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The Association between Depressive Symptoms and Care Outcomes for Diabetes in 5 Middle-Income-Countries
24 Pages Posted: 11 Jul 2023
More...Abstract
Background: The relationship between depression, diabetes, and access to diabetes care is established in high-income countries (HICs) but not in middle-income countries (MICs), where contexts and health-systems differ and may impact this relationship. In this study we investigate access to diabetes care for individuals with and without depressive symptoms in MICs.
Methods: We analyzed pooled, nationally representative household survey data for 18,301 individuals aged 50 and above in Brazil, Chile, China, Indonesia, and Mexico. Results from validated survey tools were harmonized and used to identify people with depressive symptoms. Diabetes was defined as self-reported use of medications and biochemical data per WHO PEN guidelines. Our primary outcome was the progression of individuals with diabetes through the stages of the diabetes care continuum as an indication of access to care for diabetes. Descriptive and multivariable logistic regression analyses were conducted to examine diabetes prevalence and diabetes-care continuum progression (stages of (1) received diagnosis, (2) received treatment, and (3) achieved control) in individuals with and without depressive symptoms, controlling for the known confounders of sex, age, educational attainment, and BMI.
Findings: Our final pooled sample included 18,301 individuals, with 3,309 (18.1%, CI: 17.5-18.6) having diabetes and 3,934 (21.5%, 95%-CI: 20.9-22.1) having depressive symptoms. Diabetes prevalence was non-significantly higher among participants with depressive symptoms (28.9%, 95%-CI: 27.4-30.3) compared to those without (23.8%, 95%-CI: 23.1-24.6, p for difference =0.071). In multivariable regression analysis, co-occurrence of diabetes and depression was associated with increased odds of diabetes detection (OR 1.398, p<0.001) and treatment (OR 1.344, p<0.001), but not with higher odds of achieving glycemic control (OR 0.913, p=0.377).
Interpretation: Among individuals aged 50 years and older living in MICs, the comorbidity of diabetes and depression is associated with a greater probability of identifying and treating diabetes, in contrast to what is seem in HICs.
Funding: None to declare.
Declaration of Interest: We declare no competing interests.
Suggested Citation: Suggested Citation