DEPRESSION IN ADULTS WITH DIABETES

Clinically significant depression is detectable in up to 10% of ambulatory primary care patients and 22-33% of patients in inpatient medical units (1-3). The prevalence may be even higher in subsets of patients with specific medical illnesses. These figures far exceed the approximately 4% point prevalence of depression observed in large-scale epidemiological studies of the general U.S. population (4). Depression in these physically ill individuals may be: 1) the initial occurrence or reoccurrence of depression in response to the psychosocial hardships imposed by, or intrapsychic factors related to, the medical illness; 2) the initial occurrence or reoccurrence of depression as a result of biological changes directly related to the medical illness or its treatment; or 3) the initial occurrence or reoccurrence of depression developing coincidentally with the medical illness, and resulting from biological, genetic, or psychological factors not caused by the medical illness. Although some increased risk for depression likely attends most physical illnesses, the prevalence of depression also may vary as a result of disease-specific psychological and biological factors. It is the purpose of this paper to review the, specific factors relevant to depression in adult patients with diabetes.