Association between diabetes mellitus and depressive symptoms in the Brazilian population

Briganti, Cauê Pontes; Silva, Marcus Tolentino; Almeida, José Vanilton de; Bergamaschi, Cristiane de Cássia

doi:10.11606/S1518-8787.2019053000608

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Sumário

Original Article • Rev. Saúde Pública 53 • 2019 • https://doi.org/10.11606/S1518-8787.2019053000608 copy

Association between diabetes mellitus and depressive symptoms in the Brazilian population

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To determine the prevalence of current depressive symptoms in people with diabetes mellitus and their association with the disease.

METHODS

Data were collected from the Brazilian National Health Survey (Pesquisa Nacional de Saúde - PNS), a cross-sectional, population-based study conducted in 2013. Study participants were selected by simple random cluster sampling in three stages: census tracts, households, and residents aged ≥ 18 years. The presence of diabetes was self-reported, whereas the presence of current depressive symptoms was determined by the Patient Health Questionnaire-9 (PHQ-9) and mean scores of this questionnaire were calculated for the variables assessed. Tobit regression was used to evaluate variation in these individuals.

RESULTS

Of the 60,202 interviewees, 6.03% (n = 3,636) reported diabetes mellitus. The disease was more frequent in female, older, widowed, obese and with incomplete elementary education. Depression symptoms were mild-to-moderately severe in 22% of the diabetics. The severity of current depressive symptoms was higher in individuals that were female (PHQ-9 mean = 3.35), older adults (PHQ-9 mean = 3.01), indigenous (PHQ-9 mean = 3.46), separated/divorced (PHQ-9 mean = 3.13), widowed (PHQ-9 mean = 3.39), obese (PHQ-9 mean = 3.13) and with incomplete primary education (PHQ-9 mean = 3.21). Higher severity of depressive symptoms was associated with the use of insulin and with coma (PHQ-9 mean = 8.32), limb amputation (PHQ-9 mean = 7.55), circulatory problems (PHQ-9 mean = 6.94), infarction (PHQ-9 mean = 6.83), diabetic foot (PHQ-9 mean = 6.62), and kidney problems (PHQ-9 mean = 6.68). The severity of current depressive symptoms was associated with diabetes severity and degree of limitation in activities of daily living (PHQ-9 mean = 10.62).

CONCLUSIONS

Interventions to improve depressive symptoms should be prioritized in people with diabetes are female, older adults, indigenous, widowed, separated/divorced, obese and with incomplete elementary education.

DESCRIPTORS
Adult; Diabetes Mellitus, epidemiology; Depression, epidemiology; Risk factors; Patient Health Questionnaire, utilization; Health Surveys

Variable		Population				Depressive symptoms
Variable		Total n (%)	Diabetes n (%)	p	% None-minimal	% Mild	% Moderate	% Moderately severe	% Severe	p
Gender
	Male	25,916 (43.0)	1,281 (6.3)	0.0025	85.43	9.85	3.00	1.14	0.58	< 0.0001
	Female	34,286 (56.9)	2,355 (7.6)		73.08	16.20	6.37	2.90	1.45
Age (years)
	18-39	28,722 (47.7)	315 (1.2)	< 0.001	81.25	12.32	4.07	1.63	0.73	< 0.0001
	40-59	20,613 (34.2)	1,425 (7.9)		76.73	14.09	5.50	2.32	1.36
	≥ 60	10,866 (18.0)	1,896 (19.1)		76.81	13.86	5.33	2.76	1.25
Ethnicity^* * Not all participants responded.
	White	28,571 (47.5)	1,556 (7.3)	0.0779	79.53	12.98	4.47	2.08	0.94	< 0.1241
	Black	5,538 (9.2)	415 (8.2)		79.08	12.36	5.21	2.02	1.33
	Asian	565 (0.94)	29 (6.8)		79.39	12.93	4.38	2.29	1.00
	Brown	25,272 (41.9)	1,608 (6.5)		78.22	13.56	5.06	2.05	1.11
	Indigenous	252 (0.4)	27 (8.5)		69.66	22.24	5.16	2.82	0.13
Marital status
	Married	26,669 (44.3)	1,621 (8.3)	< 0.001	79.84	12.32	4.71	2.08	1.05	< 0.0015
	Separated/Divorced	3,913 (6.5)	416 (9.8)		75.30	14.67	6.09	2.43	1.51
	Widowed	4,021 (6.7)	757 (17.5)		73.40	15.78	6.42	3.17	1.23
	Single	25,597 (42.5)	842 (3.2)		79.33	13.50	4.40	1.83	0.94
Education^* * Not all participants responded.
	Higher or postgraduate	9,228 (15.3)	365 (4.3)	< 0.001	81.35	12.95	3.75	1.44	0.50	< 0.0001
	High School	23,575 (39.2)	730 (3.8)		81.55	12.24	3.99	1.53	0.69
	Elementary School	2,516 (4.2)	1,788 (9.7)		77.09	13.61	5.42	2.35	1.52
	Incomplete elementary school	2,233 (3.7)	216 (11.5)		75.13	14.90	5.43	3.29	1.25
Body Mass Index^* * Not all participants responded.
	Normal weight (18.5-25 kg/m²)	27,801 (46.2)	602 (3.8)	< 0.001	80.72	12.52	4.37	1.50	0.89	< 0.0001
	Overweight (≥ 25 kg/m²)	21,161 (35.1)	931 (7.5)		80.81	12.64	4.11	1.65	0.78
	Obese (≥ 30 kg/m²)	1 1,239 (1 8.7)	823 (12.4)		74.98	15.02	5.94	3.06	1.00

Variable		Mean PHQ-9	Coefficient	p
Gender
	Male	1.97	Ref
	Female	3.35	2.59	< 0.001
Age (years)
	18-39	2.40	Ref
	40-59	2.96	0.99	< 0.001
	≥ 60	3.01	1.15	< 0.001
Ethnicity
	White	2.62	Ref
	Black	2.74	0.19	0.351
	Asian	2.64	-0.05	0.927
	Brown	2.78	0.36	0.020
	Indigenous	3.46	1.55	0.011
Marital status
	Married	2.63	Ref
	Separated/Divorced	3.13	0.91	< 0.001
	Widowed	3.39	1.41	< 0.001
	Single	2.60	0.00	0.991
Education
	Higher or postgraduate	2.32	Ref
	High School	2.34	0.05	0.739
	Elementary School	2.99	1.17	< 0.001
	Incomplete elementary school	3.21	1.66	< 0.001
Body Mass Index
	Normal weight (18.5-24.99 kg/m²)	2.49	Ref
	Overweight (≥ 25 kg/m²)	2.44	-0.19	0.171
	Obese (≥ 30 kg/m²)	3.13	1.00	< 0.001

Variables		% Diabetes	% None-minimal	% Mild	% Moderate	% Moderately severe	% Severe	p	Mean PHQ-9	PHQ-9 Coefficient	p
Duration of illness (years)
	0-2	27.8	66.7	18.1	8.9	4.4	1.9	0.8471	4.22	Ref
	3-7	24.8	68.3	16.9	7.7	5.3	1.8		4.05	-0.28	0.659
	8-15	23.5	67.6	19.8	6.2	3.8	2.7		3.99	-0.37	0.562
	≥ 16	23.9	68.8	15.8	6.9	5.3	3.3		4.19	-0.37	0.603
Use of oral medication		75.2	68.1	17.2	7.2	5.1	2.4	0.6740	4.09	-0.19	0.712
Use of insulin		17.8	62.2	16.1	9.2	8.9	3.7	0.0082	5.25	2.03	0.002
Do you regularly visit the doctor for diabetes
	Yes	67.7	68.1	16.98	7.28	5.18	2.46	0.3035	4.17	Ref
	No (only if you have problem)	23.0	69.81	17.64	7.32	2.64	2.58		3.76	-0.73	0.223
	Never visit	9.3	60.68	22.39	9.28	6.41	1.25		4.61	0.57	0.458
Complications of diabetes
	Visual problems	31.9	60.3	18.5	11.0	6.1	4.1	0.0004	5.26	2.41	< 0.001
	Infarction	4.3	48.4	21.2	7.3	20.5	2.6	< 0.0001	6.83	3.34	0.029
	Stroke	3.9	39.9	36.3	13.5	8.4	2.0	0.0002	6.14	3.31	< 0.001
	Other circulatory problems	13.7	49.6	20.4	13.2	8.8	8.1	< 0.0001	6.94	4.36	< 0.001
	Kidney problem	12.3	50.2	20.5	14.3	8.8	6.2	< 0.0001	6.68	3.82	< 0.001
	Diabetic foot	6.1	51.1	21.9	10.6	11.9	4.5	0.0484	6.62	3.37	0.008
	Amputation of upper or lower limbs	1.6	52.7	13.2	11.0	1.3	21.8	< 0.0001	7.55	3.55	0.215
	Diabetic coma	2.1	40.6	29.3	9.5	5.5	15.1	< 0.0001	8.32	5.51	0.001
	Other	1.8	60.7	19.8	11.1	3.9	4.5	0.7758	5.18	1.89	0.163
	Hospitalization	15.4	54.2	19.1	10.6	12.2	3.9	< 0.0001	6.19	3.34	< 0.001
Diabetes or complication of diabetes limit your habitual activities
	Does not limit	66.5	75.2	15.3	5.8	2.6	1.2	< 0.0001	3.12	Ref
	Limit a little	17.5	59.6	23.8	8.9	5.2	2.4		4.87	2.75	< 0.001
	Moderately	9.0	54.9	21.2	9.8	9.2	4.9		5.95	4.10	< 0.001
	Severely	5.1	37.1	21.3	13.1	21.6	6.9		8.80	7.15	< 0.001
	Very severely	2.0	28.1	17.2	27.6	8.2	18.9		10.62	9.34	< 0.001

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Cristiane de Cássia Bergamaschi, Universidade de Sorocaba - UNISO, Rodovia Raposo Tavares km 92.5 18023-000 Sorocaba, SP, Brasil E-mail: cristiane.motta@prof.uniso.br