Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Evidence of greater impact of diabetes complications on the mental health of Asian immigrants:a hidden co-morbidity (#50)

Margaret McGill 1 2 , Zhaolin Meng 3 , Lynda Molyneaux 1 2 , Rumaisa Banatwalla 1 , Ted Wu 1 , Dennis K Yue 1 2 , Jencia Wong 1 2
  1. Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  2. Discipline of Medicine, University of Sydney, Sydney, NSW, Australia
  3. Dept of Endocrinology, Xiamen University Hospital, Xiamen, China

Comorbid depression is associated with adverse health outcomes in people with diabetes. Immigrant Chinese (CI) may experience higher levels of diabetes-related distress given different cultural attitudes, however little is known of depression in this population. We administered the Patient Health Questionnaire-9(PHQ9), a validated clinical tool to detect significant depression to 100 CI and 88 European (E) participants with type 2 diabetes, consecutively attending the RPAH Diabetes Centre. Participants were considered depressed if they had the required number of depressive symptoms; PHQ9 score≥10 for major, ≥5 for minor depressive symptoms. Association of PHQ9 scores with metabolic factors and complications burden were studied in each group. The distribution of depression scores were equivalent, with moderate-severe depression scores in 19% and 18% of CI and E respectively. Only 2% of CI acknowledged a history of depression. Interpreter use was associated with a higher depression score in CI. There was a commensurate rise in severity of depression with increasing prevalence of complications in CI, a relationship not seen in E (figure1). By multivariate analysis, CI PHQ-9 scores were independently associated with hypoglycaemia, diabetes-complications, time spent alone, and ability to speak English, collectively explaining 36.4 % of the variance in CI PHQ-9 scores (p<0.001). In contrast, PHQ9 score was not associated with metabolic or diabetes complication factors in E cohort. Significant depression was highly prevalent in both groups and under recognized. Depression in CI was more robustly associated with diabetes-related factors than in E. This relationship may be bidirectional suggesting that CI have a higher susceptibility to the negative mental health impact of diabetes complications and/or altered disease perception and/or increased negative metabolic effects of co-incident depression. These data suggest strongly that depression is a hidden comorbidity especially for CI with diabetic-complications; an observation highlighting a need for case-finding in this group.