PREVALENCE OF DEPRESSION IN ADULTS WITH DIABETES - AN EPIDEMIOLOGIC EVALUATION

OBJECTIVE- To determine the prevalence of depression in adult diabetic populations through a comprehensive literature review and to critical ly evaluate the methods and findings of such studies from an epidemiol ogical perspective. RESEARCH DESIGN AND METHODS- A systematic review o f the scientific literature revealed a total of 20 studies, 14 of whic h had been conducted since 1988. Nine of the studies were controlled i nvestigations, whereas the remaining 11 studies did not contain compar ison groups. The studies included both treatment and community samples . RESULTS- The range of the prevalence of current depression obtained from structured diagnostic interviews in diabetic samples was 8.5-27.3 % (XBAR = 14.0%) in controlled studies and 11.0-19.9% (XBAR = 15.4%) i n uncontrolled studies. These rates are at least three times the preva lence of major depressive disorder found in the general adult populati on of the U.S. Investigations using depression symptom scales corrobor ated these findings, as the range of clinically significant depression symptomatology in diabetic samples was 21.8-60.0% (XBAR = 32.4%) in c ontrolled studies and 10.0-28.0% (XBAR = 19.6%) in uncontrolled studie s. CONCLUSIONS - An increased prevalence of depression in diabetes rel ative to the general population is highly suggested by the literature, but biases and methodological problems commonly encountered in preval ence studies may interfere with the strength of this conclusion. An in creased prevalence of depression in diabetes relative to other somatic illnesses remains unproven. The pervasive impact of depression on qua lity of life and its potential negative effect on diabetes management warrant recognition and treatment of the affective disorder in diabeti c individuals.