![]() ![]() Nepal recently endured the People’s War fought between the Communist Party of Nepal (Maoists) and government security forces from 1996 through 2006. Nepal is among the world’s poorest countries with a GDP of $260 per year, which is unequally divided. The study focuses on clinical populations with the goal of providing prevalence estimates and risk factor associations to guide clinical prevention and management of mood disorders among persons with diabetes who do not have a psychiatric history. Therefore exclusion criteria were designed to minimize the number of participants for whom depression may have preceded diabetes. We were specifically interested in the causal pathway from diabetes to depression. The aim of this cross-sectional study was to identify the prevalence of depression among type 2 diabetes patients not previously diagnosed with a mood disorder, as well as to identify risk factors for depression among persons with diabetes. In Bir Hospital, the central government hospital in Kathmandu, diabetes was reported to be the seventh most common reason for medical admissions with 2.5% prevalence, whereas in Tribhuvan University Teaching Hospital in Kathmandu, diabetes comprised 9.5% of total medical admissions per year. Other studies in Nepal have suggested prevalence rates of 15% among persons 20–39 years old and 19% among 40 years and older. Prevalence rates were highest among middle-aged and older men. However, in another study of a semi-urban sample, the current prevalence of type 2 diabetes mellitus in Nepal was identified as 9.5% with impaired fasting glucose having a prevalence of 19.2%. The prevalence of diabetes in Nepal is estimated to be 436,000 (2%) in 2000 and it is projected to affect 1,328,000 persons (10% prevalence) in 2030. In Nepal, no studies to date have investigated the prevalence of depression and diabetes comorbidity. Risk factors in Bangladesh include being unmarried, insulin use, and poor glycemic control. ![]() 22% prevalence in males and 35% prevalence in females. In Bangladesh, prevalence rates of depression among persons living with diabetes ranges from 28-34% with differences by gender, e.g. In Pakistan, history of gestational diabetes mellitus, nuclear family, obesity, marital status, history of smoking and history of high blood pressure were risk factors for depression among type 2 diabetes mellitus patients. In India, depression among persons living with diabetes has been associated with age, obesity, increased pill burden and complications of neuropathy and retinopathy, as well as somatic symptoms among females, and genital symptoms among males. In India, a hospital-based study suggested a prevalence of depression ranging from 8.5% to 32.5% depending upon the scales used. The association of depression and diabetes has been reported in South Asia. Patients with diabetes have lower quality of life ratings, with the greatest quality reduction when depression and diabetes are comorbid. ![]() An increased risk of type 2 diabetes in individuals with depression is likely due to increased counter-regulatory hormone release and action, alterations in glucose transport function, and increased immune-inflammatory activation. Depression in patients with both type 1 and type 2 diabetes is associated with psychosocial stressors of chronic medical condition. ![]() Depression is more prevalent among females with diabetes than males with diabetes, patients with type 2 versus type 1 diabetes and those who are treated with insulin. Co-morbid depression among persons living with diabetes is associated with poor markers of diabetes control, such as glycemic control, retinopathy, nephropathy, neuropathy, micro-vascular complications and sexual dysfunction. The bidirectional relationship of diabetes with depression is presented by many studies. In a meta-analysis of 42 published studies comprised of 21,351 adults, the prevalence of major depression in people with diabetes was 11% and the prevalence of clinically relevant depression was 31% (, c.f. Worldwide, the prevalence of mood and anxiety disorders is higher among persons living with diabetes compared to those without diabetes. With prevalence greater than 6% and growing rapidly in South Asia, the expected prevalence increase in India is 171% from 2007 to 2025. In South Asia, greater population-level affluence is associated with an increase in health compromising behaviors related to chronic diseases such as cardiovascular disease, cancer, and diabetes. Diabetes mellitus is a growing public health concern in Asia, where more than 110 million people are living with diabetes, and more than 1.0 million people die annually in the region from the disorder. ![]()
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