Abstract

Objective: Depression is associated with poor glycemic control and complications in people with type 1 diabetes. We assessed the prevalence of depression and antidepressant medication use among adults with and without type 1 diabetes and the association between depression and diabetic complications.

Design: In 2006-2008, the Coronary Artery Calcification in Type 1 diabetes (CACTI) Study applied the Beck Depression Inventory-II (BDI-II) to 458 participants with type 1 diabetes (47% male, age 44±9 yrs, type 1 diabetes duration 29±9 yrs) and 546 participants without diabetes (non-DM) (51% male, age 47±9 yrs). Use of antidepressant medication was self-reported. Depression was defined as a BDI-II score >14 and/or use of antidepressant medication. Occurrence of diabetic complications (retinopathy, blindness, neuropathy, diabetes-related amputation, and kidney or pancreas transplantation) was self-reported.

Results: Mean BDI-II score, adjusted for age and sex, was significantly higher in participants with type 1 diabetes than non-DM participants (LSmean±SE: 7.4±0.3 v. 5.0±0.3, p<0.0001). Type 1 diabetes participants reported using more antidepressant medication (20.7% v. 12.1%, p=0.0003). More type 1 diabetes than non-DM participants were classified as depressed by BDI-II cut-score (17.5% v. 5.7%, p<0.0001) or by either BDI-II cut-score or anti-depressant use (32.1% v. 16.0%, p<0.0001). Participants reporting diabetic complications (n=209) had higher mean BDI-II scores than those without complications (10.7±9.3 v. 6.4±6.3, p<0.0001).

Conclusions: Compared to non-DM participants, adults with type 1 diabetes report more symptoms of depression and more anti-depressant medication usage. Depression is highly prevalent in type 1 diabetes and requires further study on assessment and treatment.