Racial/ethnic minorities and the economically disadvantaged are at increased risk for diabetes. For example, 13% of African Americans have diabetes, compared to 6.2% of the general U.S. population. Deaths from diabetes and certain types of diabetes complications are more common among African Americans than among whites. The association between low socioeconomic status and diabetes risk may be due to greater prevalence of unhealthy behaviors, environmental risk factors, and acute and chronic stress among this population. Low socioeconomic status is also associated with greater prevalence of depression. Findings of race differences in depression are less consistent, with various studies reporting either similar or lower rates of depression among African Americans compared to whites. However, given that African Americans are typically under-represented in national surveys and clinical studies on diabetes, little research has examined the relationship between diabetes and depression among African Americans or, to an even lesser extent, the effects of comorbid depression on healthcare utilization patterns among African Americans with diabetes.
Diabetes and Depression
Several possible explanations have been identified for diabetes-depression comorbidity. Diabetes may lead to depression due to biochemical changes caused by the illness or treatment of diabetes, or due to the psychosocial demands related to diabetes and/or its treatment. On the other hand, depression is linked to changes in physical activity and diet that may increase risk for diabetes, and depression may also produce physiological changes that increase risk for diabetes. At the same time, the causal relationship may be reciprocal or could even be spurious, due to some prior cause (e.g., genetic or environmental) raising the risk for both disorders in a subset of the population.
Regardless of whether the relationship between depression and diabetes is causal, or in which direction, the association between diabetes and depression in the general population is well established, with studies estimating that on average individuals with diabetes have roughly two times higher odds of depression than those without diabetes. However, given the lack of research using African-American samples, it is not clear whether this association between diabetes and depression exists among African Americans.
According to a meta-analysis of existing studies, as many as one in every three individuals with diabetes may have depression at a level that impairs functioning and quality of life, adherence to medical treatment, and glycemic control. Among diabetics, depressive symptoms have been found to be associated with poor medication regimen adherence, less-regular monitoring of blood glucose, unhealthy diet, and less exercise. Depressed patients may also have a higher frequency of neuropathy and retinopathy, more problems with wound healing, and elevated levels of microalbumin and total LDL cholesterol.
Impact on Healthcare Utilization
Given the negative impact of depression on the functioning, self-care, and physical health of persons with diabetes, the co-occurrence of depression with diabetes may contribute to poor management and delayed treatment of diabetes. In addition to the negative impact on individual health outcomes, existing evidence suggests that individuals with diabetes and comorbid depression may have higher levels of utilization of acute care and other services compared to nondepressed individuals with diabetes.
In a sample of diabetic patients at two medical clinics, depressed diabetic patients had more frequent diabetes-related emergency room (ER) visits and hospitalizations than nondepressed diabetic patients. In an analysis of nationally representative data from the 1996 Medical Expenditure Panel Survey (MEPS), among individuals with diabetes, those who were depressed had higher ambulatory care use and filled more prescriptions when compared to those who were not depressed. In a nationally representative sample of Medicare claimants, elderly individuals with diabetes and major depression had more nonmental health-related physician services and inpatient days than those with diabetes alone. However, research has not tested whether the co-occurrence of diabetes and depressive symptoms affects utilization patterns among African Americans. discount drugs canda
Given that African Americans have a higher risk of diabetes but a similar or lower risk of depression compared to whites, it is important to examine whether or not the psychosocial impact of diabetes and the effects of comorbid diabetes-depression among African Americans are similar to that of the general population. This study contributes to the existing literature by examining the relationships between diabetes, depression, and healthcare utilization among a currently understudied population, namely African-American patients in a low-income, urban primary-care population.
The objectives of this study were: to compare the presence and severity of depressive symptoms among African-American patients with and without diabetes in this sample, and to determine the effect of co-occurring diabetes and depressive symptoms on healthcare utilization outcomes among African-American patients in this sample.