Association of Depression and Stress with HbA1c level of Type 2 Diabetic Patients Attending the Diabetes Clinic of Nampong Hospital, Khon Kaen Province

Abstract

Background and objective: Depression and stress are psychological factors which may affect glycemic control in diabetic patients. The purpose of this study was to investigate the association of depression and stress with HbA1c level in type 2 diabetic (T2DM) patients.

Methods: This analytic cross-sectional study was conducted among 290 T2DM patients attending the diabetes clinic of Nampong Hospital, Khon Kaen province. Depression was assessed by the nine-item Patient Health Questionnaire, and stress was measured using a validated questionnaire, the Suanprung Stress Test-20. The HbA1c data were obtained from the medical records of the hospital. Data were collected during March to June 2015.

Results : Most of the subjects (71.4%) were females, and the average age was 60.5 ± 9.8 years old. The mean time since the diagnosis of diabetes was 8.1 ± 7.6 years. Most of the subjects (82.5%) had high HbA1c  level ( ≥ 7 mg%). Depression was diagnosed in 29.7% of the subjects. There were 54.8% of the subjects that were assessed as a moderate level of stress symptoms, and 22.8% were high to severe levels of stress. A multiple logistic regression analysis revealed a negative association between depression and high HbA1c level (≥ 7 mg%) (OR_adj = 0.43, 95%CI = 0.21, 0.88), and positive association of a high HbA1c level with duration of diabetes (≥ 10 years) (OR_adj = 2.57, 95%CI = 1.22, 5.37).

Conclusions : Depression was negatively associated with poor glycemic control. However, diabetes clinics should provide screening and treatment for depression and include stress management intervention to prevent severe depression.