Behavioral and Clinical Factors Associated With Depression Among Individuals With Diabetes

Behavioral and Clinical Factors Associated With Depression Among Individuals With Diabetes Wayne Katon , MD 1 , Michael Von Korff , SCD 2 , Paul Ciechanowski , MD, MPH 1 , Joan Russo , PHD 1 , Elizabeth Lin , MD, MPH 2 , Gregory Simon , MD, MPH 2 , Evette Ludman , PHD 2 , Edward Walker , MD 1 , Terry Bush , PHD 2 and Bessie Young , MD, MPH 3 1 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 2 Center for Health Studies, Group Health Cooperative, Seattle, Washington 3 Department of Medicine, Veterans Administration Hospital, University of Washington, Seattle, Washington Address correspondence and reprint requests to Wayne J. Katon, MD, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific, Seattle, WA 98195-6560. E-mail: wkaton{at}u.washington.edu Abstract OBJECTIVE —The goal of this study was to determine the behavioral and clinical characteristics of diabetes that are associated with depression after controlling for potentially confounding variables. RESEARCH DESIGN AND METHODS —A population-based mail survey was sent to patients with diabetes from nine primary care clinics of a health maintenance organization. The Patient Health Questionnaire was used to diagnose depression, and automated diagnostic, pharmacy, and laboratory data were used to measure diabetes treatment intensity, HbA 1c levels, and diabetes complications. RESULTS —Independent factors that were associated with a significantly higher likelihood of meeting criteria for major depression included younger age, female sex, less education, being unmarried, BMI ≥30 kg/m 2 , smoking, higher nondiabetic medical comorbidity, higher numbers of diabetes complications in men, treatment with insulin, and higher HbA 1c levels in patients