Female sex, young age, northern German residence, hypoglycemia and disabling diabetes complications are associated with depressed mood in the WHO-5 questionnaire – A multicenter DPV study among 17,563 adult patients with type 2 diabetes

Background: Like other mental illnesses, depression is a culturally sensitive topic. Hence, findings cannot be transferred between countries. We investigated the frequency of depressed mood and its association with diabetes-related factors in a large type 2 diabetes (T2D) cohort from real-life care in Germany.
Methods: 17,563 adults (median [IQR]: 64.5[55.9–71.1] years) from the multicenter diabetes follow-up registry, DPV (diabetes prospective follow-up), were investigated. All had completed the WHO-5 questionnaire, a screening tool for depression. Logistic regression was applied to study the association of demographic and diabetes-related factors with depressed mood (SAS 9.4). P<0.05 was considered significant.
Results: Using a WHO-5 cut-off of <13, 27.4% of patients were at risk for depressed mood. A clinical depression diagnosis was recognized in 8.4%. Female sex (OR: 1.5[95%-CI: 1.4–1.6]), young age (1.2[1.1–1.4]), longer diabetes duration (1.2[1.1–1.3]), and living in Northern Germany (1.3[1.2–1.4]) were each associated with increased odds for depressed mood. After adjusting for these confounders, worse glycemic control (1.4[1.3–1.5]), insulin use (1.3[1.2–1.4]), myocardial infarction (1.3[1.2–1.5]), stroke (1.8[1.5–2.0]), retinopathy (1.4[1.3–1.6]), renal failure (1.4[1.2–1.8]), diabetic foot syndrome (1.3[1.2–1.4]), severe hypoglycemia (1.5[1.2–1.9]), two or more inpatient admissions (2.1[1.8–2.4]), and longer duration of hospital stay (1-<14 days: 1.3[1.2–2.3]; >14 days: 2.1[1.9–2.3]) were related to depressed mood.
Limitation: Due to the cross-sectional design, no causality can be drawn.
Conclusions: In T2D, depressed mood is not uncommon. However, in routine care a clinical depression might be missed and regular screening is advisable. Besides the well-known associations with depressed mood, northern German residence and mainly life-compromising diabetes comorbidities were identified as related factors.