Background:
Depression, both diagnosed and based on elevated symptom scores, is highly prevalent in individuals with Type II Diabetes (T2DM). Depression predisposes individuals to poorer glycemic control, higher rates of T2DM complications and elevated mortality. African Americans and Hispanics are less likely to be diagnosed with depression than non-Hispanic whites; however, prevalence studies in the general (i.e., non-diabetic) population report that rates of elevated depressive symptoms are similar across race/ethnic groups.
Objective:
To calculate the age-adjusted prevalence of comorbid depression and Type II Diabetes by race/ethnicity and to investigate whether the patterns vary according to treatment of depression or elevated depressive symptoms (EDS). We hypothesize that racial/ethnic differences in depression among adults with diabetes will vary according to whether depression is treated or based on elevated depressive symptoms.
Methods:
Participants from the National Health and Nutrition Examination Study (2005-2010) classified as White (n=459), Black (n=250), Mexican American (n=233), or “Other Racial/Ethnic Background” (n=149) and had T2DM (i.e., fasting glucose >=126, clinician diagnosis, or diabetic medication use) and responses to current prescription drug use and depression syndrome measures were included in the analysis (n=1,091, Mean age=48.2 year). Undiagnosed depression was determined by an elevated depressive symptoms (EDS) score => 10 on the Patient Health Questionnaire-9 and no report of current antidepressant use. Treatment for depression was determined by self-reported current antidepressant use (e.g., SSRI, MAOI, and TCA). Weighted age-adjusted prevalence rates of depression among adults who have diabetes were stratified by race/ethnic background.
Results:
Twelve percent used antidepressants and 7% of the sample had EDS without antidepressant use. The age-adjusted prevalence of antidepressant use among adults with diabetes was higher in Whites (16%, 95% CI: 9%, 22%) than Black (9%, 95% CI: 3%, 15%), Mexican Americans (5%, 95% CI: 3%, 8%), and “Others” (6%, 95% CI: 1%, 10%). These prevalence estimates remained significantly different after adjusting for healthcare provider and income. The prevalence of EDS among adults with diabetes was not significantly different across race/ethnic background groups (Whites- 5%, 95% CI: 3%, 8%; Blacks- 8%, 95% CI: 2%, 13%; Mexican Americans- 8%, 95% CI: 3%, 13%; “Others”- 8%, 95% CI %, 14%). The prevalence estimates of EDS and antidepressants by race/ethnic group did not vary by gender.
Conclusions:
Although African Americans and Mexican-Americans with diabetes were as likely to experience EDS, they were less likely to have to be treated for depression. These findings highlight the importance of screening for both treated depression and EDS in individuals who have Type II Diabetes.
Religious doubt, financial strain, and depressive symptoms among older Mexican Americans
