title: Association of depression with complications of type 2 diabetes--the Chennai Urban Rural Epidemiology Study (CURES- 102).
abstract: OBJECTIVE
  The aim of the study was to assess the relationship between depression and diabetic complications among urban south Indian type 2 diabetic subjects [T2DM].
  
  
  METHODS
  T2DM subjects [n = 847] were recruited from the Chennai Urban Rural Epidemiology Study [CURES], a population based study in Chennai (formerly Madras) in South India. A previously validated depression questionnaire [PHQ-12 item] was administered. Four field stereo retinal colour photography was done and diabetic retinopathy [DR] was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Neuropathy was diagnosed if the vibratory perception threshold of the right great toe, measured by biothesiometry, was > or = 20. Nephropathy was diagnosed if urinary albumin excretion was > or = 300 microg/mg creatinine. Peripheral vascular disease [PVD] was diagnosed if an ankle-brachial index was < 0.9. Coronary artery disease [CAD] was diagnosed based on a past history of documented myocardial infarction and/or electrocardiographic evidence of Q wave and/or ST segment changes.
  
  
  RESULTS
  Of the 847 T2DM studied, 198 (23.4%) were found have depression. The prevalence of depression was significantly higher among diabetic subjects with DR (35.0% vs 21.1%, p < 0.001), neuropathy (28.4% vs 15.9%, p = 0.023), nephropathy (35.6% vs 24.5%, p = 0.04) and PVD (48.0% vs 27.4%, p < 0.001) as compared to subjects without these complications. DR, neuropathy, nephropathy, and PVD were associated with depression even after adjusting for age, gender, duration of diabetes and glycated haemoglobin. DR (Odds ratio [OR] = 2.19, Confidence interval [CI]:1.45-3.51, p < 0.001) was associated with depression even after adjusting for neuropathy and nephropathy. There was also a significant association between depression and neuropathy, after adjusting for retinopathy and nephropathy (OR = 2.07, CI: 1.41-3.04, p < 0.001). There was a significant association of depression with nephropathy but this was lost (OR = 1.71, CI: 0.87-3.35, p = 0.119) after adjustment for retinopathy. PVD (OR = 3.52, CI: 1.94-6.40, p < 0.001) remained significantly associated with depression even after adjusting for CAD. However, there was no significant association of depression with CAD (OR = 0.73, CI: 0.42 -1.27, p = 0.264).
  
  
  CONCLUSIONS
  Among Asian Indians, the prevalence of depression is higher in T2DM subjects with retinopathy, neuropathy, nephropathy and PVD compared to those without the respective complications.
authors.affiliation: Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention & Control IDF Centre of Education, Gopalapuram, Chennai, India.
authors.forename: Subramani
authors.initials: S
authors.lastname: Poongothai
authors.forename: Ranjit Mohan
authors.initials: RM
authors.lastname: Anjana
authors.forename: Rajendra
authors.initials: R
authors.lastname: Pradeepa
authors.forename: Anbazhagan
authors.initials: A
authors.lastname: Ganesan
authors.forename: Ranjit
authors.initials: R
authors.lastname: Unnikrishnan
authors.forename: Mohan
authors.initials: M
authors.lastname: Rema
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D048909:Diabetes Complications / Q000453:epidemiology / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D004562:Electrocardiography; D016021:Epidemiologic Studies; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014505:Urban Population