Demographic, clinical and psychosocial factors identify a high-risk group for depression screening among predominantly Hispanic patients with Type 2 diabetes in safety net care

Gen Hosp Psychiatry. Sep-Oct 2015;37(5):414-9. doi: 10.1016/j.genhosppsych.2015.05.010. Epub 2015 May 29.

Abstract

Objective: Identify biopsychosocial factors associated with depression for patients with Type 2 diabetes.

Method: A quasi-experimental clinical trial of 1293 patients was predominantly Hispanic (91%) female (62%), mean age 53 and average diabetes duration 10 years; 373 (29%) patients were depressed and assessed by Patient Health Questionnaire-9. Demographic, baseline clinical and psychosocial variables were compared between depressed and nondepressed patients.

Results: Bivariate analyses found depression significantly associated (p<0.05) with female gender, diabetes emotional burden and regimen distress, BMI ≥ 30, lack of an A1C test, diabetes duration, poor self-care, number of diabetes symptoms and complications, functional and physical characteristics (pain, self-rated health condition, Short-Form Health Survey SF-physical, disability score and comorbid illnesses), as well as higher number of ICD-9 diagnoses and emergency room use. A multivariable regression model with stepwise selection identified six key risk factors: greater disability, diabetes symptoms and regimen distress, female gender, less diabetes self-care and lack of A1C. In addition, after controlling for identified six factors, the number of psychosocial stressors significantly associated with increased risk of depression (adjusted odds ratio=1.37, 95% confidence intervals: 1.18-1.58, p<.0001).

Conclusion: Knowing biopsychosocial factors could help primary care physicians and endocrinologists identify a high-risk group of patients needing depression screening.

Trial registration: ClinicalTrials.gov NCT01781013.

Keywords: Depression; Risk factors; Safety net; Type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Demography
  • Depression / diagnosis*
  • Depression / ethnology
  • Diabetes Mellitus, Type 2 / ethnology
  • Diabetes Mellitus, Type 2 / psychology*
  • Female
  • Hispanic Americans / psychology*
  • Humans
  • Logistic Models
  • Male
  • Mass Screening*
  • Middle Aged
  • Poverty*
  • Risk Assessment / methods
  • Risk Factors
  • Surveys and Questionnaires
  • United States

Associated data

  • ClinicalTrials.gov/NCT01781013