The Burden of Co-morbid Depression in Ambulatory Patients with Type 2 Diabetes Mellitus at Kenyatta National Hospital, Kenya

Abstract

Background: Co-morbid depression is a serious condition in patients with diabetes that negatively affects their self-management, including drug adherence, consequently, the treatment outcomes and quality of life are also affected. Objective: To determine the burden of co-morbid depression in ambulatory patients with type 2 diabetes at the Kenyatta National Hospital (KNH) and to document their socio-demographic and clinical characteristics and any associated risk factors. Methods: This was a cross-sectional study done on patients living with type-2 diabetes on follow-up at the diabetes out-patient clinic (DOPC) at the KNH. Systematic sampling method was used to recruit 220 study subjects. The PHQ-9 questionnaire was used to assess for co-morbid depression. Socio-demographic and clinical details were obtained both from the subjects and their medical records. Physical examination was done, including blood pressure and BMI determined. Blood samples were collected from the cubital fossa to measure HbA1C in COBAS INTEGRA system with its reagent in the pre-dilution cuvette for automated analysis of glycated hemoglobin (HbA1c). Statistical associations of patients’ characteristics and co-morbid depression were determined using Chi-square test and Odds Ratios. Results: The prevalence of co-morbid depression in patients with type 2 diabetes at the DOPC of KNH using the PHQ-9 was 32.3% (95% CI 26.4-38.6%). Of these, depression was mild in 42.3%,moderate in 40.8% and severe in 16%. Subjects with comorbid depression were: aged 65years and above (p = 0.006), over-weight/obese (p = 0.035), and had longer duration of diabetes of 5years and above. The presence of co-morbid depression was significantly associated with poor glycaemic control, (OR = 3.3, 95% CI, 1.6 - 6.8, p = 0.001). Conclusion: About one-third (32.3%) of the study subjects with type 2 diabetes had co-morbid depression. Patients with type 2 diabetes who are at higher risk (older age of 65 years and above, long duration of diabetes, poor glycaemic control and presence of diabetes-related complications,) should be screened for co-morbid depression.