Sociodemographic and clinical correlates of depression among patients with type 2 diabetes in rural Uganda
TL;DR
Routine screening, counseling, referral, and follow-up for depressive symptoms should be integrated into diabetes clinic services, alongside structured self-management education for patients with mild symptoms.
Abstract
Background Depressive symptoms add to the clinical and psychosocial burden of type 2 diabetes mellitus (T2DM) and may undermine patients’ ability to cope with long-term care. Evidence on this burden in rural Ugandan diabetes clinics remains limited. This study assessed the prevalence, severity, and correlates of depressive symptoms among adults with T2DM attending Kayunga Regional Referral Hospital. Methods A hospital-based cross-sectional study was conducted among 83 adults with documented T2DM from September to November 2024. Data were collected via an interviewer-administered questionnaire and medical record review. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores of ≥5 indicating depressive symptoms. Descriptive statistics summarized the study variables. Pearson’s chi-square test, with Fisher–Freeman–Halton exact tests where required, was used to assess bivariate associations. A complication-focused binary logistic regression model examined the independent associations of cardiovascular disease, retinopathy, and neuropathy with depressive symptoms. Statistical significance was set at p < 0.05. Results Depressive symptoms were identified in 34 participants (41.0%). Of these, 20 (58.8%) had mild symptoms, 7 (20.6%) had moderate symptoms, 4 (11.8%) had moderately severe symptoms, and 3 (8.8%) had severe symptoms. Sociodemographic characteristics were not significantly associated with depressive symptoms. In bivariate analysis, depressive symptoms were more common among participants with cardiovascular disease than among those without it [18/26 (69.2%) versus 16/57 (28.1%); χ² = 12.51, p < 0.001], retinopathy [10/13 (76.9%) versus 24/70 (34.3%); χ² = 8.24, p = 0.004], neuropathy [16/19 (84.2%) versus 18/64 (28.1%); χ² = 19.06, p < 0.001], and overweight/obesity [18/27 (66.7%) versus 16/56 (28.6%); χ² = 10.93, p = 0.001]. In the adjusted model, cardiovascular disease, retinopathy, and neuropathy did not retain statistically significant independent associations. Conclusion Depressive symptoms affected two in five adults receiving T2DM care in this rural Ugandan setting. Routine screening, counseling, referral, and follow-up for depressive symptoms should be integrated into diabetes clinic services, alongside structured self-management education for patients with mild symptoms.