Evaluating depression in type 2 diabetes co-

morbidities in Romanian patients -

implications for hypertensive patients

Vladut Ioana Corina, MACenter for Health Policy and Public Health, Babes-Bolyai University Cluj-Napoca, Romania

Presentation overview1. Background (issue/problem)2.Description of the problem3.Results (effects/changes)4.Lessons5.Acknowlegements6. Selected references

Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

Background Depression is one of the leading contributing factors

to the burden of disease worldwide (1)

Patients with chronic diseases have been found to have two-to threefold higher rates of major depression compared with age- and gender-matched primary care patients

High prevalence of depression in diabetes patients with co-morbid medical diseases compared with patients with type 2 diabetes only or no chronic disease at all (2)

Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

Background 75% diabetes patients have associated conditions

Special attention to depression in hypertension and diabetes

Raised blood pressure is more common in people with type 2 diabetes than in the general population(3)

Risk of hypertension increases with repeated experience of depressive episodes over time(4)

Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

Description of the problem Setting: Nutrition and Diabetes Center in Cluj-

Napoca, Romania

Participants: 1171 patients with type 2 diabetes

Objectives:1. Explore the prevalence of co-morbidities in

diabetes and the level of depression in the first five diabetes comorbidities.

2. Examine the relationship between high blood pressure and depression, as high blood pressure is a debated risk factor for type two diabetes.

Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

Description of the problem

Questionnaires: Diabetes Cost Questionnaire (DCQ) and Patient Health Questionnaire (PHQ9)

Data analysis- descriptive statistics and Chi-Square tests -> the

prevalence of co-morbidities, and the difference in the depression level in the associated diabetes conditions

- regression -> examine the probability of having major and mild depression in patients with high blood pressure

Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

Results (effects/changes)

Diabetes comorbidities 82%, majority female (64%)

high blood pressure (25.7%) arthritis or rheumatism (18.5%) heart conditions (17.2%) diabetes feet (9.1%) retinopathy (7%)

Depression-> higher in comorbidities than diabetes alone:

• asthma or chronic bronchitis (x2 =23.9, p <0.01),

• arthritis (x2 =83.7, p <0.01),• ulcers (x2 =32.4, p <0.01),• fracture (x2 =25.2, p <0.01),• osteoporosis (x2 =49.8, p <0.01),• heart conditions (x2 =80.2, p

<0.01),• retinopathy (x2 =43.7, p <0.01), • diabetes feet (x2 = 74.0, p< 0.01)

High blood pressure -> 18% major depression• more prevalent in women (67%)

and older adults (92%)

Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

The probability of having major depression for patients with high blood pressure is dependent on (p<0.01):

low educational level female gender not having a caregiver

Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

Lessons The results of the study confirm previous findings that

indicate a higher prevalence of depression in diabetes patients with associated medical conditions.

Integrated approach of diabetes management and comorbidities specific guides

Raise awareness on depression in patients with high blood pressure and diabetes, especially in women, people without caregivers and with low educational status.

More research is demanded in order to elucidate the bi-directional relationships between depression, diverse chronic diseases and the associated risk factors.

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Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

Acknowledgements

This work was financed directly by grant number 5 D43 TW005810-07, “Finance and Mental Health Services Training in Czech Republic/Central Europe,” sponsored by the U.S. National Institutes of Health “John E. Fogarty International Center”.

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Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

Selectes References1.Michaud CM, Murray CJ, Bloom BR (2001) Burden of disease- implications for future research. JAMA 285:535–539

2. Pouwer F, Beekman AT, Nijpels G et al (2003) Rates and risks for co-morbid depression in patients with type 2 diabetes mellitus: results from a community-based study. Diabetologia 46:892–898

3.Kannel W, McGee D. Diabetes and cardiovascular disease. The Framing ham study. JAMA 1979;241:2035 8

4.Nabi H., et al., Trajectories of Depressive Episodes and Hypertension Over 24 Years, Hypertension. 2011;57:710-716

Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012

Thank you for your attention !

Public Health and Social Services: Education and Practice conferenceTbilisi, Georgia, June 27th, 2012