Depression Among Patients With Diabetes Attending a Safety-Net Primary Care Clinic: Relationship With Disease Control

• Published in: Psychosomatics (Washington, D.C.) D.C.), 2014-11, Vol.55 (6), p.548-554
• Main Authors: Vanderlip, Erik R., M.D, Katon, Wayne, M.D, Russo, Joan, Ph.D, Lessler, Dan, M.D., M.H.A, Ciechanowski, Paul, M.D., M.P.H
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Anxiety Disorders - epidemiology; Biological and medical sciences; Blood Glucose - analysis; Body Mass Index; Comorbidity; Cross-Sectional Studies; Depression; Depression - epidemiology; Diabetes Complications - epidemiology; Diabetes Complications - etiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Internal Medicine; Male; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Safety-net Providers - statistics & numerical data; Socioeconomic Factors; Stress Disorders, Post-Traumatic - epidemiology
• ISSN: 0033-3182; 1545-7206
• DOI: 10.1016/j.psym.2014.01.008

Background Depression and diabetes are highly comorbid, with depression increasing risk of diabetes-related complications and mortality. Few studies have examined the relationship between depression and diabetes in safety-net populations with high rates of trauma exposure, anxiety, and substance use disorders. Methods Using a cross-sectional survey of 261 patients with diabetes attending safety-net clinics, associations between depression and key diabetes control parameters were examined in bivariate and multivariable analyses adjusting for relevant confounders and significant interactions. Results Among the participants, 57% were men, 51% were white, and the average age was 57 years. Most respondents were unemployed (81%) and earned less than $10,000 per year (51%). Overall, 28% screened positive for depression, with a high overlap of posttraumatic stress (58%) and generalized anxiety (77%) symptoms. After adjustment for socioeconomic and clinical variables, depression was associated with higher mean body mass index ( p = 0.01), severe obesity (body mass index ≥ 35 kg/m2 ) (odds ratio = 2.34, 95% CI: 1.09–5.04, p = 0.03) and uncontrolled diastolic blood pressure (odds ratio = 2.49, 95% CI: 1.15–5.39, p = 0.02). There was a nonsignificant trend for those with depression to have worse control of blood glucose. Associations with depression and diabetes clinical outcomes were not significantly worsened in the presence of comorbid anxiety disorders. Conclusions Within a highly comorbid safety-net population, significant associations between depression and key diabetes outcomes remained after accounting for relevant covariates. Further research will help elucidate the relationship between depression and diabetes control measures in safety-net populations.