1. Evaluating depression in type 2 diabetes co- morbidities in Romanian patients - implications for hypertensive patients Vladut Ioana Corina, MA Center for Health Policy and Public Health, Babes-Bolyai University Cluj-Napoca, Romania

2. Presentation overview 1. Background (issue/problem) 2.Description of the problem 3.Results (effects/changes) 4.Lessons 5.Acknowlegements 6. Selected references Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

3. Background  Depression is one of the leading contributing factors to the burden of disease worldwide (1)  Patients with chronic diseases have been found to have two-to threefold higher rates of major depression compared with age- and gender- matched primary care patients  High prevalence of depression in diabetes patients with co-morbid medical diseases compared with patients with type 2 diabetes only or no chronic disease at all (2) Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

4. Background  75% diabetes patients have associated conditions  Special attention to depression in hypertension and diabetes  Raised blood pressure is more common in people with type 2 diabetes than in the general population(3)  Risk of hypertension increases with repeated experience of depressive episodes over time(4) Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

5. Description of the problem  Setting: Nutrition and Diabetes Center in Cluj- Napoca, Romania  Participants: 1171 patients with type 2 diabetes  Objectives: 1. Explore the prevalence of co-morbidities in diabetes and the level of depression in the first five diabetes comorbidities. 2. Examine the relationship between high blood pressure and depression, as high blood pressure is a debated risk factor for type two diabetes. Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

6. Description of the problem  Questionnaires: Diabetes Cost Questionnaire (DCQ) and Patient Health Questionnaire (PHQ9)  Data analysis - descriptive statistics and Chi-Square tests -> the prevalence of co-morbidities, and the difference in the depression level in the associated diabetes conditions - regression -> examine the probability of having major and mild depression in patients with high blood pressure Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

7. Results (effects/changes) Diabetes comorbidities 82%, majority female (64%) high blood pressure (25.7%) arthritis or rheumatism (18.5%) heart conditions (17.2%) diabetes feet (9.1%) retinopathy (7%) Depression-> higher in comorbidities than diabetes alone: asthma or chronic bronchitis (x 2 =23.9, p <0.01), arthritis (x 2 =83.7, p <0.01), ulcers (x 2 =32.4, p <0.01), fracture (x 2 =25.2, p <0.01), osteoporosis (x 2 =49.8, p <0.01), heart conditions (x 2 =80.2, p <0.01), retinopathy (x 2 =43.7, p <0.01), diabetes feet (x 2 = 74.0, p< 0.01) High blood pressure -> 18% major depression more prevalent in women (67%) and older adults (92%) Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

8. The probability of having major depression for patients with high blood pressure is dependent on (p<0.01):  low educational level  female gender  not having a caregiver Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

9. Lessons  The results of the study confirm previous findings that indicate a higher prevalence of depression in diabetes patients with associated medical conditions.  Integrated approach of diabetes management and comorbidities specific guides  Raise awareness on depression in patients with high blood pressure and diabetes, especially in women, people without caregivers and with low educational status.  More research is demanded in order to elucidate the bi- directional relationships between depression, diverse chronic diseases and the associated risk factors. c Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

10. Acknowledgements This work was financed directly by grant number 5 D43 TW005810-07, “Finance and Mental Health Services Training in Czech Republic/Central Europe,” sponsored by the U.S. National Institutes of Health “John E. Fogarty International Center”. c Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

11. Selectes References 1.Michaud CM, Murray CJ, Bloom BR (2001) Burden of disease- implications for future research. JAMA 285:535– 539 2. Pouwer F, Beekman AT, Nijpels G et al (2003) Rates and risks for co-morbid depression in patients with type 2 diabetes mellitus: results from a community-based study. Diabetologia 46:892–898 3.Kannel W, McGee D. Diabetes and cardiovascular disease. The Framing­ham study. JAMA 1979;241:2035­8 4.Nabi H., et al., Trajectories of Depressive Episodes and Hypertension Over 24 Years, Hypertension. 2011;57:710-716 Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012

12. Thank you for your attention ! Public Health and Social Services: Education and Practice conference Tbilisi, Georgia, June 27 th, 2012