Female sex, young age, northern German residence, hypoglycemia and disabling diabetes complications are associated with depressed mood in the WHO-5 questionnaire - A multicenter DPV study among 17,563 adult patients with type 2 diabetes.
Like other mental illnesses, depression is a culturally sensitive topic. Hence, findings cannot be transferred between countries. We investigated the frequency of depressed mood and its association with diabetes-related factors in a large type 2 diabetes (T2D) cohort from real-life care in Germany.



17,563 adults (median [IQR]: 64.5[55.9-71.1] years) from the multicenter diabetes follow-up registry, DPV (diabetes prospective follow-up), were investigated. All had completed the WHO-5 questionnaire, a screening tool for depression. Logistic regression was applied to study the association of demographic and diabetes-related factors with depressed mood (SAS 9.4). P<0.05 was considered significant.



Using a WHO-5 cut-off of <13, 27.4% of patients were at risk for depressed mood. A clinical depression diagnosis was recognized in 8.4%. Female sex (OR: 1.5[95%-CI: 1.4-1.6]), young age (1.2[1.1-1.4]), longer diabetes duration (1.2[1.1-1.3]), and living in Northern Germany (1.3[1.2-1.4]) were each associated with increased odds for depressed mood. After adjusting for these confounders, worse glycemic control (1.4[1.3-1.5]), insulin use (1.3[1.2-1.4]), myocardial infarction (1.3[1.2-1.5]), stroke (1.8[1.5-2.0]), retinopathy (1.4[1.3-1.6]), renal failure (1.4[1.2-1.8]), diabetic foot syndrome (1.3[1.2-1.4]), severe hypoglycemia (1.5[1.2-1.9]), two or more inpatient admissions (2.1[1.8-2.4]), and longer duration of hospital stay (1-<14 days: 1.3[1.2-2.3]; >14 days: 2.1[1.9-2.3]) were related to depressed mood.



Due to the cross-sectional design, no causality can be drawn.



In T2D, depressed mood is not uncommon. However, in routine care a clinical depression might be missed and regular screening is advisable. Besides the well-known associations with depressed mood, northern German residence and mainly life-compromising diabetes comorbidities were identified as related factors.
Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. Electronic address: nicole.prinz@uni-ulm.de.
Nicole
N
Prinz
Medical Campus III, Clinic for Internal Medicine 2 - Nephrology, Endocrinology/Diabetes, Rheumatology and Gastroenterology/Hepatology, Kepler University Hospital, Linz, Austria.
Stefan
S
Ebner
Specialized Practice for Diabetes and Nutritional Medicine, Munich, Germany.
Arthur
A
Grünerbel
Internal Medicine, Hospital Malteser St. Johannes-Stift, Duisburg, Germany.
Uwe
U
Henkelüdecke
Diabetes Centre Mergentheim, Bad Mergentheim, Germany.
Norbert
N
Hermanns
Specialized Diabetes Practice, Rosenheim, Germany.
Michael
M
Hummel
Internal Medicine, Hospital Neumarkt, Neumarkt, Germany.
Claus
C
Schäfer
Specialized Diabetes Practice, Saaldorf-Surheim, Germany.
Christian
C
Wagner
Internal Medicine, Hospital Bad Reichenhall, Bad Reichenhall, Germany.
Jörg
J
Weiland
Internal Medicine, Knappschafts-Krankenhaus, Bottrop, Germany.
Reinhard
R
Welp
Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
Reinhard W
RW
Holl
D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology*; D048909:Diabetes Complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D005260:Female; D005858:Germany; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000523:psychology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
Adult; Depressed mood; Diabetes comorbidity; Treatment; Type 2 diabetes; WHO-5