title: Depression and Health-Related Quality of Life among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Nepal.
abstract: BACKGROUND
  Diabetes is accompanied by a marked reduction in patient's quality of life (QOL) and leads to higher disability-adjusted life years than most diseases. Depression further deteriorates QOL and is associated with poor treatment outcomes and lowered glycemic control in diabetes. We analysed the QOL and depression among the people living with diabetes in Nepal.
  
  
  METHODS
  We conducted a cross-sectional survey among a random sample of 157 diabetic patients visiting diabetes clinic at a major teaching hospital in Kathmandu, Nepal. We administered the Nepali version of WHO-BREF for face to face interviews to obtain data on QOL scores. The Nepali version of Patient Health Questionnaire-9was also used to record responses on depression items.
  
  
  RESULTS
  More than half of the respondents (54.1%) experienced depression with mean PHQ-9 score of 6.15 ± 5.01 on a scale of 0-27. On a scale of 0 to 100, highest QOL mean score was reported in social relationship domain (57.32 ± 11.83), followed by environment domain (54.71 ± 7.74), psychological health (53.25 ± 10.32) and physical health (50.74 ± 11.83). After adjusting for other covariates, urban residence decreased the physical health score by 4.74 (β = -4.74, 95% CI: -8.664,-0.821), social relationship domain score by 3.420 (β = -3.420, 95% CI: -6.433,-0.406) and the overall QOL by 2.773 (β = -2.773, 95% CI: -5.295,-0.252). Having diagnosed with diabetes since more than 10 years increased physical health by 5.184 score points (β = 5.184; 95% CI: 0.753, 9.615).Similarly, having severe depression decreased social relation domain score by 6.053 (β = -6.053, 95% CI:-11.169,-.936).
  
  
  CONCLUSIONS
  Having urban residence significantly decreased the physical health and social relation domain scores as well as the overall QOL scores. Similarly, having diagnosed since more than 10 years increased physical health domain score. Severe depression decreased social relationship domain score. Since depression affects QOL, we suggest early diagnosis and prompt treatment of depression in T2DM people as part of their routine primary care in Nepal.
authors.affiliation: Nepal Development Society, Bharatpur 10, Chitwan, Nepal.
authors.forename: Shiva Raj
authors.initials: SR
authors.lastname: Mishra
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.|Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Institute of Medicine, Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Parash Mani
authors.initials: PM
authors.lastname: Bhandari
authors.affiliation: Institute of Medicine, Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Shristi
authors.initials: S
authors.lastname: Bhochhibhoya
authors.affiliation: Institute of Medicine, Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Kiran
authors.initials: K
authors.lastname: Thapa
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003710:Demography; D003863:Depression / Q000150:complications* / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009390:Nepal; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014944:World Health Organization