Independent factors associated with major depressive disorder in a national sample of individuals with diabetes

OBJECTIVE - To determine whether perceived poor physical health, duration of diabetes, and smoking are associated with major depressive disorder in a national sample of individuals with diabetes. RESEARCH DESIGN AND METHODS - Data on 1,810 individuals with diabetes from the 1999 National Health interview Survey (NHIS) were analyzed. The Composite International Diagnostic Interview (CIDI) Short-Form (CIDI-SF) developed by the World Health Organization was used to identify individuals with major depressive disorder. Multiple logistic regression was used to determine whether perceived poor physical health, duration of diabetes, and smoking were associated with major depressive disorder. The model controlled for age, sex, race/ethnicity, education, income, employment, marital status, and health status. Other control variables included BMI, smoking, duration of diabetes, presence or absence of major complications, and type of treatment for diabetes. SUDAAN software was used for statistical analyses to account for the complex sampling design of NHIS. RESULTS - independent factors associated with major depressive disorder were age <64 years, female sex, at least high school education, income <124% of federal poverty level, perceived worsening of health status, and smoking. CONCLUSIONS - in addition to other psychosocial factors such as younger age, female sex, lower income, at least high school education, and smoking, perceptions about the effect of diabetes on overall health seems to play an important role in the etiology of depression.