Diabetes Research and Clinical Practice
Volume 83, Issue 2 , Pages 268-279, February 2009

Prevalence and correlates of undiagnosed depression among U.S. adults with diabetes: The Behavioral Risk Factor Surveillance System, 2006☆

  • Chaoyang Li

      Affiliations

    • Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
    • Corresponding Author InformationCorresponding author at: Centers for Disease Control and Prevention, 4770 Buford Highway, MS K66, Atlanta, GA 30341, United States. Tel.: +1 770 488 5494; fax: +1 770 488 8150.
    • ,
  • Earl S. Ford

      Affiliations

    • Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
    • ,
  • Guixiang Zhao

      Affiliations

    • Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
    • ,
  • Indu B. Ahluwalia

      Affiliations

    • Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
    • ,
  • William S. Pearson

      Affiliations

    • Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
    • ,
  • Ali H. Mokdad

      Affiliations

    • Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States

Received 20 August 2008; received in revised form 20 August 2008; accepted 6 November 2008. published online 29 December 2008.

Abstract 

Aims

Many people with depression may be undiagnosed and thus untreated. We sought to assess the prevalence and correlates of undiagnosed depression among adults with diabetes.

Methods

Data of U.S. adults from the Behavioral Risk Factor Surveillance System in 2006 were analyzed. Cox proportional hazard regression analysis was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of correlates for undiagnosed depression.

Results

The unadjusted and age-adjusted prevalences of undiagnosed depression were 8.7% and 9.2%. About 45% of diabetes patients with depression were undiagnosed. After adjustments for all correlates, female gender (PR, 1.4; 95% CI: 1.1–1.8), poor or fair health (PR, 2.8; 95% CI: 2.1–3.6), lack of social and emotional support (PR, 2.5; 95% CI: 1.8–3.3), life dissatisfaction (PR, 3.5; 95% CI: 2.2–5.5), use of special equipment (PR, 1.4; 95% CI: 1.1–1.8), no leisure-time physical activity (PR, 1.5; 95% CI: 1.2–1.9), and comorbid cardiovascular disease (PR, 1.5; 95% CI: 1.2–1.9) were associated with undiagnosed depression.

Conclusions

Undiagnosed depression among people with diabetes was common. Because depression is associated with increased risk of diabetes-related complications, early detection of depression is needed in clinical settings.

Abbreviations: BDI, Beck Depression Inventory, BMI, body mass index, BRFSS, Behavioral Risk Factor Surveillance System, CDC, Centers for Disease Control and Prevention, CES-D, Center for Epidemiological Studies-Depression, CI, confidence interval, CIDI, Composite International Diagnostic Interview, DSM-IV, Diagnostic and Statistical Manual of Mental Disordersfourth edition, ICD-9, International Classification of DiseasesNinth Revision, PHQ-8, the 8-item Patient Health Questionnaire, PR, prevalence ratio, SCI, Structured Clinical Interview, SDS, Zung Self-Rating Depression Scale, WHO, World Health Organization

Keywords: Depression, Diabetes, Prevalence, Correlates, Undiagnosed

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☆ The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

PII: S0168-8227(08)00565-2

doi:10.1016/j.diabres.2008.11.006

Diabetes Research and Clinical Practice
Volume 83, Issue 2 , Pages 268-279, February 2009

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