Background: Diabetes distress (DD) and depression are related and overlapping constructs; DD may mediate the known association between depression and glycaemic control. We examined the characteristics of community-based individuals with type 2 diabetes (T2D) by DD and depression status to elucidate the relationship.
Methods: The Fremantle Diabetes Study Phase II includes 1551 participants with T2D recruited between 2008 and 2011; 391 have been followed for 6 years. At the Year 6 assessment, the 5-item Problem Areas In Diabetes Scale (PAID-5; DD=score ≥8) and the 9-item Patient Health Questionnaire (PHQ-9; DSMIV major and minor depression defined) are completed . The Big Five Inventory (BFI) measuring five personality dimensions (agreeableness, conscientiousness, extroversion, neuroticism, and openness) was completed at baseline. Multiple logistic regression was used to identify independent associates of DD and depression.
Results: The 391 participants were 71.8±9.5 years old, 54% were male, their median [inter-quartile range] diabetes duration was 14.0 [8.9-21.6] years, 20 (5.1%) had major depression, 10 (2.6%) minor depression, 49 (12.6%) DD. Of those with DD, 28.6% had depression; of those with depression 40% had DD. DD was independently associated with major depression, as was younger age at T2D diagnosis, higher HbA1c and “other” European ethnicity (non-Anglo Celt, non-Southern European). Major depression was independently associated with DD and higher neuroticism scores.
Conclusion: One in seven community-based individuals with long-standing T2D had DD and/or major depression in a cross-sectional sample. Although some overlap exists between DD and major depression, these are distinct entities: Three-quarters of individuals with DD have no depression. DD mediates the relationship between poor glycaemic control and major depression. Non-modifiable but identifiable risk factors (ethnic background and personality) may help optimise management. Given their important implications to glycaemic control and patient’s psychological well-being, future studies need to clarify the conceptual position of DD and depression in diabetes.