Depression Among African-Americans With Diabetes

It has been well established that African-Americans have an increased prevalence of type 2 diabetes compared with Whites (10.1 vs. 5.2%, respectively) (1). Both White and African-American women have a 40% greater prevalence rate of type 2 diabetes compared with men (1). African-Americans also have higher rates of morbidity and mortality associated with a variety of diabetic complications, including higher glycemic levels, increased prevalence of microalbuminuria and kidney disease, longer duration of kidney disease, greater likelihood of retinopathy, greater incidence of diabetes-related amputations, and greater incidence of end-stage renal disease (1). It would appear that the psychosocial impact of diabetes on African-Americans is less well characterized.

We recently completed a series of meta-analyses of the literature to determine the prevalence of depression and its associations with glycemic control and diabetes complications. Depression was two times more prevalent in patients with diabetes than in those without diabetes (2). Glycemic control and diabetes complications were each significantly associated with depression in types 1 and 2 diabetic patient samples (3,4).

We reviewed 69 studies gathered for the above-referenced meta-analyses. Of these studies, 11 included African-Americans in samples gathered from U.S. localities, and 2 of the 11 studies examined the relationship of depression and diabetes using race/ethnicity as a grouping variable (5,6). In short, only 3% of all studies that have been conducted on the relationship between depression and diabetes have examined race/ethnicity as a contributing factor.

In light of the disproportionate burden that diabetes places on African-Americans, we were surprised to find so few studies that address the relationship of depression to glycemic control and diabetes complications among African-Americans. The paucity of this literature points to an important gap in our understanding of the impact of diabetes and depression on psychosocial adjustment for these patients. Little is known about cultural or behavioral factors that may contribute to the experience or outcomes associated with depression in African-Americans.

As the prevalence of type 2 diabetes increases among African-Americans and demographic expansion continues, African-Americans can be expected to represent a growing and important segment of the diabetic population. Depression may be a factor in the disproportionate prevalence rates of diabetes in African-American women. The prevalence of depression among African-Americans with diabetes needs further documentation. In addition, studies are needed to determine whether the association of depression with hyperglycemia and diabetes complications can be found in African-American as well as White samples.