Biopsychosocial and Nutritional Factors of Depression among Type 2 Diabetes Mellitus Patients: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Formulation of the Research Question
2.2. Systematic Searching Strategies
2.3. Identification
2.4. Screening Using Inclusion and Exclusion Criteria
2.5. Eligibility
2.6. Quality Assessment
2.7. Data Abstraction and Analysis
3. Results
Factors Associated with Depression among T2DM Patients
4. Discussion
4.1. Biological Factors
4.2. Psychological Factors
4.3. Social Factors
4.4. Nutritional Factors
4.5. Strength and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Articles | Introduction | Methods | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Author, Country | Were the aims/ objectives of the study clear? | Was the study design appropriate for the stated aim(s)? | Was the sample size justified? | Was the target/ reference population clearly defined? | Was the sample frame taken from an appropriate population so that it closely represented the target/reference population under investigation? | Was the selection process likely to select subjects/ participants that were representative of the target/ reference population under investigation? | Were measures undertaken to address and categorise non-responders? | Were the risk factor and outcome variables measured appropriate to the aims of the study? | Were the risk factor and outcome variables measured correctly using instruments/ measurements that had been trialled, piloted, or published previously? | Is it clear what was used to determine statistical significance and/or precision estimates? | Were the methods (Including statistical methods) sufficiently described to enable them to be repeated |
Pal et al. [16], India | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Majumdar et al. [17], India | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Kant et al. [18], India | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Al-Ozairi et al. [19], Kuwait | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | NO | YES |
Gebre et al. [20], Ethiopia | YES | YE | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Gupta et al. [21], India | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | NO | YES | YES |
Abate and Gedamu [6], Ethiopia | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YESE | YES | YES |
Woon et al. [22], Malaysia | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Alzughbi et al. [23], Saudi Arabia | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Sharma et al. [24], Nepal | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Alzahrani et al. [25], Saudi Arabia | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Kim et al. [26], Korea | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Victoria and Dampil [27], Philippines | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Radzi et al. [28], Malaysia | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Fung et al. [29], China | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Yoong et al. [30], Singapore | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Atif et al. [31], Pakistan | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Albasheer et al. [32], Saudi Arabia | YES | YES | YES | YES | YES | YES | NO | YES | YES | YES | YES |
Kayar et al. [33], Turkey | YES | YES | YES | YES | YES | YES | CANNOT TELL | YES | YES | YES | YES |
Articles | Results | Discussion | Other | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Author, Country | Were the basic data adequately described? | Does the response rate raise concerns about non-response bias? | If appropriate, was information aboutnon-responders described? | Were the results internally consistent? | Were the results for the analyses described in the methods, presented? | Were the authors’ discussions and conclusions justified by the results? | Were the limitations of the study discussed? | Were there any funding sources or conflicts of interest that may affect the authors’ interpretation of the results? | Was ethical approval or consent of participants attained? | Total Recorded “Yes” |
Pal et al. [16], India | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Majumdar et al. [17], India | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Kant et al. [18], India | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Al-Ozairi et al. [19], Kuwait | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | CANNOT TELL | YES | 15 |
Gebre et al. [20], Ethiopia | YES | CANNOT TELL | NO | YES | YES | YES | YES | NO | YES | 16 |
Gupta et al. [21], India | YES | NO | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Abate and Gedamu [6], Ethiopia | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Woon et al. [22], Malaysia | YES | CANNOT TELL | YES | YES | YES | YES | YES | NO | YES | 17 |
Alzughbi et al. [23], Saudi Arabia | YES | NO | YES | YES | YES | YES | YES | NO | YES | 16 |
Sharma et al. [24], Nepal | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Alzahrani et al. [25], Saudi Arabia | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Kim et al. [26], Korea | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Victoria and Dampil [27], Philippines | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Radzi et al. [28], Malaysia | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Fung et al. [29], China | YES | CANNOT TELL | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
Yoong et al. [30], Singapore | YES | CANNOT TELL | NO | YES | YES | YES | YES | CANNOT TELL | YES | 16 |
Atif et al. [31], Pakistan | YES | CANNOT TELL | NO | YES | YES | YES | YES | NO | YES | 16 |
Albasheer et al. [32], Saudi Arabia | YES | NO | NO | YES | YES | YES | YES | NO | YES | 16 |
Kayar et al. [33], Turkey | YES | NO | CANNOT TELL | YES | YES | YES | YES | NO | YES | 16 |
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Database | Search String |
---|---|
Scopus | TITLE = (“mental health” OR “depression *” OR “depressive disorder *”) AND (“determinants” OR “predictors” OR “risk factors”) AND (“diabetes mellitus *” OR “hyperglycaemia” OR “glucose intolerance”) |
Web of Science | TS = (“mental health” OR “depression *” OR “depressive disorder *”) AND (“determinants” OR “predictors” OR “risk factors”) AND (“diabetes mellitus *” OR “hyperglycaemia” OR “glucose intolerance”) |
PubMed | (“mental health” OR “depression *” OR “depressive disorder *”) AND (“determinants” OR “predictors” OR “risk factors”) AND (“diabetes mellitus *” OR “hyperglycaemia” OR “glucose intolerance”) |
EBSCOHost | (“mental health” OR “depression *” OR “depressive disorder *”) AND (“determinants” OR “predictors” OR “risk factors”) AND (“diabetes mellitus *” OR “hyperglycaemia” OR “glucose intolerance”) |
No. | Authors, Country | Study Design | Objectives | Sample Size | Depression Measurement | Associated Factors | Associated Factors (Group Classification) | Limitation |
---|---|---|---|---|---|---|---|---|
1. | Pal et al. [16], India | Cross-sectional study | To assess the prevalence, severity, and determinants of depression among patients with T2DM | 290 patients with T2DM, age > 18 years. | Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Hamilton Depression Rating Scale (HAM-D) | Female and diabetic retinopathy | Biological | (1) Hospital-based study with convenient sampling design.(2) Selection bias, as sick patients and those with complications are more likely to visit tertiary care hospitals. (3) It was a cross-sectional study. |
2. | Majumdar et al. [17], India | Cross-sectional study | To assess the predictors of depression as well as its prevalence in T2DM patients, the authors conducted a cross sectional study entitled ‘‘DEPression in DIABetes” (DEPDIAB). | 1371 T2DM patients from Eastern India | Patient Health Questionnaire-9 (PHQ–9) and Beck depression scales | Younger age (18–40), female, low socioeconomic status, poor compliance, hypoglycaemia, and difficulty in managing day-to-day activities | Biological, Social | (1) It was conducted in the tertiary care centres and not in the community set-up, which may limit its generalizability. (2) The assessment of depression was performed via a questionnaire-based screening tool rather than by a psychiatrist. |
3. | Kant et al. [18], India | Cross-sectional study | This study explores the predictors for depression in patients with T2DM | 250 subjects at the diabetic clinic and psychiatry outpatient department of a tertiary care teaching hospital | The Center for Epidemiological Studies (CES-D) | Age, gender, locality, BMI, and FBS among diabetic patients | Biological | It was a cross-sectional and hospital-based study. |
4. | Al-Ozairi et al. [19], Kuwait | Cross-sectional study | This study aimed to describe the prevalence of and risk factors for depression and diabetes distress in people with T2DM and whether depression and distress are independently associated with worse biomedical outcomes. | 465 patients | PAID, Patient Health Questionnaire-9 (PHQ-9) | Sociodemographic (age, gender, and marital status) and body mass index, HbA1c | Social, Biological | Cross-sectional study |
5. | Gebre et al. [20], Ethiopia | Cross-sectional study | The aim was to assess severity of depression and its determinants in diabetes outpatients at Hawassa University Comprehensive Specialized Referral Hospital, southern Ethiopia. | 688 patients | Patient Health Questionnaire-9 (PHQ-9) | Consumption of alcohol, failure to practice recommended physical activity, not practicing a recommended dietary regimen. Loss of very close relative/spouse, poor social support. | Biological, Social, Psychological, Nutritional | (1) Recall bias for the questions like the PHQ scale, subjective and social desirability bias for questions about alcohol intake, physical activity, dietary regimen, and medication. |
6. | Gupta et al. [21], India | Cross-sectional study | To determine the prevalence and predictors of depression in patients of DM among various sociodemographic, clinical, and quality-of-life variables | 300 patients from outpatient department and inpatient department of a secondary care centre of Northern India | Hindi version of Patient Health Questionnaire-9 (PHQ-9) | Poor education | Social | (1) Small sample size, (2) an assessment of depression through a self-reported questionnaire. Hindi translation of the QOLID has not been validated. |
7. | Abate and Gedamu [6], Ethiopia | Cross-sectional study | To identify psychosocial and clinical factors associated to develop depression symptoms in diabetes patients | 416 patients | Patient Health Questionnaire-9 (PHQ-9) | Fear of diabetic complications, social support, being female, and sexual dysfunction | Psychological, biological | Using self-reported question |
8. | Woon et al. [22], Malaysia | Cross-sectional study | To determine the prevalence of depression and anxiety, and their associated factors in the Malaysian diabetic population | 300 diabetic patients | The Beck Depression Inventory (BDI) | Anxiety, which increased the occurrence of depression by almost 20-fold | Psychological | (1) A single tertiary healthcare referral centre. (2) The depressive and anxiety symptoms were measured by self-reported tools rather than diagnostic interviews. |
9. | Alzughbi et al. [23], Saudi Arabia | Cross-sectional study | This study aimed to assess the prevalence of Diabetes Mellitus (DM)-related distress and depression and their associated factors in Saudi people with T2DM in Jazan, Saudi Arabia. It also aimed to assess the association between glycaemic control and DM-related distress and depression. | 300 Saudi patients with T2DM randomly from primary healthcare centres in Jazan, Saudi Arabia | 17-item Diabetes Distress Scale and the Patient Health Questionnaire-9 | Female, patients aged < 45, physical inactivity, DM duration < 5 years, and smoking were significantly associated with DM-related distress and depression. | Biological, Social, Psychological | Cross-sectional study |
10. | Sharma et al. [24], Nepal | Cross-sectional study | This study aimed to assess the depression and anxiety among patients with Type 2 Diabetes Mellitus in Chitwan. | 296 Type 2 Diabetes patients admitted in the Chitwan Medical College Teaching Hospital | Patient Health Questionnaire-9 (PHQ-9) | Educational status, smoking habit, satisfaction toward current treatment, and history of diabetes in family were the factors associated with depression | Social, Biological, Psychological | (1) It is a cross-sectional study, which could not explore the causal relationship between anxiety and depression with other associated factors. (2) The study was conducted among diabetes patients who were admitted in tertiary care hospital setting, which may itself mean higher anxiety and depression. (3) It did not exclude the patients with chronic complications, which might have influenced the study findings. |
11. | Alzahrani et al. [25], Saudi Arabia | Cross-sectional study | To investigate the prevalence and predictors of depression, anxiety, and stress among T2DM patients in the western region of Saudi Arabia | 450 adults with T2DM | Depression, Anxiety, and Stress Scale (DASS-21) questionnaire | Presence of comorbidity, female | Biological | The cross-sectional design is inadequate to assess the direction of the relationship between depression, anxiety, and stress and T2DM. |
12. | Kim et al. [26], Korea | Cross-sectional study | To evaluate the relationship between T2DM-related factors and the degree of depression based on gender in elderly patients with T2DM. We also evaluated and considered other possible factors that can affect depression, such as cognitive function, physical function, education level, and other personal factors. | 155 patients with T2DM | The Geriatric Depression Scale-Korean version (SGDS-K) | Poorer glycemic control and a longer duration of DM in elderly male patients with T2DM. | Biological | (1) The study was cross sectional; (2) The sample size was relatively small, and the participants were enrolled from several general hospitals, raising concern about the generalizability of the results. (3) They relied on the SGDS-K without an accompanying diagnostic interview by a professional |
13. | Victoria and Dampil [27], Philippines | Cross-sectional study | The objective of the study was to determine the prevalence of depression among adult Filipino patients with Type 2 Diabetes Mellitus and investigate the different clinical factors associated with it. | 476 patients aged above 18 years old diagnosed with Type 2 Diabetes Mellitus | Patient Health Questionnaire 9 (PHQ-9) | Post-graduate degree, presence of retinopathy, and higher MMA Score (lower adherence) | Biological, Social | (1) Samples were recruited from 1 hospital only, (2) complications of diabetes were noted per chart review and as reported by the subjects only, (3) this study is cross-sectional, and a causal relationship between diabetes and depression could not be established. |
14. | Radzi et al. [28], Malaysia | Cross-sectional study | To determine the prevalence of depression and its associated factors among elderly with Type 2 Diabetes Mellitus in Kedah | 511 patients | The Malay version of Geriatric Depression Scale (M-GDS-14) | Living arrangements, diabetic complication and HbA1c | Environmental, Biological | This study only explored the sociodemographic, living arrangements, and diabetes status, i.e., duration of diabetes, HbA1c, co-morbidities, and diabetic complications in general. |
15. | Fung et al. [29], China | Cohort | To examine the associations of depression using Geatric Depression Scale with control of cardiometabolic risk factors and health status in elderly patients with T2DM | 325 participants | The Traditional Chinese version of the 15-item Geatric Depression Scale (GDS) | Presence of comorbidities | Biological | - |
16. | Yoong et al. [30], Singapore | Cross-sectional study | To compare anxiety and/or depressive symptoms between patients with end-stage renal disease with and without comorbid diabetes, and identify factors associated with symptoms of distress in this population | 526 patients on haemodialysis (68.8% with diabetes) | Hospital Anxiety and Depression Scale (HADS) | Single/unpartnered, Chinese, lower albumin level (poor nutritional status) | Social, Biological, Nutritional | (1) Screening for eligibility was based on medical history with no formal cognitive diagnostic evaluation, (2) case was based on self-reported data |
17. | Atif et al. [31], Pakistan | Cross-sectional study | To assess the extent of depression and mild cognitive impairment (MCI) and their possible determinants among the elderly with Type 2 Diabetes Mellitus in Pakistan | 490 elderly patients with Type 2 Diabetes Mellitus | Geriatric Depression Scale (GDS-15) | High HbA1C and mild cognitive Impairment were significant predictors of depression | Biological and Psychological | Limited to elderly patients only |
18. | Albasheer et al. [32], Saudi Arabia | Cross-sectional study | To determine the prevalence of depression and related risk factors among Type 2 Diabetes Mellitus patients (T2DM) in the Jazan area, Saudi Arabia | 400 participants | Patient Health Questionnaire (PHQ-9) | Presence of diabetic foot, cardio-vascular diseases, eye complication, and erectile dysfunction | Biological | Other variables, such as family history of depression or other psychiatric illness, previous diagnosis of depression, and drug history, were not included in this study. |
19. | Kayar et al. [33], Turkey | Cross-sectional study | To investigate the relationship between depression and demographic and anthropometric characteristics, poor glycaemic control, and duration of diabetes in patients with Type 2 DM. The second question deals with the relationship between depression and individual lifestyle factors, and the third question investigates the relationship between depression and health complications. | 154 patients with type 2 DM | The SCID-I scales (The Structured Clinical Interview For DSMIV, Axis I disorder) was administered to all patients by a psychiatrist to detect the presence of depression | Gender, duration of disease, hypertension, and poor glycaemic control | Biological, Social, Psychological | Cross-sectional study |
Factors Associated with Depression | Studies | |
---|---|---|
Biological | Age | Al-Ozairi et al. [19] |
Gender (Female) | Al-Ozairi et al. [19], Alzahrani et al. [25], Abate and Gedamu [6], Majumdar et al. [17], Pal et al. [16] | |
Long duration of diabetes | Kim et al. [26] | |
Body mass index | Al-Ozairi et al. [19], Kant et al. [18] | |
HbA1c | Al-Ozairi et al. [19], Atif et al. [31], Kant et al. [18], Kayar et al. [33], Kim et al. [26], Radzi et al. [28] | |
Presence of comorbidities | Fung et al. [29], Kayar et al. [33], Radzi et al. [28], Victoria and Dampil [27] | |
Diabetic complications | Albasheer et al. [32], Kayar et al. [33], Pal et al. [16], Victoria and Dampil [27] | |
Sexual dysfunction | Abate and Gedamu [6] | |
Psychological | Fear of diabetic complications, anxiety | Abate and Gedamu [6], Woon et al. [22] |
Mild impairment cognitive | Atif et al. [31] | |
Low satisfaction withcurrent treatment | Sharma et al. [24] | |
Physical inactivity | Alzughbi et al. [23], Gebre et al. [20] | |
Social | Consumption of alcohol | Gebre et al. (2020) |
Poor social support | Abate and Gedamu [6], Gebre et al. [20] | |
Low educational status | Gupta et al. [21], Sharma et al. [24], Victoria and Dampil [27] | |
Smoking habit | Alzughbi et al. [23], Sharma et al. [24] | |
Marital status, Single/Unpartnered | Al-Ozairi et al. [19], Yoong et al. [30] | |
Ethnicity (Chinese) | Yoong et al. [30] | |
Living arrangement | Radzi et al. [28] | |
Low socioeconomic status | Majumdar et al. [17] | |
Nutritional | Lower albumin level (poor nutritional status) | Yoong et al. [30] |
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Amsah, N.; Md Isa, Z.; Ahmad, N. Biopsychosocial and Nutritional Factors of Depression among Type 2 Diabetes Mellitus Patients: A Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 4888. https://doi.org/10.3390/ijerph19084888
Amsah N, Md Isa Z, Ahmad N. Biopsychosocial and Nutritional Factors of Depression among Type 2 Diabetes Mellitus Patients: A Systematic Review. International Journal of Environmental Research and Public Health. 2022; 19(8):4888. https://doi.org/10.3390/ijerph19084888
Chicago/Turabian StyleAmsah, Norizzati, Zaleha Md Isa, and Norfazilah Ahmad. 2022. "Biopsychosocial and Nutritional Factors of Depression among Type 2 Diabetes Mellitus Patients: A Systematic Review" International Journal of Environmental Research and Public Health 19, no. 8: 4888. https://doi.org/10.3390/ijerph19084888