The pattern of depressive symptoms in people with type 2 diabetes: A prospective community study

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Abstract

Objective

The aim of the present study was to identify and describe longitudinal patterns of depression in a community sample of people with type 2 diabetes in Quebec, Canada.

Methods

A prospective community based study in Quebec, Canada, was carried out between 2008 and 2011. Participants with diabetes were assessed at baseline and at 1, 2 and 3 years follow-up (n = 1388). Depression was assessed using the Patient Health Questionnaire (PHQ-9).

Results

Longitudinal latent class analysis yielded four clusters representing different longitudinal patterns of depression: Cluster 1 (“no depression”; 67%): participants had neither minor nor major depression over time. Cluster 2 (“slowly increasing prevalence of minor and major depression over time”; 20%): participants had low levels of depression at baseline but increasing levels of minor and major depression over time; while most of the Cluster 3 (“increasing major depression”; 6%) participants had high and increasing levels of major depression over time. Participants in Cluster 4 (“improved depression”; 7%) started with high levels of depression but progressed to low levels of depression.

Conclusions

Our results provide important evidence of different longitudinal patterns of depression in people with type 2 diabetes. Identification of four distinct groups of participants might improve our understanding of the course of depression and may provide a basis of classification for intervention.

Introduction

Type 2 diabetes is a progressive chronic disease that is recognized as an important public health problem. Recent national surveys show that the incidence of type 2 diabetes mellitus is increasing at epidemic rates [1].

Depression has been shown to be a common co-morbidity in diabetes, affecting 10% to 30% of the diabetic population [2]. Growing evidence indicates that people with diabetes 3with comorbid depression demonstrate poor adherence to antidiabetic regimens and are at increased risk for morbidity and mortality [3], [4], [5], [6].

The natural course of depression in general population samples is poorly understood. Only a few prospective studies have attempted to evaluate the longitudinal course of depression using more than two time points [7], [8], [9], [10], [11]. In a recent review, Richards [12] concluded that a) the majority of individuals in the general population who experience depression will recover within one year (50%–70%), but some may not experience recovery even after 5 years or more; and b) that recovery is not permanent and that for many people with depression, recurrence after recovery is the rule.

Mapping the trajectories of mental disorders is one of the main objectives of the US National Institute of Mental Health. As pointed out in their 2008 Strategic Plan [13], the “developmental trajectory of illnesses opens the possibility that we could intervene and alter trajectories.” Identification of depression trajectories is an important issue in diabetes. Although there is evidence that prevalence and incidence of depression are higher in people with diabetes than in people without diabetes, there is only very limited information about the course of depression in this condition, e.g. there is no information about the development, persistence and recurrence of both minor and major depression.

The aim of the present study was to identify and describe groups of people with type 2 diabetes defined by their pattern of both minor and major depression over time using a community sample of people with diabetes in Quebec, Canada. The two specific objectives were a) to identify whether there were distinct groups of people with type 2 diabetes with different longitudinal patterns of depression in the past 3 years; and b) to determine whether membership in the groups was associated with demographic and clinical characteristics at baseline assessment or during the three year follow ups.

Section snippets

Method

Data from the Montreal Diabetes Health and Well Being Study (DHS) were used. The DHS is a telephone survey of adults with diabetes in Quebec, Canada. Participants were recruited in 2008 through random digit dialling. Eligible participants were individuals who were between 18 and 80 years of age and had a diagnosis of diabetes. Three follow-up interviews were conducted approximately 12, 24 and 36 months after baseline interview (late winter/early spring). More details from the baseline assessment

Results

A total of 2003 individuals with type 1 or type 2 diabetes participated in the DHS at baseline. After excluding those who refused to participate in a follow-up interview (n = 246), had type 1 diabetes (n = 125) or unknown type of diabetes (n = 4), 1628 individuals formed the baseline sample for the longitudinal cohort. The number of participants with complete information on depression in the three follow ups was 1187, 1065 and 1064, respectively (Fig. 1). A total of 799 people participated in all

Discussion

We studied the longitudinal course of depression in a community based study of people with self-reported type-2 diabetes. Four distinct longitudinal patterns of depression were identified: a group without depression, a group with a moderate increase in minor and major depression, a group with a high and increasing level of prevalence of major depression and a group with a decreasing prevalence of depression.

To our knowledge this study is the first to analyze the course of depression in a large

Role of the sponsors

The funding agencies had no role in the design or conduct of the study, in the collection, management, analysis, or interpretation of the data, or in the preparation, review, or approval of the manuscript.

Competing interest statement

The authors have no competing interests to report and have no potential or real conflicts of interest to declare.

Acknowledgments

Funding/support: This work was supported by operating grant MOP-84574 from the Canadian Institutes of Health Research (CIHR).

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