title: Comorbid depression is associated with increased healthcare utilization and lost productivity in persons with diabetes: a large nationally representative Hungarian population survey.
abstract: OBJECTIVE
  To estimate the prevalence of depression among people with diabetes and to examine the association of comorbid depression with lost productivity and health resource utilization in persons with and without diabetes.
  
  
  METHODS
  Cross-sectional survey, enrolling 12,643 individuals aged >18 years. Clustered, stratified sampling procedure was utilized. This sample represented 0.16% of the Hungarian adult population according to age, gender, and geographic regions. The severity of depressive symptoms was measured by the abbreviated Beck Depression Inventory.
  
  
  RESULTS
  The prevalence of diabetes in the sample was 6.2% (95% Confidence Interval (CI) = 5.7-6.6), and 13.4% (95% CI = 12.8-13.9) were classified as depressed. Adults with diabetes were two times more likely to have depression (adjusted odds ratio (OR) = 1.83, 95% CI = 1.53-2.19, p < .001) versus individuals without diabetes. Compared with nondepressed people with diabetes, those with diabetes and comorbid depression were older, less educated, more likely to be female and physically inactive, less likely to be employed, and married and had more comorbidities. In multivariate regression analyses, people with diabetes and depression had significantly greater odds of prolonged bed days due to illness (>or=20 days) (OR = 2.6, 95% CI = 1.69-3.88, p < .001), prolonged length of hospital stay (>or=18 days) (OR = 2.1, 95% CI = 1.27-3.45, p = .004), and multiple hospital admissions (>or=2) (OR = 1.8, 95% CI = 1.13-2.82, p = .01) compared with nondepressed diabetic patients.
  
  
  CONCLUSIONS
  These findings further document the association between depression and health resource utilization and lost productivity in people with diabetes. Screening and treating depression are important for everyday clinical care and public health initiatives to improve health outcomes for people with diabetes.
authors.affiliation: Institute of Behavioral Sciences, Semmelweis University, Budapest, Nagyvarad ter 4., Budapest, Hungary.
authors.forename: Eszter Panna
authors.initials: EP
authors.lastname: Vamos
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.forename: Andras
authors.initials: A
authors.lastname: Keszei
authors.forename: Maria S
authors.initials: MS
authors.lastname: Kopp
authors.forename: Marta
authors.initials: M
authors.lastname: Novak
mesh_terms: D000328:Adult; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology; D004526:Efficiency; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D010555:Personality Inventory; D015995:Prevalence