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Abstract
Depressive syndrome (DS) occurs twice as often in patients with diabetes mellitus (DM), while in the general population it is especially common in hospitalized patients with advanced illness. Similarly, DS occurs more often in patients with another important somatic pathology – after a myocardial infarction and/or with oncological diseases. In clinical practice, various questionnaires are used to determine depressive states, which are characterized by high relevance and specificity and are proposed for use in the diagnosis of DS. However, the diagnostic value of the basic questionnaires in patients with DM and the possibility of
improving the diagnosis of DS still remain insufficiently studied. This question remains especially relevant considering the importance of timely diagnosis of DS, which is one of the factors contributing to the course of DM and leading to its decompensation. The aim: to determine the prevalence of DS in diabetic to patients using different questionnaires for define depression and to compare their diagnostic value. Material and methods: a survey using Beck Depression Inventory-II (BDI-II), the Patient Health Questionnaire-9 (PHQ-9) and the Zung self-rating depression scale (ZSDS), which are most commonly used in clinical practice, was conducted in 167 patients with type 1 diabetes mellitus and type 2 diabetes mellitus who were on inpatient treatment in the diabetology department of clinic. Results. Among the examined 167 patients with moderate and severe DM there were 110 women and 57 men aged 18 to 82 years (mean age 55.3±1.1 years). According to the results of the survey, DS was observed in 110 of them (65.9%) according to BDI-II, and in 97 (58.1%) according to PHQ-9. In the same group of people, a survey using ZSDS revealed depressive disorders in only 24 patients (14.4%). Taking into account the results of two scales (PHQ-9 and BDI-II), DS was detected in 124 patients (74.3%). This was due to the fact that DS was diagnosed simultaneously using the PHQ-9 and BDI-II in 83 patients (49.7%), and in the remaining DS was detected using one of the questionnaires: in 27 (16.2%) according to the BDI-II and in 14 (8.4%) according to PHQ-9. All patients with DS diagnosed using ZSDS had confirmation of the diagnosis using both the PHQ-9 and BDI-II, and therefore these data did not affect
the total number of cases of depression. Of 110 patients with DS identified by BDI-II, the majority had changes of mild and moderate degree of severity – 49 and 27 people, respectively, which amounted to a total of 69.1%. Among the remaining patients, DS of pronounced (26 people or 23.6%) and severe (8 people or 7.3%) degrees was diagnosed. Among 97 patients with DS, determined by PHQ-9, 52 (53.6%) had minimal manifestations of depression, 28 (28.9%) had mild depression, which amounted to 82.5%. Only 9 patients (9.3%) showed signs of pronounced depression (moderate severity) and 8 (8.2%) – severe. Of 24 patients with DS, identified by ZSDS, 23 (95,8%) of them had mild depressive disorders and 1 (4.2%) patient had moderate depression. Conclusions. In hospitalized patients with DM, DS is detected in 65.9% according to BDI-II, in 58.1% according to PHQ-9, and the state is significantly lower, in 14.4%, according to ZSDS. The simultaneous use of two questionnaires, PHQ-9 and BDI-II, made it possible to diagnose DS in 74.3% of patients. A feature of DS in patients with DM is that in the vast majority of cases (69.1% and 82.5% according to BDIII and PHQ-9, respectively) it was of mild and moderate degree of severity. In patients with DM, DS is diagnosed on average 2 times more often in women than in men. Most often, DS occurs in women with type 2 diabetes of the older age category (60-75 years), who often experience a severe form of depression. Surveys based on BDI-II and PHQ-9 have greater and equal diagnostic value, while surveys using ZSDS have lesser value. The simultaneous use of BDI-II and PHQ-9 improves the quality of diagnosis of DS in patients with DM. The high incidence of DS and its known negative impact on the course of DM indicates the need for timely diagnosis and treatment of depression in patients with DM.
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