December 1, 2013

Depression and Type 2 Diabetes among Alaska Native Primary Care Patients

D.A. Dillard, R.F. Robinson, J.J. Smith, B.A. Khan, E.V. Dubois, M.K. Mau

Ethnicity & Disease

Objective: To assess whether type 2 diabetes mellitus (DM2) and DM2 complications are associated with presence and severity of depression among Alaska Native and American Indian people (AN/AIs).

Design: Retrospective, cross-sectional analysis of medical records.

Setting: Southcentral Foundation Primary Care Center (SCF-PCC) in Anchorage, Alaska.

Participants: Total of 23,529 AN/AI adults.

Primary Outcome Measures: Patient Health Questionnaire (PHQ) scores (0–9 negative, 10–14 mild, 15–19 moderate, 20+ severe) and DSM-IV depression diagnosis.

Results: DM2 prevalence was 6% (n51,526). Of those with DM2, 19% (n5292) had one or more DM2 complications and average HbA1c was 7.1%. Prevalence of depression diagnosis was similar between AN/AIs with and without DM2 (P5.124). Among those screened for depression (n512,280), there were similar rates of PHQ severity between those without and with DM2; respectively 4% (n5452) vs 4% (n542) mild, 4% (n5404) vs 3% (n529) moderate, and 4% (n5354) vs 4% (n538) severe. In multivariable logistic regression, DM2 was not associated with PHQ severity (OR 1.02, 95% CI 0.81–1.27) or depression diagnosis (OR 1.27, 95% CI 1.00–1.62). Increased odds of depression and higher depression severity were associated with female sex, younger age, being unmarried, substance abuse/dependence, and increased ambulatory visits. Depression was associated with number of other chronic conditions among AN/AIs with DM2 but not with number of complications.

Conclusions: Presence and severity of depression among AN/AI primary care patients was not significantly associated with DM2 nor DM2 complications, despite a slightly higher rate of depression diagnosis among those with DM2.

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