Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2025; 16(4): 100638
Published online Apr 15, 2025. doi: 10.4239/wjd.v16.i4.100638
Prevalence and associated factors of depressive symptoms in Chinese diabetic patients: A study based on Andersen’s behavioral model
Wen-Hui Xiao, Xiao-Cong Yang, Si-Jie Xu, Ying Bian, Guan-Yang Zou
Wen-Hui Xiao, Si-Jie Xu, Guan-Yang Zou, School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Wen-Hui Xiao, Ying Bian, State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau 999078, China
Xiao-Cong Yang, School of Public Administration, Guangzhou University, Guangzhou 510006, Guangdong Province, China
Ying Bian, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau 999078, China
Co-first authors: Wen-Hui Xiao and Xiao-Cong Yang.
Co-corresponding authors: Ying Bian and Guan-Yang Zou.
Author contributions: Xiao WH, Yang XC, Bian Y and Zou GY conceptualized and designed the research; Xiao WH, Yang XC and Xu SJ accessed and analyzed the data; Xiao WH and Yang XC wrote the paper; Bian Y provided critical advice and suggestions on data analysis, data interpretation, and the preparation of figures and tables. Zou GY substantially revised the manuscript and provided constructive guidance and suggestions for the preparation and submission of the final version of the manuscript. All the authors have read and approved the final manuscript. Xiao WH proposed, designed, and prepared the first draft of the manuscript. Yang XC was responsible for collecting, processing, analysing the data and drafting the manuscript. Both authors have made crucial and indispensable contributions towards the completion of the project and thus qualify as co-first authors of the paper. Both Bian Y and Zou GY have played important and indispensable roles in the research design, data interpretation, and manuscript preparation as co-corresponding authors. Bian Y was instrumental in selecting analytical methods, interpreting parameters, and normalizing figures and tables. Zou GY conceptualized, designed, and supervised the entire project. This collaboration between Bian Y and Zou GY is crucial for the publication of this manuscript and other manuscripts still in preparation.
Supported by National Natural Science Foundation of China, No. 72104058; Open Bidding for Selecting the Best Candidates, Guangzhou University of Chinese Medicine; and University of Macau Research Funding, No. QRCM-IRG2022-001.
Institutional review board statement: The Biomedical Ethics Review Committee of Peking University granted ethical approval for CHARLS. The ethical approval number assigned to the study was IRB00001052-11015.
Informed consent statement: Informed consent was obtained from all participants before conducting interviews by the original data collectors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets analyzed during the current study are available in the CHARLS repository, http://charls.pku.edu.cn/.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guan-Yang Zou, PhD, Professor, School of Public Health and Management, Guangzhou University of Chinese Medicine, No. 232 Waihuandong Road, Higher Education Mega Centre, Panyu District, Guangzhou 510006, Guangdong Province, China. gzou@gzucm.edu.cn
Received: August 25, 2024
Revised: December 17, 2024
Accepted: January 22, 2025
Published online: April 15, 2025
Processing time: 190 Days and 18.1 Hours
Abstract
BACKGROUND

Diabetes mellitus (DM) is a rapidly growing global health emergency of the 21st century. Comorbidities, such as DM and depression, are common, presenting challenges to the healthcare system.

AIM

To investigate the prevalence of depression and its associated factors in patients with DM and to strengthen the management of depression in this patient group.

METHODS

Participants were selected from the 2018 China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale, with a score of 10 or more indicating depression. Group differences were compared using analysis of variance and χ2 tests. Binary logistic regression was conducted to explore the odds ratios (ORs) of independent variables. Following Andersen’s behavioral model, predisposing, enabling, health need, and health behavior variables were introduced stepwise into the logistic model.

RESULTS

Of the 1673 patients with diabetes, 41.4% had depressive symptoms. Regarding the predisposing characteristics, patients who were male (OR 0.426, P < 0.05), married (OR 0.634, P < 0.05), and received a high school education or higher (OR 0.432, P < 0.05) reported fewer depressive symptoms. Healthcare needs, including better self-rated health (OR 0.458 for fair and OR 0.247 for good, P < 0.05) and more sleep (OR 0.642, P < 0.05), were associated with a lower likelihood of depressive symptoms. In contrast, pain (OR 1.440 for mild and OR 2.644 for severe, P < 0.05) and impairment in the basic activities of daily living (OR 1.886, P < 0.05) were inversely associated. Additionally, patients highly satisfied with healthcare services (OR 0.579, P < 0.05) were less likely to have depressive symptoms.

CONCLUSION

Nearly half of the patients with DM reported depressive symptoms, which were strongly associated with predisposing characteristics and healthcare needs, particularly physical pain and impairment in basic activities of daily living. Our study emphasizes the significance of enhanced screening and intervention for depression in diabetes care along with improved management of functional impairments.

Keywords: China; Comorbidity; Depressive symptoms; Diabetes mellitus; Health correlates

Core Tip: In this cross-sectional analysis, we present the prevalence of and factors associated with depressive symptoms in patients with diabetes mellitus (DM). Nearly half (41%) of the patients with DM reported depressive symptoms, which were strongly associated with predisposing characteristics and healthcare needs, particularly physical pain and impairment in basic activities of daily living. Enhanced screening and interventions for depression in diabetes care, along with improved management of functional impairment, should be implemented.