engleski

Persistence of depression in type 2 diabetic patients

Knowing about a course of depression in persons with diabetes may be helpful in planning screening and treatment strategies. One hundred patients found to be at risk for depression by using CES-D scale in a random sample of 463 type 2 patients, and among them 30 diagnosed with clinical depression using structured clinical interview, were followed for one year in order to highlight the course of their depression. The patients were aged 57 +/- 7 yrs., suffered from diabetes for 9 +/- 6 yrs., had BMI of 29 +/- 4 kg/m^2 and baseline HbA1C 7.9% +/- 1.5% ; 66% were female, 44% treated with insulin, 22% had retinopathy, 40% neuropathy and 29% were diagnosed with cardiopathy. The follow-up procedure included phone calls at 3-month intervals, and re-assessment of depression after 12 months. Seventy-two patients provided complete follow-up information. Changes in depressive symptoms were determined using t-test. Discriminant analysis was used to compare patients with and without improvement in symptoms. The entire group's mean CES-D score dropped from 24.6 +/- 8.5 to 17.3 +/- 10.5 (p=0.00001). After one year 56% of patients with baseline CES-D scores&#8805; 16 were below this cut-off, while 44% remained in the category indicative of pervasive depression. Twenty patients entered depression treatment. Discriminant analysis indicated that the type of depression, physical and social functioning as assessed by SF-12 subscales, gender, and presence of retinopathy and neuropathy could differentiate still depressed patients from those who improved their depressive symptoms (Wilks' Lambda=0.638 F=5.949 p<0.0001). Clinical depression, poor social and physical functioning and male gender were the strongest predictors of persistent depression at one-year follow-up (p=0.02 ; p=0.03 and p=0.03 and p=0.05, respectively). These data indicated that diagnosing depression within diabetes care and support during follow-up affected patients' readiness to receive treatment for depression and improved depressive symptoms. However, the proportion of still depressed patients suggests the necessity of psychoeducation on depression in addition to diagnostic procedure.

depression; type 2 diabetes; persistence of depressive symptoms

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