title: The association between depression, quality of life, and the health care expenditure of patients with diabetes mellitus in Uganda.
abstract: BACKGROUND
  Depression is one of the commonest neuropsychiatric disorders in patients with diabetes mellitus (DM) and is associated with poor glycaemic control, vascular complications, a low quality of life and increased health care expenditure. Co-morbid DM and depression remains poorly identified and inadequately treated in sub-Saharan Africa.
  
  
  METHODS
  We conducted a cross-sectional survey of 437 patients with DM at 3 DM clinics in Uganda. Participants were assessed for depression, blood sugar levels, diabetic neuropathy, quality of life, and health care expenditures.
  
  
  RESULTS
  The prevalence of depression was 34.8%. Depressed participants were more likely to be suicidal [OR=3.81, (CI 2.87-5.04)], younger [OR=3.98 CI (1.20-13.23)], un-employed [OR=1.99(CI 1.04-3.81)], and having lost a spouse [OR=2.36 (CI 1.29-4.31)]. Overall quality of life was poor [OR=0.67 (CI 0.47-0.96)], they scored poorer in the physical [OR=0.97, (CI 0.95-0.99)], psychological [OR=1.05 (CI 1.03-1.07)], and environmental [OR=0.97, (CI 0.95-0.99)] domains. They had an increased likelihood of incurring direct out-of-pocket payments for health care services [OR=1.56 (CI 1.03-2.36)], and were more likely to be impoverished [OR=1.52 (CI 1.01-2.28)].
  
  
  CONCLUSIONS
  The cross sectional nature of this study makes it difficult to examine causation. More studies are required in order to better understand the associations and impact of the factors examined above on patient outcomes.
  
  
  CONCLUSIONS
  Depression is highly prevalent among patients with DM in Uganda, and is associated with a number of adverse outcomes. A holistic approach that focuses on the depression management among patients with diabetes is recommended.
authors.affiliation: Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Dickens
authors.initials: D
authors.lastname: Akena
authors.affiliation: Infectious Diseases Institute, Makerere University, Kampala, Uganda.
authors.forename: Philippa
authors.initials: P
authors.lastname: Kadama
authors.affiliation: Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda.
authors.forename: Scholastic
authors.initials: S
authors.lastname: Ashaba
authors.affiliation: Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Carolyne
authors.initials: C
authors.lastname: Akello
authors.affiliation: Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Institute, Makerere University, Kampala, Uganda; Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda; Department of Psychiatry, Gulu University, Gulu, Uganda; Clinical Epidemiology Unit, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK.
authors.forename: Brendan
authors.initials: B
authors.lastname: Kwesiga
authors.affiliation: Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Lalitha
authors.initials: L
authors.lastname: Rejani
authors.affiliation: Department of Psychiatry, Gulu University, Gulu, Uganda.
authors.forename: James
authors.initials: J
authors.lastname: Okello
authors.affiliation: Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Emmanuel K
authors.initials: EK
authors.lastname: Mwesiga
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
authors.forename: Ekwaro A
authors.initials: EA
authors.lastname: Obuku
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000191:economics* / Q000453:epidemiology* / Q000209:etiology; D003865:Major Depressive Disorder / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D014454:Uganda / Q000453:epidemiology