Elders with Diabetes: Implications for Depression Screening

Diabetes has been concluded to be a global epidemic (Wild, Sicree, Roger, King & Green, 2004). By the year 2030, it is predicted that depression will become the second leading cause of disability worldwide (World Health Organization [WHO], 2007). The relationship between diabetes and depression is likely not casual. Those with diabetes are twice as likely to develop depression (Eaton, Armenian, Gallo, Pratt & Ford, 1996; Kawakami, Shimizu, Takatsuka, & Ishibashi, 1999). Conversely, diabetes doubles the likelihood of comorbid depression (Anderson, Clouse, Freedland & Lustman, 2001). The intersection of these two devastating diseases is far from benign. Black, Markides and Ray (2003) found that overall mortality was increased five times in those with diabetes who also suffered from depression. There is a particularly increased burden of depression in elders with diabetes, with up to 30% of those over age 65 having this dual diagnosis (Anderson et al., 2001). Despite this high prevalence, depression is underdiagnosed in the elderly, and this group has a disproportionate rate of suicide. Better strategies are needed for identifying and treating depression in elders with concomitant diabetes. The purpose of this study was to assess the prevalence of depression in a community-dwelling population of elders with type 2 diabetes who were receiving diabetes self-management education (DSME) services. Specific characteristics of elders with diabetes were assessed in relationship to depression. A diabetes and depression survey instrument (DD-S) and a self-administered depression instrument (CES-D) were administered to 153 elderly clients of Humphreys Diabetes Center in Boise, Idaho. Twenty-six completed surveys were returned by mail. An extremely high prevalence of depression (46%) was discovered. Most participants in the depression group were female (88.8%). Four participants in this group had not been previously diagnosed with depression, and two participants under treatment for depression were found to have ongoing symptoms. Depression was found to be significantly associated with the total number of medications participants reported taking. Individual medical conditions were not associated with being classified in the depression group nor were complications of diabetes. Depression was not associated with any specific demographic variable, with diabetes care compliance, or with diabetes control as measured by HA1c. It is concluded that elders with diabetes, especially females, are at very high risk of concomitant depression. Assessment of the total number of medications in elders with diabetes might help identify a subgroup at particularly high risk for depression. The findings from this study suggest that the use of the survey tools (DD-S in combination with the CES-D administered during DSME) may be an effective means of screening for depression in elders with diabetes