ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

The Screening of Comorbid Depressive Disorders and Associated Risk Factors in Adult Patients with Type 2 Diabetes
Erişkin Tip 2 Diyabet Hastalarında Depresif Bozuklukların ve İlişkili Risk Faktörlerinin Taranması
Received Date : 01 Feb 2020
Accepted Date : 15 Jun 2020
Available Online : 26 Jun 2020
Doi: 10.25179/tjem.2020-73401 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24-189-197
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Elevated depressive symptoms and disorders affect one in five patients with diabetes. Current guidelines recommend screening depression in the diabetic population. Turkey has the highest (13.7%) prevalence of diabetes in Europe. However, there are limited data about the prevalence of depressive disorders among diabetic patients in Turkey. We aim to investigate the prevalence of a comorbid depressive disorder in Type 2 diabetic patients who were referred to the Endocrinology outpatient unit of a tertiary hospital. Material and Methods: All the Type 2 diabetic patients admitted to our endocrinology department were consecutively included in the study. Their sociodemographics, concomitant diseases and medications, macro and microvascular complications, lifestyle and personal habits, and treatment regimens were obtained by a specifically designed questionnaire. Laboratory data were obtained from the hospital records. The Patient Health Questionnaire-9 (PHQ-9), a depression screening tool, was used as a screening method for depression. Patients with a score of 10 or above determined high risk for depressive disorder according to PHQ-9. The scores were re-evaluated by a psychiatrist to minimize the false negative and positive results. Result: A total of 460 patients with Type 2 diabetic were enrolled in this crosssectional study. 18.9% (n=87) of the participants were found to have depressive disorders according to the psychiatric evaluation done after the PHQ-9 questionnaire. Patients with depressive disorders were predominantly female (69.0% vs. 55.5%; p=0.022), younger (57.2±10.5 vs. 60.0±9.5; p=0.014), had higher HbA1c (8.51±2.51 vs. 7.98±2.05; p=0.042), total cholesterol (205.6±44.2 vs. 194.2±46.0; p=0.045), LDL-cholesterol (123.1±37.8 vs. 113.1±35.4; p=0.026) and non-HDL-cholesterol (158.5±41.61 vs. 146.6±42.7; p=0.024). These patients had frequent neuropathy (37.3% vs. 19.0%, p=0.001), they were less likely to perform exercise (31.8% vs. 53.1%; p<0.001) while smoke in excess (31.4% vs. 14.3%; p<0.001). The analysis showed that female gender (OR=4.4; 95% CI=1.6-12.8; p=0.005) and smoking (OR=7.6; 95% CI=2.8-20.5, p<0.001) are independent determinants of a depressive disorder. Conclusion: Approximately one-fifth of diabetic patients had a depressive disorder, and their metabolic parameters were worse than those without a depressive disorder. Therefore, to assess a diabetic patient from all aspects, screening for depressive disorder should be made an indispensable part of the evaluation process.
ÖZET
Amaç: Depresif bozukluk ve artmış depresif durumlar her beş diyabet hastasından birini etkilemektedir. Güncel rehberler, diyabetik popülasyonda depresif semptom ve bozuklukların taranmasını önermektedir. Türkiye, Avrupa’da en yüksek (%13,7) diyabet prevalansına sahip ülke konumundadır. Bununla birlikte, Türkiye’de diyabet hastaları arasında depresif bozukluğun sıklığı hakkında kısıtlı veri bulunmaktadır. Biz bu çalışma ile bir üçüncü basamak Endokrinoloji polikliniğine başvuran Tip 2 diyabetik hasta popülasyonunda eşlik eden depresif bozukluk prevalansını saptamayı amaçladık. Gereç ve Yöntemler: Endokrinoloji polikliniğine başvuran tüm tip 2 diyabet hastaları ardışık olarak çalışmaya dâhil edildi. Katılımcıların sosyodemografik özellikleri, eşlik eden hastalıkları ve uygulanan tedaviler, makro ve mikro komplikasyonlar, yaşam tarzı ve kişisel alışkanlıkları hazırlanan sorgu formu ile kayıt altına alındı. Laboratuvar verileri hastane bilgi sisteminden alındı. Depresif bozukluk taraması için “Patient Health Questionnaire-9 (PHQ-9)” depresyon tarama aracı kullanıldı. PHQ-9 puanı 10 ve üzeri olan hastalar, depresif bozukluk açısından yüksek riskli olarak değerlendirildi ve olası yanlış negatif-pozitif sonuçları en aza indirgemek amacıyla bir psikiyatri uzmanı tarafından yeniden değerlendirildi. Bulgular: Çalışmaya toplam 460 Tip 2 diyabet hastası dâhil edildi. PHQ-9 skorları ve akabinde yapılan psikiyatri değerlendirmesi sonrası hastaların %18,9 (n=87)’unda depresif bozukluk saptandı. Depresif bozukluk saptanan hastalar ağırlıklı olarak kadın cinsiyette (%69,0’a karşı %55,5; p=0,022), daha genç yaşta (57,2±10,5’e karşı 60,0±9,5; p=0,014), daha yüksek HbA1c (8,51±2,51’e karşı 7,98±2,05; p=0,042), total kolesterol (205,6±44,2’ye karşı 194,2±46,0; p=0,045), LDL kolesterol (123,1±37,8’e karşı 113,1±35,4; p=0,026) ve non-HDL-kolesterol (158,5±41,61’e karşı 146,6±42,7; p=0,024) seviyelerine sahip idi. Ek olarak, bu hastalarda nöropati daha sık (%37,3’e karşı %19,0, p=0,001), egzersiz yapma oranları daha düşük (%31,8’e karşı %53,1; p<0,001) ve sigara içme sıklığı daha yüksek (%31,4’e karşı %14,3; p<0,001) idi. Kadın cinsiyette olmak (OR=4,4; %95 GA=1,6-12,8; p=0,005) ve sigara içmek (OR=7,6; %95 GA=2,8-20,5; p<0,001) depresif bozukluğa sahip olmanın bağımsız öngördürücüleri idi. Sonuç: Diyabetik hastaların yaklaşık beşte birinde depresif bozukluk mevcuttu ve metabolik parametreleri depresif bozukluk olmayanlara göre daha kötü idi. Bu nedenle, bir diyabet hastasını kapsamlı bir şekilde değerlendirebilmek için depresif bozukluk taraması hasta değerlendirmesinin ayrılmaz bir parçası olarak uygulanmalıdır.
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