Advertisement

Acta Diabetologica

, Volume 55, Issue 9, pp 943–953 | Cite as

Prevalence and predictors of depression and anxiety in adult patients with type 1 diabetes in tertiary care setting

  • A. M. Castellano-Guerrero
  • R. Guerrero
  • F. Relimpio
  • F. Losada
  • M. A. Mangas
  • A. Pumar
  • M A. Martínez-Brocca
Original Article

Abstract

Aims

To determine gender and age differences in the prevalence of depression and anxiety and their predictive factors in adult patients with type 1 diabetes (DM1).

Methods

Random sample of DM1 adult patients from a tertiary care hospital cohort. To evaluate the presence of depression and anxiety, psychological evaluation was performed using structured clinical interview (MINI). For the specific evaluation of fear of hypoglycemia (FH), FH-15 questionnaire was used.

Results

339 patients [51.6% male; 38.5 ± 12.9 years; HbA1c 7.5 ± 1.1% (58.5 ± 14.2 mmol/mol); 20.1 ± 12.0 years of DM1] met the inclusion criteria. Prevalence of depression, anxiety, and FH in men vs. women was as follows (%): depression: 15.4 vs. 33.5 (p < 0.05); anxiety: 13.7 vs. 26.2 (p < 0.05); and FH: 42.8 vs. 46.0 (p = NS). Among midlife female patients, prevalence of depression and anxiety was higher compared to male. Moreover, comorbid depressive and anxious symptoms were also higher in midlife female patients compared to age-matched male patients (3.5 vs. 14%, p < 0.05). Apart from age-related vulnerability, female gender, poor glycemic control, and microvascular and macrovascular complications were predictive factors for depressive and anxious symptomatology. Unawareness hypoglycemia and anxiety-prone personality were predictor factors for FH.

Conclusions

In adults with DM1, prevalence of depression and anxiety is higher in women. Midlife patients, in particular women, show a significantly higher prevalence of anxiety symptoms and comorbid depression and anxiety. The presence of secondary complications and sustained poor glycemic control should alert to the possibility of these mental disorders, especially in the most vulnerable age population; clinical, gender and age-related patterns could help to design more effective psychological assessment and support in adult patients with DM1.

Keywords

Type 1 diabetes mellitus Depression Anxiety Gender differences Age difference Fear of hypoglycemia 

Notes

Acknowledgements

The authors thank Sofía Perea, Pharm D, PhD, for her support in writing the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors have declared no conflict of interest.

Ethical Standard

The study was reviewed by the local Ethics Committee and has been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki.

Informed consent

All persons gave their informed consent prior to their inclusion in the study.

References

  1. 1.
    Mental disorders (2017) http://www.who.int/mediacentre/factsheets/fs396/en/. Accessed 3 Oct 2017
  2. 2.
    Murray CJL, Lopez AD (1996) The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Harvard University Press, CambridgeGoogle Scholar
  3. 3.
    (2017) Investing in treatment for depression and anxiety leads to fourfold return. http://www.who.int/mediacentre/news/releases/2016/depression-anxiety-treatment/en/. Accessed 3 Oct 2017
  4. 4.
    Maia AC, Braga Ade A, Brouwers A, Nardi AE, Oliveira e Silva AC (2012) Prevalence of psychiatric disorders in patients with diabetes types 1 and 2. Compr Psychiatry 53:1169–1173CrossRefPubMedGoogle Scholar
  5. 5.
    Lustman PJ, Clouse RE (2007) Depression in diabetes: the chicken or the egg? Psychosom Med 69:297–299CrossRefPubMedGoogle Scholar
  6. 6.
    Chaudhry R, Mishra P, Mishra J, Parminder S, Mishra BP (2010) Psychiatric morbidity among diabetic patients: a hospital-based study. Ind Psychiatry J 19:47–49CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Smith KJ, Béland M, Clyde M, Gariépy G, Pagé V, Badawi G et al (2013) Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res 74:89–99CrossRefPubMedGoogle Scholar
  8. 8.
    Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM (2000) Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 23:434–442CrossRefGoogle Scholar
  9. 9.
    Abrahamian H, Kautzky-Willer A, Rießland-Seifert A, Fasching P, Ebenbichler C, Hofmann P et al (2016) Mental disorders and diabetes mellitus. Wien Klin Wochenschr 128:170–178CrossRefGoogle Scholar
  10. 10.
    Tong A, Wang X, Li F et al (2016) Risk of depressive symptoms associated with impaired glucose metabolism, newly diagnosed diabetes, and previously diagnosed diabetes: a meta-analysis of prospective cohort studies. Acta Diabetol 53:589–598CrossRefPubMedGoogle Scholar
  11. 11.
    Kuniss N, Rechtacek T, Kloos C et al (2017) Diabetes-related burden and distress in people with diabetes mellitus at primary care level in Germany. Acta Diabetol 54:471–478CrossRefPubMedGoogle Scholar
  12. 12.
    Ehrmann D, Schmitt A, Reimer A et al (2017) The affective and somatic side of depression: subtypes of depressive symptoms show diametrically opposed associations with glycemic control in people with type 1 diabetes. Acta Diabetol 54:749–756CrossRefPubMedGoogle Scholar
  13. 13.
  14. 14.
    Lloyd CE, Roy T, Nouwen A et al (2012) Epidemiology of depression in diabetes: international and cross-cultural issues. J Affect Disord 142:S22–S29CrossRefGoogle Scholar
  15. 15.
    American Diabetes Association (2014) Standards of medical care in diabetes—2014. Diabetes Care 37:S14–S80CrossRefGoogle Scholar
  16. 16.
    Clarke WL, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W (1995) Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care 18:517–522CrossRefPubMedGoogle Scholar
  17. 17.
    Sheehan DV, Lecrubier Y, Sheehan KH et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:22–33PubMedPubMedCentralGoogle Scholar
  18. 18.
    Soto M, Bobes J, Soto O et al. MINI Entrevista Neuropsiquiátrica Internacional http://www.academia.cat/files/425-7297-DOCUMENT/MinientrevistaNeuropsiquatribaInternacional.pdf. Accessed 16 Apr 2018
  19. 19.
    Frances A (1994) Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric AssociationGoogle Scholar
  20. 20.
    Anarte Ortiz MT, Caballero FF, Ruiz de Adana MS et al (2011) Development of a new fear of hypoglycemia scale: FH-15. Psychol Assess 23:398–405CrossRefPubMedGoogle Scholar
  21. 21.
    Meurs M, Roest AM, Wolffenbuttel BH et al. (2016) Association of depressive and anxiety disorders with diagnosed versus undiagnosed diabetes: an epidemiological study of 90,686 participants. Psychosom Med 78:233–241CrossRefPubMedGoogle Scholar
  22. 22.
    Carreira M, Anarte MT, Ruiz De Adana MS et al (2010) Depression in type 1 diabetes mellitus and associated factors. Med Clin (Barc) 135:151–155CrossRefGoogle Scholar
  23. 23.
    Li C, Ford ES, Zhao G, Ahluwalia IB, Pearson WS, Mokdad AH (2009) Prevalence and correlates of undiagnosed depression among U.S. adults with diabetes: the Behavioral Risk Factor Surveillance System 2006. Diabetes Res Clin Pract 83:268–279CrossRefPubMedGoogle Scholar
  24. 24.
    Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2001) The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 24:1069–1078CrossRefPubMedGoogle Scholar
  25. 25.
    Lloyd CE, Nouwen A, Sartorius N et al. (2018) Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries. Diabet Med.  https://doi.org/10.1111/dme.13611 CrossRefPubMedGoogle Scholar
  26. 26.
    Afifi M (2007) Gender differences in mental health. Singapore Med 48:385–391Google Scholar
  27. 27.
    Alonso-Morán E, Orueta JF, Fraile Esteban JI et al (2014) The prevalence of diabetes-related complications and multimorbidity in the population with type 2 diabetes mellitus in the Basque Country. BMC Public Health 14:1059CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Enzlin P, Mathieu C, Demyttenaere K (2002) Gender differences in the psychological adjustment to type 1 diabetes mellitus: an explorative study. Patient Educ couns 48:139–145CrossRefPubMedGoogle Scholar
  29. 29.
    Ali S, Davies MJ, Taub NA, Stone MA, Khunti K (2009) Prevalence of diagnosed depression in South Asian and white European people with type 1 and type 2 diabetes mellitus in a UK secondary care population. Postgrad Med J 85:238–243CrossRefPubMedGoogle Scholar
  30. 30.
    Simonds VM, Whiffen VE (2003) Are gender differences in depression explained by gender differences in co-morbid anxiety? J Affect Disord 77:197–202CrossRefPubMedGoogle Scholar
  31. 31.
    Silverstein B (2002) Gender differences in the prevalence of somatic versus pure depression: a replication. Am J Psychiatry 159:1051–1052CrossRefPubMedGoogle Scholar
  32. 32.
    Parker G, Hadzi-Pavlovic D (2004) Is the female preponderance in major depression secondary to a gender difference in specific anxiety disorders? Psychol Med 34:461–470CrossRefPubMedGoogle Scholar
  33. 33.
    Tsang A, Von Korff M, Lee S et al. (2008) Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain 9:883–891CrossRefPubMedGoogle Scholar
  34. 34.
    Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2002) Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res 53:1053–1060CrossRefPubMedGoogle Scholar
  35. 35.
    Negrato CA, Mattar R, Gomes MB (2012) Adverse pregnancy outcomes in women with diabetes. Diabetol Metab Syndr 4:41–44CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Aguilar Figueroa VD, Morales Carmona F (1995) Ansiedad y autoconcepto en pacientes embarazadas diabéticas. Perinatol Reprod Hum 9:99–105Google Scholar
  37. 37.
    López MEG, Calva EA (2013) Alteraciones psicológicas en la mujer con embarazo de alto riesgo. Psicología y Salud 17:53–61Google Scholar
  38. 38.
    Linzer M, Spitzer R, Kroenke K et al (1996) Gender, quality of life, and mental disorders in primary care: results from the PRIME-MD 1000 study. Am J Med 101:526–533CrossRefPubMedGoogle Scholar
  39. 39.
    Roy T, Lloyd CE (2012) Epidemiology of depression and diabetes: a systematic review. J Affect Disord 142:S8-21CrossRefPubMedGoogle Scholar
  40. 40.
    Collins MM, Corcoran P, Perry IJ (2009) Anxiety and depression symptoms in patients with diabetes. Diabet Med 26:153–161CrossRefPubMedGoogle Scholar
  41. 41.
    Golden SH, Lazo M, Carnethon M, Bertoni AG, Schreiner PJ, Diez Roux AV et al (2008) Examining a bidirectional association between depressive symptoms and diabetes. JAMA 299:2751–2759CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Anarte MT, Carreira M, Machado A et al (2014) Identification of risk factors for suffering fear of hypoglycemia in type 1 Diabetes Mellitus patients. Scand J Psychol 55:554–557CrossRefPubMedGoogle Scholar
  43. 43.
    Anderbro T, Gonder-Frederick L, Bolinder J et al (2015) Fear of hypoglycemia: relationship to hypoglycemic risk and psychological factors. Acta Diabetol 52:581–589CrossRefPubMedGoogle Scholar
  44. 44.
    Schram MT, Baan CA, Pouwer F (2009) Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium. Curr Diabetes Rev 5:112–119CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Lustman PJ, Clouse RE (2005) Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complicat 19:113–122PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • A. M. Castellano-Guerrero
    • 1
  • R. Guerrero
    • 1
    • 3
  • F. Relimpio
    • 1
    • 3
  • F. Losada
    • 1
    • 3
  • M. A. Mangas
    • 1
    • 3
  • A. Pumar
    • 1
    • 3
  • M A. Martínez-Brocca
    • 2
    • 3
  1. 1.Unidad de Gestión Clínica de Endocrinología y NutriciónHospital Universitario Virgen del RocíoSevilleSpain
  2. 2.Unidad de Gestión Clínica de Endocrinología y NutriciónHospital Universitario Virgen MacarenaSevilleSpain
  3. 3.Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de SevillaSevilleSpain

Personalised recommendations