title: Depression among patients with diabetes attending a safety-net primary care clinic: relationship with disease control.
abstract: BACKGROUND
  Depression and diabetes are highly comorbid, with depression increasing risk of diabetes-related complications and mortality. Few studies have examined the relationship between depression and diabetes in safety-net populations with high rates of trauma exposure, anxiety, and substance use disorders.
  
  
  METHODS
  Using a cross-sectional survey of 261 patients with diabetes attending safety-net clinics, associations between depression and key diabetes control parameters were examined in bivariate and multivariable analyses adjusting for relevant confounders and significant interactions.
  
  
  RESULTS
  Among the participants, 57% were men, 51% were white, and the average age was 57 years. Most respondents were unemployed (81%) and earned less than $10,000 per year (51%). Overall, 28% screened positive for depression, with a high overlap of posttraumatic stress (58%) and generalized anxiety (77%) symptoms. After adjustment for socioeconomic and clinical variables, depression was associated with higher mean body mass index (p = 0.01), severe obesity (body mass index ≥ 35kg/m(2)) (odds ratio = 2.34, 95% CI: 1.09-5.04, p = 0.03) and uncontrolled diastolic blood pressure (odds ratio = 2.49, 95% CI: 1.15-5.39, p = 0.02). There was a nonsignificant trend for those with depression to have worse control of blood glucose. Associations with depression and diabetes clinical outcomes were not significantly worsened in the presence of comorbid anxiety disorders.
  
  
  CONCLUSIONS
  Within a highly comorbid safety-net population, significant associations between depression and key diabetes outcomes remained after accounting for relevant covariates. Further research will help elucidate the relationship between depression and diabetes control measures in safety-net populations.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA. Electronic address: ervander@uw.edu.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Vanderlip
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.affiliation: Washington State Health Care Authority, Olympia, WA.
authors.forename: Dan
authors.initials: D
authors.lastname: Lessler
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
mesh_terms: D001008:Anxiety Disorders / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D048909:Diabetes Complications / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology
chemical_list: D001786:Blood Glucose