Association between the Type of Diabetes Treatment and Depressive Symptoms among Patients with Diabetes: A Cross-Sectional Study of Korea Community Health Surveys Data, 2011–2016
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection and Participants
2.2. Dependent Variable
2.3. Independent Variable
2.4. Control Variables
2.5. Statistical Analysis
3. Results
3.1. Study Population
3.2. Association between Type of Diabetes Treatment and Depressive Symptoms
3.3. Results of Subgroup Analyses
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | Total | Male | p-Value * | Female | p-Value * | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Yes | No | Yes | No | |||||||||
N | % | N | % | N | % | N | % | N | % | |||
Total | 99,752 | 100.0 | 2911 | 2.9 | 47,863 | 48.0 | 5207 | 5.2 | 43,771 | 43.9 | ||
Diabetes treatment | <0.0001 | <0.0001 | ||||||||||
Oral agents | 90,182 | 90.4 | 2384 | 2.6 | 43,415 | 48.1 | 4471 | 5.0 | 39,912 | 44.3 | ||
Insulin injection | 2521 | 2.5 | 128 | 5.1 | 1273 | 50.5 | 157 | 6.2 | 963 | 38.2 | ||
Oral agents and insulin injection | 7049 | 7.1 | 399 | 5.7 | 3175 | 45.0 | 579 | 8.2 | 2896 | 41.1 | ||
Age | <0.0001 | 0.0006 | ||||||||||
30–39 | 1396 | 1.4 | 79 | 5.7 | 780 | 55.9 | 67 | 4.8 | 470 | 33.7 | ||
40–49 | 7528 | 7.5 | 286 | 3.8 | 4402 | 58.5 | 343 | 4.6 | 2497 | 33.2 | ||
50–59 | 21,613 | 21.7 | 738 | 3.4 | 11,794 | 54.6 | 1011 | 4.7 | 8070 | 37.3 | ||
60–69 | 32,185 | 32.3 | 850 | 2.6 | 15,683 | 48.7 | 1592 | 4.9 | 14,060 | 43.7 | ||
70–79 | 29,785 | 29.9 | 793 | 2.7 | 12,594 | 42.3 | 1774 | 6.0 | 14,624 | 49.1 | ||
80~ | 7245 | 7.3 | 165 | 2.3 | 2610 | 36.0 | 420 | 5.8 | 4050 | 55.9 | ||
Educational level | <0.0001 | 0.2868 | ||||||||||
Elementary school or less | 44,717 | 44.8 | 879 | 2.0 | 12,627 | 28.2 | 3337 | 7.5 | 27,874 | 62.3 | ||
Middle school | 18,166 | 18.2 | 607 | 3.3 | 9650 | 53.1 | 822 | 4.5 | 7087 | 39.0 | ||
High school | 24,168 | 24.2 | 925 | 3.8 | 15,642 | 64.7 | 831 | 3.4 | 6770 | 28.0 | ||
College or over | 12,701 | 12.7 | 500 | 3.9 | 9944 | 78.3 | 217 | 1.7 | 2040 | 16.1 | ||
Marital status | <0.0001 | <0.0001 | ||||||||||
Married-cohabit | 72,774 | 73.0 | 2022 | 2.8 | 41,690 | 57.3 | 2768 | 3.8 | 26,294 | 36.1 | ||
Married non-cohabitant or bereaved or divorced | 25,153 | 25.2 | 716 | 2.8 | 4972 | 19.8 | 2371 | 9.4 | 17,094 | 68.0 | ||
Unmarried | 1825 | 1.8 | 173 | 9.5 | 1201 | 65.8 | 68 | 3.7 | 383 | 21.0 | ||
Occupation | <0.0001 | <0.0001 | ||||||||||
White collar | 7244 | 7.3 | 246 | 3.4 | 5855 | 80.8 | 90 | 1.2 | 1053 | 14.5 | ||
Pink collar | 8424 | 8.4 | 164 | 1.9 | 3838 | 45.6 | 392 | 4.7 | 4030 | 47.8 | ||
Blue collar | 32,561 | 32.6 | 752 | 2.3 | 20,694 | 63.6 | 826 | 2.5 | 10,289 | 31.6 | ||
Others | 51,523 | 51.7 | 1749 | 3.4 | 17,476 | 33.9 | 3899 | 7.6 | 28,399 | 55.1 | ||
Monthly household income, 1000 KRW | <0.0001 | <0.0001 | ||||||||||
~999 | 35,161 | 35.2 | 1370 | 3.9 | 12,982 | 36.9 | 2683 | 7.6 | 18,126 | 51.6 | ||
1000–1999 | 22,848 | 22.9 | 603 | 2.6 | 11,569 | 50.6 | 1092 | 4.8 | 9584 | 41.9 | ||
2000–2999 | 15,729 | 15.8 | 377 | 2.4 | 8401 | 53.4 | 627 | 4.0 | 6324 | 40.2 | ||
3000–3999 | 10,287 | 10.3 | 242 | 2.4 | 5714 | 55.5 | 321 | 3.1 | 4010 | 39.0 | ||
4000–4999 | 6181 | 6.2 | 120 | 1.9 | 3535 | 57.2 | 212 | 3.4 | 2314 | 37.4 | ||
5000~ | 9546 | 9.6 | 199 | 2.1 | 5662 | 59.3 | 272 | 2.8 | 3413 | 35.8 | ||
Residency region | <0.0001 | <0.0001 | ||||||||||
Urban area–large city | 23,897 | 24.0 | 833 | 3.5 | 11,457 | 47.9 | 1458 | 6.1 | 10,149 | 42.5 | ||
Urban area–small city | 18,580 | 18.6 | 592 | 3.2 | 8790 | 47.3 | 1041 | 5.6 | 8157 | 43.9 | ||
Rural area | 57,275 | 57.4 | 1486 | 2.6 | 27,616 | 48.2 | 2708 | 4.7 | 25,465 | 44.5 | ||
Alcohol status | 0.5162 | <0.0001 | ||||||||||
Ever | 73,066 | 73.2 | 2640 | 3.6 | 43,232 | 59.2 | 3074 | 4.2 | 24,120 | 33.0 | ||
Never | 26,686 | 26.8 | 271 | 1.0 | 4631 | 17.4 | 2133 | 8.0 | 19,651 | 73.6 | ||
Smoking status | 0.0476 | <0.0001 | ||||||||||
Ever | 44,517 | 44.6 | 2413 | 5.4 | 38,972 | 87.5 | 623 | 1.4 | 2509 | 5.6 | ||
Never | 55,235 | 55.4 | 498 | 0.9 | 8891 | 16.1 | 4584 | 8.3 | 41,262 | 74.7 | ||
Walking activity | <0.0001 | <0.0001 | ||||||||||
Inactive | 29,997 | 30.1 | 1062 | 3.5 | 14,062 | 46.9 | 1851 | 6.2 | 13,022 | 43.4 | ||
Low | 15,902 | 15.9 | 438 | 2.8 | 7364 | 46.3 | 873 | 5.5 | 7227 | 45.4 | ||
Middle | 13,996 | 14.0 | 372 | 2.7 | 6453 | 46.1 | 711 | 5.1 | 6460 | 46.2 | ||
High | 39,857 | 40.0 | 1039 | 2.6 | 19,984 | 50.1 | 1772 | 4.4 | 17,062 | 42.8 | ||
Perceived health status | <0.0001 | <0.0001 | ||||||||||
Good | 13,026 | 13.1 | 160 | 1.2 | 8543 | 65.6 | 190 | 1.5 | 4133 | 31.7 | ||
Normal | 34,556 | 34.6 | 628 | 1.8 | 19,126 | 55.3 | 890 | 2.6 | 13,912 | 40.3 | ||
Bad | 52,170 | 52.3 | 2123 | 4.1 | 20,194 | 38.7 | 4127 | 7.9 | 25,726 | 49.3 | ||
Perceived stress level | <0.0001 | <0.0001 | ||||||||||
Very | 25,887 | 26.0 | 1863 | 7.2 | 10,076 | 38.9 | 3443 | 13.3 | 10,505 | 40.6 | ||
Less | 45,860 | 46.0 | 832 | 1.8 | 22,838 | 49.8 | 1412 | 3.1 | 20,778 | 45.3 | ||
Low | 28,005 | 28.1 | 216 | 0.8 | 14,949 | 53.4 | 352 | 1.3 | 12,488 | 44.6 | ||
Body mass index (kg/m2) | <0.0001 | <0.0001 | ||||||||||
Underweight (~18.4) | 2959 | 3.0 | 163 | 5.5 | 996 | 33.7 | 295 | 10.0 | 1505 | 50.9 | ||
Normal weight (18.5–22.9) | 33,982 | 34.1 | 1040 | 3.1 | 15,412 | 45.4 | 1794 | 5.3 | 15,736 | 46.3 | ||
Overweight (23.0–24.9) | 27,470 | 27.5 | 754 | 2.7 | 14,260 | 51.9 | 1198 | 4.4 | 11,258 | 41.0 | ||
Obesity (25.0~) | 35,341 | 35.4 | 954 | 2.7 | 17,195 | 48.7 | 1920 | 5.4 | 15,272 | 43.2 | ||
Hypertension diagnosis | 0.0027 | 0.0732 | ||||||||||
Yes | 60,434 | 60.6 | 1752 | 2.9 | 27,451 | 45.4 | 3379 | 5.6 | 27,852 | 46.1 | ||
No | 39,318 | 39.4 | 1159 | 2.9 | 20,412 | 51.9 | 1828 | 4.6 | 15,919 | 40.5 | ||
Dyslipidemia diagnosis | <0.0001 | <0.0001 | ||||||||||
Yes | 32,578 | 32.7 | 1078 | 3.3 | 13,732 | 42.2 | 2308 | 7.1 | 15,460 | 47.5 | ||
No | 67,174 | 67.3 | 1833 | 2.7 | 34,131 | 50.8 | 2899 | 4.3 | 28,311 | 42.1 | ||
Year | <0.0001 | <0.0001 | ||||||||||
2011 | 14,080 | 14.1 | 362 | 2.6 | 6660 | 47.3 | 627 | 4.5 | 6431 | 45.7 | ||
2012 | 14,856 | 14.9 | 351 | 2.4 | 7209 | 48.5 | 663 | 4.5 | 6633 | 44.6 | ||
2013 | 16,061 | 16.1 | 462 | 2.9 | 7753 | 48.3 | 812 | 5.1 | 7034 | 43.8 | ||
2014 | 17,230 | 17.3 | 591 | 3.4 | 8204 | 47.6 | 1042 | 6.0 | 7393 | 42.9 | ||
2015 | 18,280 | 18.3 | 582 | 3.2 | 8746 | 47.8 | 993 | 5.4 | 7959 | 43.5 | ||
2016 | 19,245 | 19.3 | 563 | 2.9 | 9291 | 48.3 | 1070 | 5.6 | 8321 | 43.2 |
Variables | Male | Female | ||
---|---|---|---|---|
Adjusted OR | 95% CI | Adjusted OR | 95% CI | |
Diabetes treatment | ||||
Oral agents | 1.00 | - | 1.00 | - |
Insulin injection | 1.27 | (1.04–1.56) | 1.17 | (0.98–1.41) |
Oral agents and insulin injection | 1.41 | (1.25–1.60) | 1.35 | (1.22–1.50) |
Age | ||||
30–39 | 1.00 | - | 1.00 | - |
40–49 | 0.71 | (0.54–0.95) | 1.20 | (0.88–1.62) |
50–59 | 0.73 | (0.56–0.97) | 1.17 | (0.87–1.56) |
60–69 | 0.63 | (0.48–0.84) | 0.92 | (0.68–1.24) |
70–79 | 0.58 | (0.44–0.78) | 0.82 | (0.61–1.11) |
80~ | 0.44 | (0.32–0.62) | 0.70 | (0.51–0.96) |
Educational level | ||||
Elementary school or less | 1.00 | - | 1.00 | - |
Middle school | 1.01 | (0.90–1.14) | 1.05 | (0.96–1.15) |
High school | 0.96 | (0.86–1.08) | 1.12 | (1.01–1.24) |
College or over | 0.90 | (0.79–1.04) | 1.10 | (0.92–1.31) |
Marital status | ||||
Married-cohabit | 1.00 | - | 1.00 | - |
Married non-cohabitant or bereaved or divorced | 1.93 | (1.74–2.13) | 1.40 | (1.31–1.50) |
Unmarried | 1.41 | (1.15–1.72) | 1.26 | (0.94–1.68) |
Occupation | ||||
White collar | 1.00 | - | 1.00 | - |
Pink collar | 0.92 | (0.74–1.13) | 1.14 | (0.88–1.48) |
Blue collar | 0.86 | (0.72–1.02) | 1.12 | (0.87–1.45) |
Others | 1.81 | (1.52–2.16) | 1.78 | (1.39–2.27) |
Monthly household income, 1000 KRW | ||||
~999 | 1.00 | - | 1.00 | - |
1000–1999 | 0.69 | (0.62–0.77) | 0.82 | (0.76–0.89) |
2000–2999 | 0.63 | (0.55–0.72) | 0.73 | (0.66–0.81) |
3000–3999 | 0.58 | (0.49–0.68) | 0.58 | (0.50–0.66) |
4000–4999 | 0.48 | (0.38–0.59) | 0.71 | (0.60–0.83) |
5000~ | 0.49 | (0.40–0.58) | 0.61 | (0.53–0.71) |
Residency region | ||||
Urban area–large city | 1.00 | - | 1.00 | - |
Urban area–small city | 0.84 | (0.75–0.95) | 0.84 | (0.77–0.92) |
Rural area | 0.74 | (0.67–0.81) | 0.74 | (0.69–0.80) |
Alcohol status | ||||
Ever | 1.00 | - | 1.00 | - |
Never | 0.90 | (0.78–1.03) | 0.89 | (0.83–0.95) |
Smoking status | ||||
Ever | 1.00 | - | 1.00 | - |
Never | 1.10 | (0.99–1.23) | 0.67 | (0.60–0.74) |
Walking activity | ||||
Inactive | 1.00 | - | 1.00 | - |
Low | 0.94 | (0.83–1.07) | 0.94 | (0.86–1.03) |
Middle | 0.95 | (0.83–1.09) | 0.95 | (0.86–1.05) |
High | 0.86 | (0.78–0.95) | 0.90 | (0.83–0.97) |
Perceived health status | ||||
Good | 1.00 | - | 1.00 | - |
Normal | 1.44 | (1.21–1.72) | 1.14 | (0.97–1.35) |
Bad | 2.53 | (2.13–3.00) | 1.90 | (1.63–2.23) |
Perceived stress level | ||||
Very | 1.00 | - | 1.00 | - |
Less | 0.24 | (0.22–0.26) | 0.24 | (0.22–0.25) |
Low | 0.09 | (0.08–0.11) | 0.10 | (0.09–0.11) |
Body mass index (kg/m2) | ||||
Underweight (~18.4) | 1.51 | (1.24–1.84) | 1.45 | (1.25–1.68) |
Normal weight (18.5–22.9) | 1.00 | - | 1.00 | - |
Overweight (23.0–24.9) | 0.92 | (0.83–1.02) | 0.96 | (0.88–1.04) |
Obesity (25.0~) | 0.92 | (0.83–1.02) | 0.98 | (0.91–1.06) |
Hypertension diagnosis | ||||
Yes | 1.00 | - | 1.00 | - |
No | 1.04 | (0.96–1.14) | 1.06 | (0.99–1.13) |
Dyslipidemia diagnosis | ||||
Yes | 1.00 | - | 1.00 | - |
No | 0.75 | (0.69–0.82) | 0.78 | (0.73–0.84) |
Year | ||||
2011 | 1.00 | - | 1.00 | - |
2012 | 0.89 | (0.76–1.04) | 1.06 | (0.94–1.19) |
2013 | 1.15 | (0.99–1.34) | 1.31 | (1.16–1.47) |
2014 | 1.36 | (1.18–1.57) | 1.58 | (1.42–1.77) |
2015 | 1.31 | (1.13–1.51) | 1.42 | (1.27–1.59) |
2016 | 1.17 | (1.01–1.36) | 1.52 | (1.36–1.70) |
Variables | Diabetes Treatment | ||||
---|---|---|---|---|---|
Oral Agents | Insulin Injection | Oral Agents and Insulin Injection | |||
OR | OR | 95% CI | OR | 95% CI | |
Male | |||||
Age | |||||
30–39 | + | + | + | ||
40–49 | 1.00 | 0.98 | (0.51–1.89) | 1.89 | (1.28–2.81) |
50–59 | 1.00 | 1.17 | (0.78–1.74) | 1.53 | (1.19–1.96) |
60–69 | 1.00 | 1.47 | (1.02–2.10) | 1.28 | (1.02–1.62) |
70–79 | 1.00 | 1.26 | (0.84–1.91) | 1.34 | (1.05–1.70) |
80~ | - | ||||
Educational level | |||||
Elementary school or less | + | + | + | ||
Middle school | 1.00 | 1.38 | (0.90–2.12) | 1.36 | (1.03–1.78) |
High school | 1.00 | 1.53 | (1.10–2.12) | 1.53 | (1.23–1.91) |
College or over | 1.00 | 0.95 | (0.55–1.65) | 1.75 | (1.30–2.35) |
Walking activity | |||||
Inactive | 1.00 | 1.31 | (0.94–1.84) | 1.55 | (1.27–1.88) |
Low | 1.00 | 1.32 | (0.76–2.32) | 1.46 | (1.03–2.06) |
Middle | 1.00 | 1.07 | (0.60–1.89) | 1.49 | (1.04–2.13) |
High | 1.00 | 1.27 | (0.91–1.78) | 1.22 | (0.98–1.52) |
Body mass index (kg/m2) | |||||
Underweight (~18.4) | 1.00 | 2.13 | (1.00–4.54) | 1.66 | (0.98–2.79) |
Normal weight (18.5–22.9) | 1.00 | 1.33 | (0.98–1.81) | 1.36 | (1.11–1.67) |
Overweight (23.0–24.9) | 1.00 | 1.33 | (0.88–2.02) | 1.46 | (1.13–1.89) |
Obesity (25.0~) | 1.00 | 0.96 | (0.62–1.50) | 1.41 | (1.13–1.76) |
Female | |||||
Age | |||||
30–39 | + | + | + | ||
40–49 | 1.00 | 1.22 | (0.67–2.22) | 1.54 | (1.04–2.28) |
50–59 | 1.00 | 1.03 | (0.67–1.57) | 1.42 | (1.12–1.80) |
60–69 | 1.00 | 1.30 | (0.93–1.83) | 1.18 | (0.98–1.42) |
70–79 | 1.00 | 1.21 | (0.86–1.71) | 1.38 | (1.15–1.64) |
80~ | - | ||||
Educational level | |||||
Elementary school or less | + | + | + | ||
Middle school | 1.00 | 1.26 | (0.80–1.98) | 1.31 | (1.01–1.70) |
High school | 1.00 | 1.09 | (0.73–1.63) | 1.45 | (1.12–1.88) |
College or over | 1.00 | 0.76 | (0.36–1.60) | 1.84 | (1.15–2.95) |
Walking activity | |||||
Inactive | 1.00 | 1.32 | (0.98–1.78) | 1.45 | (1.23–1.72) |
Low | 1.00 | 1.08 | (0.66–1.76) | 1.39 | (1.08–1.79) |
Middle | 1.00 | 1.80 | (1.11–2.89) | 1.23 | (0.91–1.66) |
High | 1.00 | 0.88 | (0.62–1.24) | 1.24 | (1.04–1.49) |
Body mass index (kg/m2) | |||||
Underweight (~18.4) | 1.00 | 1.14 | (0.56–2.35) | 1.27 | (0.79–2.03) |
Normal weight (18.5–22.9) | 1.00 | 1.03 | (0.76–1.40) | 1.46 | (1.22–1.74) |
Overweight (23.0–24.9) | 1.00 | 1.28 | (0.87–1.88) | 1.35 | (1.08–1.67) |
Obesity (25.0~) | 1.00 | 1.30 | (0.94–1.79) | 1.27 | (1.07–1.50) |
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Lee, H.J.; Jang, J.; Lee, S.A.; Oh, S.S.; Park, E.-C. Association between the Type of Diabetes Treatment and Depressive Symptoms among Patients with Diabetes: A Cross-Sectional Study of Korea Community Health Surveys Data, 2011–2016. Int. J. Environ. Res. Public Health 2019, 16, 4441. https://doi.org/10.3390/ijerph16224441
Lee HJ, Jang J, Lee SA, Oh SS, Park E-C. Association between the Type of Diabetes Treatment and Depressive Symptoms among Patients with Diabetes: A Cross-Sectional Study of Korea Community Health Surveys Data, 2011–2016. International Journal of Environmental Research and Public Health. 2019; 16(22):4441. https://doi.org/10.3390/ijerph16224441
Chicago/Turabian StyleLee, Hyeon Ji, Jieun Jang, Sang Ah Lee, Sarah Soyeon Oh, and Eun-Cheol Park. 2019. "Association between the Type of Diabetes Treatment and Depressive Symptoms among Patients with Diabetes: A Cross-Sectional Study of Korea Community Health Surveys Data, 2011–2016" International Journal of Environmental Research and Public Health 16, no. 22: 4441. https://doi.org/10.3390/ijerph16224441