Prevalence and determinants of depression among patients living with diabetes mellitus and/or hypertension at Byumba district hospital and its health centers, Rwanda

Abstract

Background: The largest cause of disability worldwide and a chronic illness that can strike anyone at any time is depression. Studies have found that depression is two to three times more common in those with diabetes than in those without it, and that one- third of adults worldwide have hypertension, with 75% of those cases occurring in developing countries while depression is common in hypertensive patients. Methods: A cross-sectional study, where 357 participants were recruited from June 15th 2022 to July30th 2022, using a consecutive sampling and a structured questionnaire for data collection using PHQ-9 instrument to evaluate depressive symptoms. Scores of 0-4, 5-9, 10-14, 15-19 and 2027 were classified as non-depressive, mild, moderate, moderately severe and severe depression respectively. 27% (n=97) participants with scores of ≥10 were referred to mental health department for better management. To investigate the connection between the outcome (presence of depression and determinants), we used the logistic regression analysis. The threshold for statistical significance for relationships was set at p< 0.05. Results: Out of 357 participants, the mean age was 59.4 years. A total of 81% (n=290) of patients were hypertensive patients, 10% (n=36) were living with DM and 8.7 %( n=31) were suffering from both diseases. The overall prevalence of depression was 66%, in which, 35%, 17%, 11.2%, and 2.8% had mild, moderate, moderately severe and severe depression respectively. Almost 34% were screened for non-depression. 97 patients (27.17%) who participated in the study had scores equal to or above 10. Low socioeconomic category (OR=3.11; 95% CI: 1.72-5.59; p<0.001), uncontrolled hypertension (OR=6.05; 95% CI: 2.52-14.6; p<0.001), personal history of depression (OR=7.43; 95% CI: 4.08-13.52; p<0.001), family history of depression(OR= 3.78; 95% CI: 1.2911.06; p=0.015), having other chronic diseases(OR=4.47; 95% CI: 1.85-10.82; p=0.001), having both chronic illness(DM+HBP: (OR=4.15; 95% CI: 1.3-13.28; p=0.016), occasional mobility impairment (OR=4.75; 95% CI: 2.60-8.66; p<0.001), sporadic visual impairment(OR=2.37; 95% CI: 1.5-3.74; p<0.001), perception that the waiting time of consultation is longer(OR=2.04; 95% CI: 1.24-3.35; p=0.005), the self-esteem (OR=0.34;95% CI: 0.13-0.85; p=0.021) and peer acceptance (OR=2.58; 95% CI: 1.35-4.94; p=0.004) were the determinants of depression among study participants. Conclusion: DM and hypertension are frequently linked to depression, thus treating both illnesses concurrently may be more beneficial.