the prevalence of clinical depression and presence of elevated depressive symptoms are higher among persons with diabetes compared to the general population . this association may be bidirectional .
newly diagnosed diabetics suffer not only from somatic symptoms of the disease , but also from indisposition due to lifestyle alteration , which can possibly cause depressive emotions in the initial stage of diagnosis .
negative emotions can cause stress in diabetic patients , while a series of adverse hormones increase , they reduce the sensitivity of insulin and induce insulin resistance .
negative emotions can adversely affect glucose control or the quality of life and should be detected early to be intervened .
the present study was conducted with the aim of studying the association of depression with diabetes and its complications in newly diagnosed type 2 diabetics and to compare its prevalence with age- and sex - matched healthy controls .
this single point cross - sectional case control study was conducted at a tertiary care hospital from august 2010 to july 2011 .
cases were selected as per the american diabetes association ( ada ) 2007 guidelines and were newly diagnosed (  3 months since diagnosis ) subjects who gave consent for the study .
diabetic patients with other predisposing factors for depression such as other chronic diseases , disability , other major psychiatric illness , those with recent stressful and psychological causes of depression , and patients with gross cognitive deficit were excluded from the study .
iv tr criteria and severity was assessed using the beck depression inventory ( bdi ) .
those having difficulty in understanding the english language were given assistance in the form of literal translation of bdi in the local language , without modifying the basic tool .
a bdi score of 11  16 was taken as mild ; 17  30 as moderate , and more than 30 as severe depression .
the control subjects were from the same socioeconomic background , to minimize possibility of any bias .
a complete physical and mental examination was done and they were assessed on the aforementioned parameters in the same way as was done for the patient group .
cases and controls were investigated for their diabetic status ; cases were also investigated for complications of diabetes and then bdi was applied .
chi square test and two sample proportion tests were used to calculate the p value .
mean age of cases was 47.67  9.78 years and mean age of controls was 46.85  10.08 years . among the cases 65% were males and 35% were females .
male : female ratio was 1.86 : 1 . among the controls 61.66% were males and 38.33% were females with a male : female ratio of 1.61 : 1 .
on statistical analysis it was found that both groups were age- and sex - matched ( p = 0.6519 for age and 0.70 for gender distribution ) .
similarly they were matched regarding other demographic data like socioeconomic status ( p = 0.99 ) , marital status ( p = 0.57 ) , and religion ( p = 0.64 ) [ table 1 ] .
demographic characteristics of the study population out of the 60 newly diagnosed diabetics , depression was found in 43.34% , while it was present in only 13.33% out of 60 age- and sex - matched healthy controls ( p = 0.002 ) [ table 2 ] .
status of depression in cases and controls mild - to - moderate depression was present in 69.33% of the cases and 87.5% of the controls .
severe depression was present in 30.77% of the cases and 12.5% of the controls . among the cases , 42.85% of the females and 43.58% of the males had depression .
similarly , among the controls , 13.04% of the females and 13.51% of the males had depression .
thus , in our study there was no significant difference among the cases and controls regarding the gender distribution of depression .
mg / dl while the mean ppbg value was 230.1  47.43 mg / dl .
the average hba1c of the cases was 8.26  1.79% . among those diabetics who were found to be depressed , the average values of fbg , ppbg , and hba1c were 177.80  47.15 mg / dl ,
244.50  57.56 mg / dl , and 8.56  1.66% , respectively , while among the non - depressed diabetics , the same values were 149.5
 26.85 , 219.09  34.97 mg / dl , and 8.04  1.88% , respectively [ table 3 ] . although the levels of all the three parameters ( fbg , ppbg , and hba1c ) were higher in the depressed individuals as compared to the non - depressed individuals , the difference was significant only for fbg ( p = 0.0048 ) and ppbg ( p = 0.0386 ) , but not for hba1c ( p = 0.26 ) .
glycemic status of newly diagnosed diabetics the presence of diabetic complications among those with depression versus those without depression is shown in table 4 .
thus , a majority of diabetics had evidence of nephropathy even at diagnosis ; 80.76% diabetics having depression had microalbuminuria at diagnosis , while only 47.05% of the non - depressed diabetics had microalbuminuria ( p = 0.0078 ) .
thus , positive urine microalbumin was significantly associated with depression in newly diagnosed type 2 diabetics .
presence of complications in depressed versus non - depressed newly diagnosed diabetics serum creatinine was raised in 13.33% of the cases , among which 26.92% of the cases having depression had raised serum creatinine , while only 2.94% of the cases who had no depression had raised creatinine ( p = 0.0068 ) .
dyslipidemia was present in 65% of the cases ; 65.38% of the cases having depression had dyslipidemia , while 64.70% of the cases who were without depression had dyslipidemia ( p = 0.9564 ) .
abnormal retinal findings were present in 15% of the cases . among the depressed diabetics 19.23% had abnormal fundus examination , while among those who did not have depression
thus , diabetic retinopathy was not significantly associated with depression in newly diagnosed type 2 diabetics .
electrocardiographic abnormalities such as st - t changes were present in 16.67% of the cases . among depressed diabetics , 19.23% had abnormal electrocardiograms ( ecg ) , while among those not having depression , 14.70% had ecg abnormalities ( p = 0.6408 ) .
in the present study the prevalence of depression in newly diagnosed cases of t2 dm was 43.34% , while in normal healthy controls it was 13.33% .
most studies looking for such an association have been done in diabetics , irrespective of the duration since diagnosis .
found evidence of depressive symptoms in 29% of the males and 30.5% of the females , with newly diagnosed diabetes .
perveen et al . also found significantly higher prevalence of depression among diabetics compared to non - diabetics , while yu et al . found that 28% newly diagnosed diabetics in their study had depression .
evaluated 300 diabetic patients for depression , irrespective of the duration of diabetes , and found that 41% of the diabetics had depression . in a study by sotiropoulos
found that depression prevalence was 14.7% among those with diabetes as opposed to 4.9% among those without diabetes , in a rural area of pakistan .
conducted a hospital - based prospective study and found major depression in 71.8% of a sample of 206 iranian patients with diabetes .
ali et al . found that the prevalence of depression was significantly higher among patients with t2 dm ( 17.6% ) compared to those without diabetes ( 9.8% ) .
various indian studies have reported prevalence rates of depression that vary from 9  83% in primary care practices.[913 ] there are few population - based studies from india .
the chennai urban rural epidemiology study , which is the largest population - based study from india , to report on prevalence of the depression , showed that among urban south indians , the prevalence of depression was 15.1% .
the presence of depression in 13% of the healthy controls in the present study correlated with the above - mentioned studies .
the prevalence of depression in 43% of the newly diagnosed diabetics correlated with the meta - analyses of several studies done by anderson et al . , who reported the prevalence of depression in diabetes ranging from 8 to 61% .
similarly all the above - mentioned studies concluded that depression was significantly associated with diabetes .
however , a study by brown and colleagues , which also considered newly diagnosed diabetics in their study , did not find any relation between the two . in the present study
it was also found that the glycemic status was worse among those having depression compared to non - depressed diabetics .
, who also found that the mean fbg and hba1c among depressed diabetics was significantly higher than in non - depressed diabetics .
larijani et al . also correlated hyperglycemia with depression . in the present study , although the level of all the three parameters fbg , ppbg , and hba1c were higher in depressed individuals , as compared to non - depressed individuals , the difference was significant only for fbg and ppbg , but not for hba1c .
various studies have also noted an association between diabetic complications and depression . in the present study
it was also found that among patients of newly diagnosed t2 dm , the majority of those having nephropathy ( screened by microalbuminuria and serum creatinine ) also had significantly associated depression ( p = 0.0078 for microalbuminuria and p = 0.0068 for serum creatinine ) .
however , the relation between dyslipidemia , retinopathy , or ecg abnormalities and depression was not significant .
yu et al . also found a significant association between microalbuminuria and depression in newly diagnosed diabetics , whereas , raval et al . found that significant risk factors associated with depression in type 2 diabetes included age , socioeconomic status , waist circumference , neuropathy , nephropathy , microvascular and macrovascular complications , diabetic foot , peripheral vascular disease ( pvd ) , and a greater pill burden .
however no significant risk was attributed to gender , hba1c , dyslipidemia , retinopathy , blood pressure , or bmi .
one of the major strengths of our study is its matched case control design , which controlled two fundamental confounders of age and sex , at the design stage .
cases were recruited on the basis of diabetic status measured by objective laboratory values , which avoided selection biases .
both cases and controls were selected from the same source population , so they were representative of the source population with respect to depression within age- and sex - matched strata .
finally , the screening tool used for depression exclusively screened out depression , thus avoiding false - positive results due to anxiety and somatic symptoms . limitations of the study : because of the stringent selection criteria , the sample size was small , and hence , the results were subjected to type ii error and they could not be generalized . the study was a cross - sectional study , and to further assess the effects of the diabetic disease process over mental status , longitudinal studies were needed . in this study , the differences noted compared to the previous studies might be because of the small sample size .
in newly diagnosed type 2 diabetics , the prevalence of depression was significantly higher as compared to age- and sex - matched healthy controls . the presence of depression correlated with the level of hyperglycemia at presentation , as measured by the fbg and ppbg values .
the prevalence of other complications of diabetes ( retinopathy , dyslipidemia , or ecg abnormalities ) was found to be higher among those with depression .
therefore , the association between t2 dm and depression was epidemiologically associated even in our subpopulation , highlighting the integrated management protocols between various specialities and psychiatric management helping the overall prognosis .
screening for depression by a self - scored questionnaire may be easily carried out , even in a busy clinic .
treating depression with psychotherapy , medication , or a combination of these treatments may improve the patients well - being and ability to manage symptoms of both diseases , thus , improving the quality of their lives as well as providing disease - free longevity .
 introduction : the prevalence of major depressive disorders is higher among persons with diabetes compared to the general population . 
 these associations may be related to the increased risk of depressive symptoms in individuals with diabetes , increased risk of type 2 diabetes ( t2 dm ) in individuals with depressive symptoms , or both.objectives:to study the association of depression with diabetes and its complications in newly diagnosed type 2 diabetes in eastern up.material and methods : sixty cases and an equal number of age- and sex - matched controls were assessed for depression , diabetes complications , and a demography profile.results:depression was found in 26 ( 43.34% ) cases , while it was present in only eight ( 13.33% ) controls ( p = 0.002 ) . 
 depression correlated with the level of hyperglycemia at presentation , as measured by fasting and postprandial blood glucose ( fbg and ppbg ) values . 
 the presence of diabetic nephropathy was significantly associated with depression , while the prevalence of other complications of diabetes ( retinopathy and dyslipidemia ) , although higher among those with depression , was not statistically significant . 
 the level of hba1c was 8.56  1.66 in the depressed versus 8.04  1.88 in the non - depressed diabetics ( p = 0.26).conclusions : the association of depression with diabetes and its complications in newly diagnosed type 2 diabetics was highlighted in our subpopulation and emphasized the need for integrated health services . 
 the prevalence of depression was higher among them compared to controls . 
 the chances of becoming depressed increased as the diabetes complications worsened . 
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