When association of various socio-demographic variables was assessed, marital status of the study participants was found to be statistically significantly associated with depression (p < 0.05). 

The prevalence of depression is in line with the study by Rajput R et al 10 and lesser than the study by Raguramalu P et al 11 and this could due to the differences in the sample studied, scales of assessment of depression and their other life events that may an impact on depression. Our study found that of the people found to be suffering from depression, most of them (46.87%) were having mild mood disturbances and this finding falls in line with the study by Raguramulu P et al, 11 where in 46% of the study participants with diabetes mellitus were suffering from mild mood disturbances. A review article on Cross-national epidemiology of DSM-IV major depressive episode 12 showed that the prevalence of depression ranges from 11% in low income countries to 15% in high income countries in general population, our study finding on prevalence of depression fall in line with various studies where prevalence of depression among diabetics is 2 to 3 times higher than the general population. 3, 13, 14

Our study finding of advancing age and female gender (53.1% vs. 46.9%) with diabetes mellitus were more depressed than males, though statistically non-significant but was in line with the study finding by Yu S et al, 15 where in female gender (OR = 1.984; p < 0.05) and older age had statistically significant relationship with depressive symptoms. In our study marital status was found to have statistically significant association with depression among adults with diabetes mellitus (p < 0.05) and this is in line with the findings of Rajput R et al 10 and Bromet E et al, 12 where in marital status has significant relationship with depression.

Our study had paved a way in assessing magnitude of depression among rural diabetics and their association with few socio-demographic variables but our study has certain limitations, the first being cross-sectional design, the second being absence of control population and the third could be the smaller sample size.

Conclusion:

Our study found that prevalence of depression among diabetic population is two to three times higher than the general population as revealed in other studies. Of the study participants with depression, most were suffering from mild mood disturbances and marital status was found to be the significant predictor of depression. Because of the high prevalence of depression, further higher studies are warranted to assess the various risk factors involved in making a diabetic person more prone for depression, as depression may have poor clinical outcomes among diabetics

References:

  1. International Diabetes Federation South-East Asia. India [Internet]

[Accessed on 24 April 2017] Available at: http://www.idf.org/membership/sea/india

  1. World Health Organization. World Health Day 2016: Diabetes [Internet]

[Access 24 April 2017] Available at: http://www.searo.who.int/india/mediacentre/events/2016/en/

  1. Badescu SV, Tataru C, Zagrean L. The Association between Diabetes mellitus and depression. J Med Life 2016;9(2):120-5.
  2. American Psychiatric Association, Task F. Diagnostic and statistical manual of mental disorders DSM-5.Fifth edition 2013.
  3. Chen S, Zhang Q, Dai G, Hu J, Zhu C, Su L, Wu X. Association of depression with depression with pre-diabetes, undiagnosed diabetes and previously diagnosed diabetes: a Meta analysis. Endocrine 2016;53(1):35-46
  4. Griqs AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res 2002;53(6):1053-60
  5. Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care. 2008;31(12):2383-90.
  6. Rubin RR, Ma Y, Marrero DG, Peyrot M, Barrett-Connor EL, Kahn SE, Haffner SM, Price DW, Knowler WC. Elevated depression symptoms, antidepressant medicine use, and risk of developing diabetes during the diabetes prevention program. Diabetes Care 2008;31(3):420-6
  7. Appendix 14. Beck Depression Inventory [Internet] [cited on 25 April 2017] Available from: http://shodhganga.inflibnet.ac.in/bitstream/10603/78871/16/16_appendix%202.pdf
  8. Rajput R, Gehlawat P, Gehlan D, Gupta R, Rajput M. Prevalence and predictors of depression and anxiety in patients of diabetes mellitus in a tertiary care center. Indian J Endocr Metab 2016;20:746-751. [cited on 24 April 2017] Available from:http://www.ijem.in/text.asp?2016/20/6/746/192924
  9. Raguramulu P, Kosaraju SKM, Dayakar E, Rajyam PL, Kalasapati LK. Prevalence of depression among the rural population suffering from type 2 diabetes. Int J Adv Pharmacy Med Bioallied Sci 2015.

[Accessed on 24 April 2017], Available at: http://biomedjournal.com/prevalence-of-depression-among-the-rural-population-suffering-from-type-2-diabetes/

  1. Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, Girolamo GD et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Medicine 2011;9:90 [Accessed on: 24 November 2017] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163615/pdf/1741-7015-9-90.pdf
  2. Eaton WW, Armenian H, Gallo J, Pratt L, Ford D. Depression and risk for onset of type II diabetes: a prospective population-based study. Diabetes Care 1996;19:1097–1102 [Accessed on 24 November 2017 ] Available at: https://www.ncbi.nlm.nih.gov/pubmed/8886555
  3. Stellato R, Feldman H, Hamdy O, Horton E, McKinlay J. Testosterone, sex hormone-binding globulin and the development of type 2 diabetes in middle-aged men: prospective results from the Massachusetts male aging study. Diabetes Care 2000;23:490–494 [Accessed on 24 November 2017 ] Available at: http://care.diabetesjournals.org/content/diacare/23/4/490.full.pdf
  4. Yu S, Yang H, Guo X, Zheng L, Sun Y. Prevalence of depression among rural residents with Diabetes Mellitus: A Coss-sectional study from Northeast China. Int J Environ Res Public Health 2016;13:542-49

Table 1: socio-demographic profile of the study participants (n=94)

Variables

Frequency

(n)

Percentage

(%)

Age (years)

Less than40

6

6.4

40 - Less than50

10

10.6

50 - Less than60

23

24.5

60 and above

55

58.5

Gender

Male

52

55.3

Female

42

44.7

Marital status

Married

89

94.7

single

5

5.3

Occupation

Employed

59

62.8

Unemployed

35

37.2

Education

Literate

33

35.1

Illiterate

61

64.9

Table 2: Prevalence of depression among the study participants (n=94)

Depression

Frequency (n)

Percentage (%)

Present

32

34%

Absent

62

66%

Table 3: Association of various socio-demographic variables with depression (n=94)

 

Depression

Chi-square value

p value

Present

Absent

Age (Years)

Less than40

3(9.4%)

3(4.8%)

2.72

0.436*

40 - Less than50

3(9.4%)

7(11.3%)

50 - Less than60

5(15.6%)

18(29.0%)

60 and above

21(65.6%)

34(54.8%)

gender

Male

15(46.9%)

37(59.7%)

1.400

0.237

Female

17(53.1%)

25(40.3%)

Marital status

Married

28(87.5%)

61(98.4%)

4.915

0.044*

single

4(12.5%)

1(1.6%)

Education

Literate

11(34.4%)

22(35.5%)

0.011

0.915

Illiterate

21(65.6%)

40(64.5%)

Occupation

Employed

18(56.2%)

41(66.1%)

0.881

0.348

Unemployed

14(43.8%)

21(33.9%)

*Fishers exact test with continuity correction





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