The relationship between diabetes mellitus, depression, and missed appointments in a low-income uninsured population

Diabetes Educ. 2009 Nov-Dec;35(6):966-77. doi: 10.1177/0145721709345164. Epub 2009 Sep 23.


Purpose: The purpose of this project is to identify rates of depression and document mental health needs of adults with diabetes who obtained care in free clinics. Data were collected to determine if there is a relationship between diabetes and depression and missed appointments in a sample of patients who were low-income, uninsured, and represented a variety of racial groups.

Methods: A sample of 183 adults with diabetes participated by completing paper and computerized questionnaires. Instruments included the Patient Health Questionnaire 9 (to measure prevalence of depression), the RAND 36 Health Survey (to measure quality of health), the Audit of Diabetes Dependent Quality of Life (to measure diabetes-dependent quality of life), and the Diabetes Empowerment Scale (to measure self-efficacy).

Results: The prevalence of depression at a moderate or greater level in the sample was found to be 30.1%. Levels of quality of health and self-efficacy were found to be reduced among those with the presence of depression. A significant increase in the rate of depression was found among those who had attended the free clinic for a longer period. No significant differences were found in diabetes-dependent quality of life and missed appointments among those with depression compared with those without.

Conclusions: Rates of depression among adults with diabetes in a free clinic setting were found to be comparable with the highest rates reported by other studies of insured populations. Results of this study support the need to develop mental health treatment programs for free clinic settings.

MeSH terms

  • Adolescent
  • Adult
  • Appointments and Schedules
  • Cognition
  • Cross-Sectional Studies
  • Depression / epidemiology*
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / psychology*
  • Female
  • Humans
  • Male
  • Medically Uninsured / psychology*
  • Middle Aged
  • Patient Compliance
  • Poverty*
  • Prevalence
  • Quality of Life
  • Racial Groups / psychology
  • Surveys and Questionnaires
  • Young Adult