Assessing Prevalence of Depressive Symptoms and Its Association with Type 2 Diabetes Mellitus in Primary Care: A Cross-Sectional Study from 9 residency training family health Units in Istanbul

Özla Çelik, Ahmet Faruk Demir, Seda Erdaloğlu Ayaz, Alper Tuğrul Gül, Gözde Güvenç, Volkan Kaplan, Büşra Kaptan, Serkan Özbakış, Serhat Uprak, Esra Yalçınkaya, Eda Yaldırak, Demet Dinç, Efe Onganer, Şirin Parkan, Pınar Topsever

Background:

The association between Type 2 Diabetes Mellitus(T2DM) and depression is a complex dynamic, and evidence suggests bidirectional effects. This study aims to evaluate the prevalence of depressive symptoms among adults attending nine family health units in two districts of Istanbul served by family medicine residents.

Research questions:

What is the prevalence of screening positive for depressive symptoms by two case-finding questions(PHQ-2) among adults (≥18 years) attending 9 academic primary care units?
Is there a difference between frequency of chronic disease (like T2DM) in people who screen positive or negative by PHQ-2?

Method:

For this cross-sectional study, a representative sample size of n=422 (error margin 0.05%, power 0.8) stratified by health unit population size and sex was calculated. Adults (age ≥18 years) presenting to the family health units without known diagnosis of depression (verified by ICD-10 codes and/or antidepressant therapy) after giving their informed consent will be recruited by convenience sampling. Data collection will encompass sociodemographic, clinical, and lifestyle factors. Participants will complete the PHQ-2 and the BDI-PC. Chronic conditions (verified by ICD-10 codes and/or related pharmacotherapy) with an emphasis on T2DM as the index disease will be extracted from medical records. T2DM specific variables (diabetes duration, HbA1c, BMI, blood pressure, smoking, and exercise habits) will also be assessed. The study will utilize a range of statistical methods, including descriptive and correlation analyses.

Results:

Findings will show the performance of the PHQ-2 in identifying depressive symptoms in a primary care setting. Moreover, the study will provide insight into the association between depression and T2DM, thereby facilitating holistic approaches to patient care.

Conclusions:

The results will shed light on the multi-morbid epidemiology of depression and diabetes in a primary care population and show extra diagnostic yield of screening for depression in T2DM.

Points for discussion:

Could stepwise screening for depression in primary care with a short tool like PHQ-2 improve quality of mental health care by improving diagnostic yield?

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