Prevalence of depression and associated factors among adolescents with type one Diabetes attending Diabetes clinics in Dar-es-salaam, Tanzania

Abstract

ABSTRACT Introduction: Children with type one diabetes (T1DM) are surviving to adulthood due to improved care and awareness which in turn increase number of cases of T1DM among adolescents. Compared to individuals without diabetes, those with diabetes are 2 to 3 more likely to develop depression, especially among adolescents. Depressive symptoms during the adolescent period have been associated with suboptimal glycaemic control. Objectives: To determine the prevalence of depression and associated factors among adolescents with T1DM attending diabetes clinics in Dar-es-Salaam. Methodology: A hospital-based cross-sectional study was conducted amongst adolescents aged 10-19 years with T1DM attending 4 public diabetes clinics in Dar es Salaam (Muhimbili national hospital (MNH), Mwananyamala Regional Referral Hospital (RRH), Temeke RRH, and Vijibweni District level Hospital) from November 2023 to April 2024. A pre-tested structured questionnaire was used to obtain socio-demographic and clinical information about the participants and the caregivers, while the validated Patient Health Questionnaire (Swahili version) modified for adolescents (PHQ-A) was used to assess depression symptoms. Results: A total of 186 adolescents with T1DM were recruited in the study. The majority, 144 (77.4%) were aged > 14 years with median age of 15 years, and female predominance (58.1%). Depressive symptoms were detected in 107 (57.5%) adolescents, of whom 50 (26.9%) had clinical depression (moderate, moderately severe, and severe depression). A higher odds of having depression was noted among females (Adjusted Odds Ratio (AOR) = 2.86, 95% CI: 1.32- 6.18, p = 0.008), those aged >14 years, (AOR 3.88, 95% CI: 1.64-9.15, p = 0.002) and those with <5 years duration since being diagnosed with diabetes (AOR 1.16, 95% CI: 1.06-1.26, p =0.001). However, those with lower average blood glucose levels of ≤7 mmol/L exhibited significantly lower odds of depression compared to their counterparts (p = 0.002). Conclusion: Depression is prevalent in adolescents with T1DM. Several factors including older age, female sex, and a shorter duration since diagnosis of diabetes were associated with an increased risk of depression. Having average blood glucose of <7mmol/L was found to be protective. Recommendation: Routine screening for depression and integration of mental health services in diabetes clinics will aid in early diagnosis and management of depression in adolescents with TIDM.