Elsevier

Journal of Affective Disorders

Volume 174, 15 March 2015, Pages 7-12
Journal of Affective Disorders

Research report
The association between depression, quality of life, and the health care expenditure of patients with diabetes mellitus in Uganda

https://doi.org/10.1016/j.jad.2014.11.019Get rights and content

Abstract

Background

Depression is one of the commonest neuropsychiatric disorders in patients with diabetes mellitus (DM) and is associated with poor glycaemic control, vascular complications, a low quality of life and increased health care expenditure. Co-morbid DM and depression remains poorly identified and inadequately treated in sub-Saharan Africa.

Methods

We conducted a cross-sectional survey of 437 patients with DM at 3 DM clinics in Uganda. Participants were assessed for depression, blood sugar levels, diabetic neuropathy, quality of life, and health care expenditures.

Results

The prevalence of depression was 34.8%. Depressed participants were more likely to be suicidal [OR=3.81, (CI 2.87–5.04)], younger [OR=3.98 CI (1.20–13.23)], un-employed [OR=1.99(CI 1.04–3.81)], and having lost a spouse [OR=2.36 (CI 1.29–4.31)]. Overall quality of life was poor [OR=0.67 (CI 0.47–0.96)], they scored poorer in the physical [OR=0.97, (CI 0.95–0.99)], psychological [OR=1.05 (CI 1.03–1.07)], and environmental [OR=0.97, (CI 0.95–0.99)] domains. They had an increased likelihood of incurring direct out-of-pocket payments for health care services [OR=1.56 (CI 1.03–2.36)], and were more likely to be impoverished [OR=1.52 (CI 1.01–2.28)].

Limitation

The cross sectional nature of this study makes it difficult to examine causation. More studies are required in order to better understand the associations and impact of the factors examined above on patient outcomes.

Conclusions

Depression is highly prevalent among patients with DM in Uganda, and is associated with a number of adverse outcomes. A holistic approach that focuses on the depression management among patients with diabetes is recommended.

Section snippets

Introduction and background

Diabetes mellitus (DM) a chronic and disabling disease, is a major contributor to disability adjusted life years (Murray and Vos, 2012, International Diabetes Federation, 2013). Approximately 6.7% of people worldwide suffer from DM, and this figure is anticipated to rise to 7.8% by 2030. The prevalence of DM is on the increase the world over. In a national survey conducted in Australia, between 2001 and 2008, there was a 36% increase in the prevalence of DM in persons older than 25 years (

Study design and setting

This was a cross sectional study at the out-patients DM clinics of Mulago, Mbarara and Gulu hospitals in Uganda. Mulago Hospital is a national referral 1500 bed capacity Hospital in the centre of Kampala, the capital city of Uganda. Mbarara Hospital is a 600 bed capacity regional referral hospital 275 km west of the capital Kampala. Gulu regional referral Hospital is 340 km north of the capital Kampala. All three hospitals have diabetic clinics which run once a week with an average of 100

Discussion

In this study we found a high (34.5%) prevalence of depression in DM patients, in keeping with rates reported in some studies conducted in SSA (Akinlade and Ohaeri, 1996, Kagee, 2008, Shehatah and Rabie, 2010a, Shehatah and Rabie, 2010b). A recent systematic review showed a wide variation in the prevalence of depression among DM patients in SSA (15.2–45.9% ) (Mendenhall et al., 2014). The variations in the prevalence of depression among DM patients could be a result of a number of differences

Role of funding source

The project was supported by the MESAU‐MEPI Programmatic Award through Award Number 1R24TW008886 from the Fogarty International Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center or the National Institutes of Health.

Conflict of interest

The authors declare no conflict of interest.

Author consent forms

All the stated authors in this article consented to have their names in the article.

Dr Dickens Akena conceptualized the project. Dr’s Dickens Akena, Ekwaro Obuku, Phillipa Kadama, Rejani Lalitha, Dr Carolyne Akello and Mr Brendan Kwesiga wrote the protocol for the application of funds to conduct the study.

Dr Carolyne Akello was the statistician. Mr Brendan Kwesiga conducted the analysis of the health economics part of the project.

Dr’s Scholastic Ashaba , and James Okello supervised data

Acknowledgement

The project was supported by the MESAU‐MEPI Programmatic Award through Award Number 1R24TW008886 from the Fogarty International Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center or the National Institutes of Health.

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