Key Words: type 2 diabetes mellitus , depression, diabetic retinopathy
Abstract
BACKGROUND
Patients with type 2 diabetes mellitus (DB2) are more prone to poor quality of life, disability and even death. They also have a greater predisposition to depression compared with non-diabetic patients; as well as a favorable prognosis after mental health-oriented interventions.
OBJECTIVES
The aim of this study was to explore the presence of depressive symptoms in an outpatient population diagnosed with DB2 and military affiliation. Also, to examine the factors associated with the presence of depressive symptoms.
METHODS
We performed a cross sectional study in 108 people with type 2 diabetes mellitus in January 2012 in an outpatient sample of a military hospital. Depressive symptoms were assessed with Zung’s self-administered test. We used the chi-square test or Fisher's exact test to examine associations between depressive symptoms and factors of interest. We use crude and adjusted generalized linear models to estimate prevalence ratios (PRs) for association between clinical and sociodemographic characteristics with the presence of depressive symptoms.
RESULTS
The prevalence of depressive symptoms was 56.5% (95% CI: 46.6 to 66.0%). The bivariate analysis showed significant association between depressive symptoms and variables: sex, age and clinical complications of diabetes. Adjusted analysis showed that diabetic retinopathy [RP: 1.3; 95% CI: 1.1-1.7], and diabetic neuropathy [RP: 1.4; 95% CI: 1.1-1.7] were associated with a greater presence of depressive symptoms after taking into account sex of participants.
CONCLUSIONS
We observed a high prevalence of depressive symptoms in the study population, especially in female or elderly patients. This was also true among subjects with late complications of type 2 diabetes mellitus that likely represent the impact of the disease on quality of life and its ultimate effect being manifested as depressive symptoms. A multidisciplinary approach focusing on mental health-oriented aspects should be considered, as it could benefit the evolution of these patients in Peru.
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INTRODUCCIÓN
Los pacientes con diabetes mellitus tipo 2 son más propensos a una baja calidad de vida, discapacidad e incluso muerte. También, tienen una mayor predisposición a la depresión en comparación con los pacientes no diabéticos; así como una evolución favorable producto de la evaluación e intervención de su salud mental.
OBJETIVOS
El objetivo de este estudio fue explorar la presencia de síntomas depresivos en una población ambulatoria con diagnóstico de diabetes mellitus tipo 2 y filiación militar. También examinar los factores asociados a la presencia de síntomas depresivos.
MÉTODOS
Realizamos un estudio transversal en 108 personas con diabetes mellitus tipo 2, durante enero de 2012 en una muestra ambulatoria de un hospital de las fuerzas armadas. Los síntomas depresivos se evaluaron con el test autoaplicado de Zung. Usamos la prueba de Chi-cuadrado para examinar las asociaciones entre síntomas depresivos y los factores asociados de interés. Usamos modelos lineales generalizados crudos y ajustados para estimar las Razones de Prevalencia (RP) de la asociación entre las características clínicas y sociodemográficas con la presencia de síntomas depresivos.
RESULTADOS
La prevalencia de sintomatología depresiva fue de 56,5% (intervalo de confianza 95%: 46,6-66,0%). El análisis bivariado mostró como significativa la asociación entre la presencia de síntomas depresivos con las variables: sexo, edad y complicaciones clínicas de la diabetes. En los análisis ajustados, la retinopatía diabética [RP: 1,3; intervalo de confianza 95%: 1,1-1,7], y la neuropatía diabética [RP: 1,4; intervalo de confianza 95%: 1,1-1,7] se asociaron a una mayor presencia de síntomas depresivos luego de considerar el sexo de los participantes.
CONCLUSIONES
Observamos una elevada presencia de síntomas depresivos en la población de estudio, especialmente en los pacientes geriátricos o del sexo femenino. También en aquellos con complicaciones tardías de la diabetes mellitus tipo 2, y que probablemente representen la repercusión de la enfermedad en la calidad de vida del paciente. Un abordaje multidisciplinario, con enfoque físico y mental, debe ser considerado ya que podría beneficiar a la evolución de los pacientes con esta concomitancia en Perú.
Authors:
Débora Urrutia-Aliano[1], Eddy R Segura[2]
Affiliation:
[1] Departamento de Urología, Hospital Militar Central del Perú, Lima, Perú
[2] Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
E-mail: deboraxlii@hotmail.com
Author address:
[1] Calle José Gonzáles 458
Departamento 501
Miraflores
Lima
Perú
Citation: Urrutia-Aliano D, Segura ER. Depressive symptoms and type 2 diabetes mellitus in outpatients of an Armed Forces hospital in Lima, Peru, 2012: a cross-sectional study. Medwave 2016 Abr;16(3):e6435 doi: 10.5867/medwave.2016.03.6435
Submission date: 9/1/2016
Acceptance date: 20/4/2016
Publication date: 29/4/2016
Origin: not requested
Type of review: reviewed by four external peer reviewers, double-blind
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Internacional Diabetes Federation. Diabetes in Peru - 2015. IDF South and Central America Region; 2015 [on line]. | Link |World Health Organization. Global status report on noncommunicable diseases 2010. Geneve,2011 [on line]. | Link |Sociedad Andaluza de Medicina de Familiar y Comunitaria. Diabetes Mellitus Guía Clínica: Epidemiologia. Andalucia, 2010 [on line]. | Link |Gutiérrez-Hermosillo H, Díaz de León-González E, Pérez-Cortez P, Cobos-Aguilar H, Gutiérrez-Hermosillo V, Tamez-Pérez H. Prevalencia de diabetes mellitus de tipo 2 y factores asociados en la población geriátrica de un hospital general del norte de México. Gac Med Mex. 2012; 148(1):14-8. | Link |International Diabetes Federation. Global Diabetes Scorecard - Tracking Progress for Action, 2014. idf.org [on line]. | Link |Jimenez M, Davila M. Psicodiabetes. Avances en la Psicologia Latinoamericana. 2007;25:126-43. | Link |International Diabetes Federation. IDF International Standards for Diabetes Education. IDF: Bruselas, 2009 [on line]. | Link |Wayne J, Katon M. Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues Clin Neurosci. 2011;13(1):7-23. | PubMed | Link |Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with Type 2 diabetes: A systematic review and meta-analysis. Diabet Med. 2006 Nov;23(11):1165-73. | PubMed |Rivas-Acuña V, García-Barjau H, Cruz-León A, Morales-Ramón F, Enríquez-Martínez RM, Román-Alvarez J. Prevalencia de ansiedad y depresión en las personas con diabetes mellitus tipo 2. Salud en Tabasco. 2011;17(1-2). | Link |Anderson RJ, Kenneth B, Freedland E, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabet Care. 2001; 24(6):1069-78. | Link |Lin EH, Katon W, Von-Korff M, Rutter C, Simon GE, Oliver M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabet Care. 2004;27(9):2154-60. | Link |Lin EH, Rutter C, Katon W, Heckbert S, Ciechanowski P, Oliver M, et al. Depression and advanced complications of diabetes. A prospective cohort study. Diabetes Care. 2010 Feb;33(2):264-9. | CrossRef | PubMed |Novara J, Sotillo C, Warthon D. Estandarización de las escalas de Beck, Hamilton y Zung para Depresión de Lima Metropolitana. Lima - Perú: Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi"; 1985. Wacholder S. Binomial regression in GLIM: Estimating risk ratios and risk differences. Am J Epidemiol. 1986; 123(1):174-84. | Link |Deddens JA, Petersen MR. Approaches for estimating prevalence ratios. Occup Environ Med. 2008;65(481):501-6. | Link |Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003; 3: 21. | CrossRef | PubMed |Petersen MR, Deddens JA. A comparison of two methods for estimating prevalence ratios. BMC Med Res Methodol. 2008 Feb 28;8:9. | CrossRef | PubMed |Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and cox regression. Am J Epidemiol. 2007;165(6):710-18. | Link |Colunga-Rodríguez C, Alba JEGd, Salazar-Estrada JG, Ángel-González M. Diabetes tipo 2 y depresión en Guadalajara, México. 2005. Rev Salud Pública. 2008;10(1):137-49. | Link |Javanbakht M, Abolhasani F, Mashayekhi A, Baradaran HR, Noudeh YJ. Health related quality of life in patients with type 2 diabetes mellitus in iran: a national survey. PLoS One. 2012;7(8):e44526. | CrossRef | PubMed |Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older mexican americans with type 2 diabetes. Diabetes Care. 2003;26:2822-8. | Link |Guadalupe M, Miguel FS, Sancho MG, Carlos Cobo Abreu. Prevalencia de síntomas de ansiedad y depresión en pacientes con diabetes mellitus tipo 2 y su asociación con el tipo de tratamiento, complicaciones de la diabetes y comorbilidades. Medicina Interna Mexico. 2010;26(2):100-8. | Link |Cosgrove MP, Sargeant LA, Griffin SJ. Does depression increase the risk of developing type 2 diabetes? Occupational Medicine. 2007;58(1):7-14. | Link |Katon WJ, Young BA, Russo J, Lin EH, Ciechanowski P, Ludman EJ, et al. Association of depression with increased risk of severe hypoglycemic episodes in patients with diabetes. Ann Fam Med. 2013 May-Jun;11(3):245-50. | CrossRef | PubMed |Bangasser DA, Curtis A, Reyes BAS, Bethea TT, Parastatidis I, Ischiropoulos H, et al. Sex differences in corticotropin-releasing factor receptor signaling and trafficking: potential role in female vulnerability to stress-related psychopathology. Mol Psychiatry. 2010 Sep;15(9):877, 896-904. | CrossRef | PubMed |Kalantari S, Jafarinezhad A, Zohrevand B. Association of depression with type 2 diabetes and relevant factors. Adv Biomed Res. 2014 Nov 29;3:244. | CrossRef | PubMed |Xu X, Zhao X, Qian D, Dong Q, Gu Z. Investigating factors associated with depression of type 2 diabetic retinopathy patients in China. PLoS One. 2015 Jul 7;10(7):e0132616. | CrossRef | PubMed |Honkasalo MT, Elonheimo OM, Sane T. Severe hypoglycaemia in drug-treated diabetic patients needs attention: a population-based study. Scandinavian Journal of Primary Health Care. 2011;29(3):165-70. | Link |Bogner HR, Morales KH, Post EP, Bruce ML. Diabetes, depression, and death: a randomized controlled trial of a depression treatment program for older adults based in primary care. Diabetes Care. 2007;30:3005-10. | Link |Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K, et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010 Dec;53(12):2480-6. | CrossRef | PubMed |Vazquez C, Jiménez F. Depresión y manía. Medición clínica en psiquiatría y psicología. Barcelona - España: Masson S.A.; 2000:225-56. Mezuk B, Johnson-Lawrence V, Lee H, Rafferty JA, Abdou CM, Uzogara EE, et al. Is ignorance bliss? Depression, antidepressants, and the diagnosis of prediabetes and type 2 diabetes. Health Psychol. 2013 Mar;32(3):254-63. | CrossRef | PubMed |Lloyd C. Los efectos de la diabetes sobre la depresión y de la depresión sobre la diabetes. Diabetes Voice. 2008;53(1):23-6. | Link |Aníbal V. La carga de enfermedad y lesiones en el Perú y las prioridades del plan esencial de aseguramiento universal. Rev Peruana Med Exp Salud Pública. 2009;26(2):222-31. | Link |
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