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Cited by 90Diabetes Management and EducationDiabetes Management and ResearchMental Health Treatment and Access

Prevalence of depression in Type 1 diabetes and the problem of over‐diagnosis

Fisher, L., Hessler, D. M., Polonsky, W. H., Masharani, U., Peters, A. L., Blumer, I., Strycker, L. A.·2016·Diabetic Medicine
DOI 10.1111/dme.12973
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Abstract

Aims: To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false‐positives when compared with rates of major depressive disorder. Methods: The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight‐item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 (DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. Results: The prevalence rates of depression according to the eight‐item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false‐positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ‐8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA 1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. Conclusions: We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false‐positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology.

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Crossref · 10.1111/dme.12973

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  • Psychological distress, including mild to major depression, is a risk factor for poor self-care, hyperglycemia, complications, and excess mortality.

    “Psychological distress, including mild to major depression, is a risk factor for poor self-care, hyperglycemia, complications, and excess mortality (174-176).”

    From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [176]

  • Among type 2 adults, elevated DD is highly stable over time and the point prevalence of elevated DD is approximately 46%.

    “Recent studies have indicated that among type 2 adults (T2D) elevated DD is highly stable over time and that the point prevalence of elevated DD is approximately 46%, suggesting a widespread clinical problem in this population [7].”

    From Diabetes distress in adults with type 1 diabetes: prevalence, incidence and change over time (2016) · cites this paper as [7]

  • The point-prevalence and 9-month incidence of elevated DD among adults with T1D are similar to the 46.2% prevalence and 9-month 54.3% incidence of DD among adults with T2D, re-calculated from an earlier study (N = 502).

    “These figures are similar to the 46.2% prevalence and 9-month 54.3% incidence of DD among adults with T2D, re-calculated from an earlier study (N = 502) [7].”

    From Diabetes distress in adults with type 1 diabetes: prevalence, incidence and change over time (2016) · cites this paper as [7]

  • Unlike depression, elevated DD does not appear to be episodic, ebbing and flowing over time; instead, when it occurs, without intervention it is generally persistent and continuous.

    “Thus, unlike depression [7], elevated DD does not appear to be episodic, ebbing and flowing over time; instead, when it occurs, without intervention it is generally persistent and continuous.”

    From Diabetes distress in adults with type 1 diabetes: prevalence, incidence and change over time (2016) · cites this paper as [7]

  • Substance-related and addictive disorders were reported in 9 studies; 7 diagnostic interview studies reported prevalence from 0.00% to 34.67% and 2 register/medical record studies reported 0.92% and 2.16%.

    “N = 9 [20,21,23,31,34,38,42,52,58] studies reported on the prevalence of substance-related and addictive disorders.Where specified, n = 5 reported alcohol-related, n = 1 was cannabis-related, n = 1 was tobacco-related, n = 1 was medication-related, and n = 1 not specified.N = 7 studies used diagnostic interviews and reported prevalence ranging from 0.00% to 34.67% and n = 2 studies used patient”

    From Prevalence of mental disorders in people living with type 1 diabetes: A systematic literature review and meta-analysis (2023) · cites this paper as [38]

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Authors
Fisher, L., Hessler, D. M., Polonsky, W. H., Masharani, U., Peters, A. L., Blumer, I., & Strycker, L. A.
Affiliations
  • University of California, San Francisco (US)
  • Texas Diabetes Institute (US)
  • University of Southern California (US)
  • Charles H. Best Diabetes Centre Ontario Canada
  • Oregon Research Institute (US)
Corresponding author
Fisher, L.
ORCID
Venue
Diabetic Medicine
Publisher
Wiley
Published
2016-01-05
Volume
33
Issue
11
Pages
1590-1597
ISSN
  • 0742-3071 (ISSN-L)
  • 1464-5491
DOI
10.1111/dme.12973
OpenAlex
W2165206891
Cited by
90
References
28
Citations by year
2026: 6 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 12 · 2021: 10 · 2020: 11 · 2019: 13 · 2018: 10 · 2017: 13 · 2016: 5
FWCI
8.11
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Diabetic Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institutes of Health (DK094863)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
depression, type 1 diabetes, diabetes distress, major depressive disorder, prevalence, overdiagnosis, false positives, Patient Health Questionnaire, PHQ-8, diabetes complications, life events, HbA1c, chronic disease management
MeSH terms
Medical Overuse, Adult, Depression, Depressive Disorder, Major, Major Depressive Disorder, Diabetes Mellitus, Type 1, False Positive Reactions, Female, Humans, Male, Middle Aged, Psychometrics, Surveys and Questionnaires, Stress, Psychological, Prevalence, Young Adult

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