Title

Association of depression with newly diagnosed type 2 diabetes among adults aged 25-60 years in Karachi, Pakistan: a matched case-control studycby Shazia Perveen.

Date of Award

2007

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

Type 2 Diabetes is a global public health problem. Patients suffering from it are vulnerable to develop complications that lead to loss of productivity and premature mortality. Similarly depression is reported to be one of the major causes of disability worldwide. The mixture of depression and Type 2 Diabetes can further increase disability, morbidity and mortality. The purpose of this study was to explore the association between depression and newly diagnosed Type 2 Diabetes. We conducted a hospital-based matched case control study for determining the association between depression and newly diagnosed Type 2 Diabetes among adults aged 25-60 years in Out Patient Department of tertiary care hospital (Civil Hospital, Karachi). 296 cases of newly diagnosed Type 2 Diabetes were matched on age and sex with 296 non-diabetic controls. The distribution of males and females was 82.1 and 17.9 percent respectively. The main independent variable "Depression" was categorized into none, mild and moderate to severe level. It was screened by Siddiqui Shah Depression Scale. The Conditional Logistic Model was applied to calculate the odds ratio and 95 percent Confidence Limits for factors associated with Type 2 Diabetes. Our study results revealed the Family history of diabetes (mOR 1.70), History of gestational diabetes (mOR 3.02), Family type (mOR 1.89), BMI (mOR 1.53 for obese vs healthy to underweight, mOR 2.24 overweight vs healthy to underweight were significantly associated with newly diagnosed Type 2 Diabetes, controlling for other potential confounding variables at 10% significance level. The interactions between Depression level* Cooking medium and Depression level* History of high BP were found. The calculation of odds ratio for 2-way interaction terms revealed synergism between cooking medium (both oil and ghee), positive history of high BP and levels of depression. The interaction between levels of depression on newly diagnosed Type 2 Diabetes with history of high BP might be the result of attitude of seeking less care in depressed people especially in those having positive history of high BP. The interaction between levels of depression and cooking medium needs further research for explaining the possible mechanism. Moreover, the inter-relation between all three variables taking part in interaction is still a question which is needed to be answered by future research. The difference between the relationship with mild and moderate to severe depression could be due to the reason that it is a more long standing condition, unrelated to Type 2 Diabetes. The findings suggest that the patients with newly diagnosed Type 2 Diabetes should be screened and treated simultaneously for depression. It is important to note that all the interventions used to address depression and Type 2 Diabetes should also include strategies to prevent above mentioned significant associated factors. Addressing these issues concomitantly will reduce the health care cost in highest productivity period of 25 to 60 years of age which will effectively contribute to the economy of the country. Since the study design limits causal interpretations; therefore, further research is needed to replicate these findings with longitudinal study design.

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