Indian Journal of Medical Research

: 2011  |  Volume : 133  |  Issue : 5  |  Page : 555--556

Prevalence & determinants of depression in type 2 diabetes patients: Problem in generalization

Debajyoti Datta 
 Student, MBBS 4th year, N.R.S. Medical College & Hospital, Kolkata 700 014, India

Correspondence Address:
Debajyoti Datta
Student, MBBS 4th year, N.R.S. Medical College & Hospital, Kolkata 700 014

How to cite this article:
Datta D. Prevalence & determinants of depression in type 2 diabetes patients: Problem in generalization.Indian J Med Res 2011;133:555-556

How to cite this URL:
Datta D. Prevalence & determinants of depression in type 2 diabetes patients: Problem in generalization. Indian J Med Res [serial online] 2011 [cited 2020 Nov 27 ];133:555-556
Available from:

Full Text


I have read with interest the study by Raval et al[1] regarding the prevalence and determinants of depression in type 2 diabetes patients. They found 41 per cent prevalence of depression among the diabetic subjects. Age >54 yr, central obesity, neuropathy, nephropathy, peripheral vascular disease, diabetic foot disease and pill burden were strongly associated with depression. These findings demonstrate the need for the assessment of depression among the diabetes patients. However, the lack of comparison to a similar population without diabetes prevents generalization of the study. Various studies have placed the incidence of depression among elderly Indian population to be between 12.7 and 58 per cent [2],[3] . Although the authors demonstrate the association between depression and its risk factors, it is not clear whether the presence of diabetes has an additive or synergistic effect on the prevalence of diabetes. The association was based on analysis of the group of diabetic patients only. Without a comparison to a suitably selected normal population sample it would not be possible to determine whether diabetes has any effect on the prevalence of depression or the associations are of the same magnitude as observed in the general population.

This was a hospital-based study [1] and no statistical sampling method was applied. Hence it is subject to selection bias [4],[5] . It may be possible that diabetic patients with depression were reluctant to visit the hospital. Or it may be the other way round. In any case, it would not be possible to draw a firm conclusion.

The authors have acknowledged that causal relationship could not be assumed but in conclusion they have stated that depression and diabetes are causally related. It should be noted that the study showed no difference in HbA 1 C or duration or diabetes between diabetes patients with or without depression, which would be likely if there was a causal relation. Temporal relationship has not been established either. The association between depression and diabetes indicates that there may be a causal relationship [6] . However, the direction and underlying mechanisms remain unclear [7],[8] . There may be a bi-directional relationship as found by Golden et al[9] .


1Raval A, Dhanaraj E, Bhansali A, Grover S, Tiwari P. Prevalence & determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian J Med Res 2010; 132 : 195-200.
2Rajkumar AP, Thanqudurai P, Senthilkumar P, Gayathri K, Prince M, Jacob KS. Nature, prevalence and factors associated with depression among the elderly in a rural south Indian community. Int Psychogeriatr 2009; 21 : 372-8.
3Devi ES, Neenu A, Anu P, Rosemary J, Anju B, Dalphina S, et al. Elderly and depression. Nur J India 2007; 98 : 221-3.
4Mann CJ. Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emerg Med J 2003; 20 : 54-60.
5 Abramson JH, Abramson ZH. Survey methods in community medicine, 5 th ed. Edinburgh, UK: Churchill Livingstone; 1999.
6Williams JW, Katon W, Lin EH, Noel PH, Worchel J, Cornell J, et al. The effectiveness of depression care management on diabetes-related outcomes in older patients. Ann Intern Med 2004; 140 : 1015-24.
7Talbot F, Nouwen A. A review of the relationship between depression and diabetes in adults: is there a link? Diabetes Care 2000; 23 : 1556-62.
8Egede LE, Simpson K. Epidemiology, treatment and costs of depression in adults with type 2 diabetes. Expert Rev Pharmacoeconomics Outcomes Res 2003; 3 : 251-62.
9Golden SH, Lazo M, Carnethon M, Bertoni AG, Schreiner PJ, Diez Roux AV, et al. Examining a bidirectional association between depressive symptoms and diabetes. JAMA 2008; 299 : 2751-9.