Age, Education, Health Status Predict Depression Risk in Women with Diabetes

Analysis of data from a large survey has identified a number of factors that predict depression in women with diabetes and could help physicians provide better care for such patients.

Investigators used information collected for the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2012 to look for connections between clinical depression and a number of potential risk factors in 946 diabetic women.

Overall, 19% of the women reported that they suffered depression. Factors that were significantly associated with an even greater risk of depression included being less than 65 years old, having failed to complete high school, having self-reported poor health, being inactive due to poor health and suffering pain that interfered with usual activities.

Women with diabetes were significantly more likely than all women to report that they suffered depression, but disease-related factors did not predict which diabetic women were most at risk. Years with the disease, use of insulin and similar factors were not significantly associated with depression.

Marital status was also unrelated to depression levels.

“When educating and counseling women with diabetes, diabetes educators should be aware that some of the predictors of depression in women with diabetes differ from those of populations that include both sexes,” the study authors wrote in The Diabetes Educator. “Depression screening, although important for all women with diabetes, should especially be performed among women with female-specific depression predictors.”

Prior studies have shown that adults with diabetes are more prone to depression than the population at large. A 2001 meta-analysis that appeared in Diabetes Care combined results from 20 prior studies that compared depression rates in diabetic and nondiabetic subjects and found that people with diabetes were about twice as likely to be depressed (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2). That same meta-analysis found that roughly 28% of diabetic women had suffered comorbid depression, while only 18% of diabetic men did. (Women without diabetes are similarly more prone to depression than men without diabetes.)

“Both clinicians and epidemiologists can expect individuals with diabetes to be twice as likely to be depressed than otherwise similar nondiabetic individuals in similar settings (i.e., individuals selected by similar procedures, of the same sex, and assessed with comparable depression assessment methods),” the authors of the meta-analysis wrote.

“The complex interactions of physical, psychological, and genetic factors that contribute to this association (between diabetes and depression) remain uncertain. Depression may occur secondary to the hardships of advancing diabetes or to diabetes-related abnormalities in neurohormonal or neurotransmitter function. On the other hand, evidence from prospective studies in the U.S. and Japan indicates that depression doubles the risk of incident type 2 diabetes independent of its association with other risk factors.”

A few prior studies have examined predictors of depression among diabetic women, but the authors of the new study believe that the superior data available through NHANES allowed them to reach stronger conclusions than any of their predecessors.

“NHANES is exceptional in the collection of various types of data,” said lead author Shiela Strauss, PhD, an associate professor of nursing in the New York University Rory Meyers College of Nursing. “By combining interviews with physical examinations, NHANES uniquely gathers sociodemographic and physiological data, including existing medical conditions and history.”