Biopsychosocial factors associated with a current depressive episode in diabetes: the ELSA-Brasil study

Diabet Med. 2020 Oct;37(10):1742-1751. doi: 10.1111/dme.14349. Epub 2020 Jul 14.


Aims: Depression is more prevalent in people with diabetes, and is associated with worse diabetes outcomes. Depression in diabetes is more treatment resistant, and as underlying mechanisms are unknown, development of more effective treatment strategies is complicated. A biopsychosocial model may improve our understanding of the pathophysiology, and therewith help improving treatment options.

Methods: Diabetes was diagnosed according to American Diabetes Association (ADA) criteria and a current depressive episode according to the International Classification of Diseases (ICD-10), based on the Clinical Interview Schedule Revised (CIS-R). From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we included 455 participants without diabetes with a current depressive episode and 10 900 without either diabetes or a current depressive episode. Furthermore, 2183 participants had diabetes alone and 106 had both diabetes and a current depressive episode. Variable selection was based on their relationship with depression and/or diabetes. Multinomial multivariate logistic regression was used to determine how the models differed between participants with and without diabetes.

Results: A current depressive episode in diabetes was related to being older and female, having poorer education, financial problems, experiencing discrimination at work, home and school, higher waist circumference, albumin to creatinine ratio and insulin resistance, and the presence of hypertension and cardiovascular disease. In non-diabetes, a current depressive disorder was related to being female, not being black, low income, psychological and social factors, non-current alcohol use, lower HDL cholesterol, higher insulin resistance and the presence of cardiovascular disease.

Conclusions: A current depressive episode in the presence compared with the absence of diabetes was related more to biological than to psychosocial factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Alcohol Drinking / epidemiology
  • Black People
  • Brazil / epidemiology
  • Cardiovascular Diseases / epidemiology
  • Case-Control Studies
  • Cholesterol, HDL / blood
  • Creatinine / blood
  • Depressive Disorder / psychology*
  • Diabetes Mellitus / psychology*
  • Educational Status
  • Female
  • Financial Stress
  • Humans
  • Income
  • Insulin Resistance
  • Logistic Models
  • Male
  • Middle Aged
  • Models, Biopsychosocial
  • Multivariate Analysis
  • Serum Albumin
  • Sex Factors
  • Social Discrimination
  • Waist Circumference


  • Cholesterol, HDL
  • Serum Albumin
  • Creatinine