title: More co-morbid depression in patients with Type 2 diabetes with multiple complications. An observational study at a specialized outpatient clinic.
abstract: OBJECTIVE
  The impact of depression on patients with chronic medical illnesses such as diabetes is well documented. Depression is relatively common in diabetes patients with diabetes-related complications and they are more likely to be referred to specialized outpatient facilities. Only a few studies have addressed the association between depression and multiple diabetes-related complications at these specialized outpatient facilities. The aim of this study was to determine the association between diabetes with multiple complications and depression in patients with Type 2 diabetes at a specialized outpatient clinic.
  
  
  METHODS
  After giving informed consent, 1194 patients were screened for depression using the Patient Health Questionnaire (PHQ-9). Additional data on the type of diabetes and complications were taken from the medical records. Logistic regression analysis was conducted, with complications as the predictor variable and the probability of depression as the dependent variable.
  
  
  RESULTS
  A total of 596 (63%) patients with Type 2 diabetes participated in the study. The presence of two or more complications (OR 2.23, 95% CI 1.02–2.94) was significantly associated with depression. Neuropathy (OR 1.7, 95% CI 1.10–2.77) and nephropathy (OR 1.68, 95% CI 1.00–2.48) were especially related to depression.
  
  
  CONCLUSIONS
  Patients with Type 2 diabetes with two or more complications, especially neuropathy or nephropathy, are at high risk of depression. Knowing this can help clinicians identify patients at risk for depression and facilitate timely and adequate treatment.
authors.affiliation: Department of Psychiatry and Medical Psychology, Onze Lieve Vrouwe Gasthuis, VU University Medical Centre, Amsterdam, the Netherlands. Ksteenbergen@trimbos.nl
authors.forename: K M
authors.initials: KM
authors.lastname: van Steenbergen-Weijenburg
authors.forename: A L
authors.initials: AL
authors.lastname: van Puffelen
authors.forename: E K
authors.initials: EK
authors.lastname: Horn
authors.forename: J
authors.initials: J
authors.lastname: Nuyen
authors.forename: P Sytze
authors.initials: PS
authors.lastname: van Dam
authors.forename: T B
authors.initials: TB
authors.lastname: van Benthem
authors.forename: A T F
authors.initials: AT
authors.lastname: Beekman
authors.forename: F F H
authors.initials: FF
authors.lastname: Rutten
authors.forename: L
authors.initials: L
authors.lastname: Hakkaart-van Roijen
authors.forename: C M
authors.initials: CM
authors.lastname: van der Feltz-Cornelis
mesh_terms: D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology