Correlates of Undiagnosed Depression among Diabetic Patients on Follow-Up at a Regional Referral Hospital in Western Kenya

Citation:
Nyaberi Z, Oyieke J, Chege M, Mwaura, F; Wamalwa J, Gitonga M. "Correlates of Undiagnosed Depression among Diabetic Patients on Follow-Up at a Regional Referral Hospital in Western Kenya." Global Journal of Interdisciplinary Social Sciences. 2014;Vol.3(6):24-30.

Abstract:

Abstract
The prevalence of diabetes mellitus in Kenya is estimated to be 4.66%. The comorbidity of diabetes and depression is associated with poor outcomes. The study aimed at determining the prevalence and factors associated with depression among diabetics. A cross-sectional survey was conducted among 181 diabetics attending clinic at a referral hospital in western Kenya. A questionnaire was used to collect data on the independent variables. Beck’s Depression Inventory (BDI-II) was used to assess depression symptoms.
Depression was observed in 19% of the participants. Female gender, being single, urban residence, low income and no family support were significantly associated with depression. Others are; longer duration of illness, difficulties adhering to treatment and alcohol consumption (p<0.05). A significant proportion of diabetic patients have comorbid depression. Integration of mental health services into diabetics care setting will lead to detection and early treatment of depression.
Keywords: Undiagnosed Depression, Diabetes Mellitus

Abstract

The prevalence of diabetes mellitus in Kenya is estimated to be 4.66%. The comorbidity of diabetes and depression is associated with poor outcomes. The study aimed at determining the prevalence and factors associated with depression among diabetics. A cross-sectional survey was conducted among 181 diabetics attending clinic at a referral hospital in western Kenya. A questionnaire was used to collect data on the independent variables. Beck’s Depression Inventory (BDI-II) was used to assess depression symptoms.

Depression was observed in 19% of the participants. Female gender, being single, urban residence, low income and no family support were significantly associated with depression. Others are; longer duration of illness, difficulties adhering to treatment and alcohol consumption (p<0.05). A significant proportion of diabetic patients have comorbid depression. Integration of mental health services into diabetics care setting will lead to detection and early treatment of depression.

Keywords: Undiagnosed Depression, Diabetes Mellitus

Introduction

Diabetes mellitus is a major public health problem in the world. Globally,382 million people suffer from the condition(International Diabetes Federation, 2013). The figure is projected to rise to 592 million people by the year 2035. 80 % of persons with the condition live in middle to low-income countries (International Diabetes Federation, 2013). The comparative prevalence of diabetes mellitus in Kenya is estimated to be 4.66 %(International Diabetes Federation, 2012).The two types of diabetes mellitus are chronic and debilitating.

Internationally, available data shows wide variability in the prevalence rates of depression among persons with diabetes mellitus. However, there is a general agreement that the comorbidity of diabetes and depression is common. Compared to those without diabetes mellitus, persons with diabetes mellitus are up to three times as likely to develop depression(Andreoulakis, Hyphantis, Kandylis, & Iacovides, 2012). In a study done in Greece, it was reported that 33.4 % of persons with diabetes mellitus had elevated depressive symptoms(Sotiropoulos et al., 2008). In the United States of America, prevalence rates ranging from 2 % to 28 % have been reported(Li, Ford, Strine, & Mokdad, 2008). In other studies, rates of as high as 40.3 % have been reported(Niraula et al., 2013).

From studies that have been conducted in some African countries, it has been shown that the prevalence of depression in persons living with chronic conditions is quite high. In a study conducted in a Nigerian teaching hospital, it was demonstrated that 30 % of the respondents in the group with diabetes mellitus had depressive symptoms(James, Omoaregba, & Eze, 2010). From a study done in South Africa, it was reported that a sizeable proportion of participants with chronic conditions experienced symptoms of depression and anxiety(Kagee, 2008).

A number of factors have been associated with depression in persons living with diabetes mellitus. In India, It has been demonstrated that the prevalence and severity of depression is higher among females than in males(Chaudhry, Mishra, Mishra, Parminder, & Mishra, 2010). A study in Bangladesh demonstrated that both mild to moderate and severe depression were more common in females than males(Rahman, Rahman, & Flora, 2011).

The levels of income and affluence have been associated with depression and diabetes comorbidity. In Nepal, higher personal income and urban residence have been shown to be associated with more depression severity(Niraula et al., 2013). In India, however, it was reported that low income was associated with higher prevalence of depression among persons living with diabetes (Mendenhall et al., 2012).

The family structure, marital status and race or ethnicities have been associated with depression among persons with diabetes. In Pakistan, it has been reported that the nuclear family is a predictor of depression among individuals with diabetes mellitus(Perveen, Otho, Siddiqi, Hatcher, & Rafique, 2010). In Bangladesh and Pakistan, it has been reported that being single is a risk factor for depression among persons with diabetes mellitus(Rahman et al., 2011) and(Perveen et al., 2010). Race and ethnicity have been reported to be predictors of depression in the United States of America(Li et al., 2008).

Other factors that have been associated with depression and diabetes comorbidity include family history of diabetes, duration of diabetes, presence of complications and the mode of treatment. In Nepal, it was reported that family history of diabetes ,longer duration of illness and absence of diabetes complications were all associated with less depressive symptoms(Niraula et al., 2013). In a study done in Bangladesh, it was demonstrated that insulin users were more likely to develop severe depression than those that were using oral drugs(Rahman et al., 2011).

Depression in persons with diabetes has been associated with negative outcomes. In one study, depression was shown to be associated with poor adherence to the diabetes treatment regimen(Gonzalez et al., 2008). In Nepal, it was reported that high glycosylated haemoglobin was seen in patients with depression and diabetes comorbidity(Niraula et G.J.I.S.S.,Vol.3(6):24-30 (November-December, 2014) ISSN: 2319-8834

 

al., 2013). From a study conducted in Nigeria, it was reported that major depressive disorder is associated with lower scores on the aspects of overall quality of life and health satisfaction(James et al., 2010).

Treatment of depression in persons with diabetes mellitus can lead to good blood sugar control and minimize complications. Lack of assessment is a barrier to effective treatment of depression in this group of people. To convince policymakers on the need to prioritize the screening of persons with diabetes for depression, data should be provided. Literature review did not reveal any studies that have been done to investigate the comorbidity of depression and diabetes in Kenya.

The objectives of this study were to determine the prevalence of and factors associated with undiagnosed depression among persons with diabetes mellitus.

Methods

The study was a cross sectional survey including 181 diabetic patients who were seen at Moi Teaching and Referral Hospital between 13th June 2014 to 11th July 2014.

The study was conducted at the diabetes clinic of the hospital. The hospital is located 310 km North West of Nairobi. The public hospital with a capacity of 800 beds is the largest referral facility in the Western Kenya region. It serves patients from Western Kenya, Uganda, Rwanda, Burundi and Southern Sudan. A number of special clinics are run at the hospital. Among these clinics is the diabetes outpatient. On average, 273 persons with diabetes are attended to in this clinic every month.

Sample size was estimated using the prevalence of depression among people with diabetes mellitus from a study conducted at a Nigerian teaching hospital(James et al., 2010). With prevalence of 30 % and at 95 % confidence interval, a sample size of 181 was determined. Clients were consecutively recruited until the desired sample size of participants was attained.

To be eligible to participate in the study, patients were required to have lived with diabetes for at least three months. This was besides being aged 18 years or more. Those with an established diagnosis of any psychiatric disorder, those with a history of psychiatric disorder, patients on psychotropic medication, pregnant women, patients with cognitive impairment and those with severe organic illness were excluded.

A semi-structured questionnaire was administered by the interviewer to collect data on socio-demographic, behavioural and disease-related characteristics. Pre-testing of the questionnaire was carried out at Kenyatta National Hospital. Beck’s Depression Inventory (BDI-II) was used to assess symptoms of depression. The BDI-II has been tested and shown to be reliable with high internal consistency and good item-total intercorrelations.

All data were analyzed using STATA 11.2 (StataCorp, Inc, Texas, USA).Basic descriptive statistics were used to summarize the data. Chi-squared statistical tests were used. The relationship between the socio-demographic, disease-related, behavioural and outcome variables were examined by use of bivariate analysis models. P value < 0.05 was considered statistically significant. The prevalence of depression was established by determining the number of patients with BDI-II score >13.

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