Depression in diabetic patients presenting to the emergency department in Trinidad and Tobago – a hidden epidemic

The likelihood of depression in diabetics presenting to the Emergency Department in developing countries is unknown. The aim of this study was to determine the prevalence of undiagnosed depression among diabetic patients presenting to the Emergency Department in Trinidad and Tobago, and to determine the risk factors associated with depression in these patients. The prevalence of depression was 46.2%, of which 76.1% had mild depression, 20.6% moderate depression and 3.3% severe depression. Depressed patients were more likely to be Indo Trinidadian (69.7%), married (61.8%) and working in the public sector (42.3%). Factors independently associated with depression included lower education level (p=0.003), and a history of co-existing heart disease (p=0.048), myocardial infarction (p=0.04) or other co-morbidities (p=0.010). Depressed patients had higher HbA1c% values (p<0.0001), and were less likely to adhere to meal plans (p=0.015) and exercise regimes (p=0.028). Depression is an unrecognised epidemic among diabetics in the Trinidad and Tobago. This study suggests that screening for depression among diabetics in the Emergency Department may be a useful method of identifying these patients. Additionally, the association between poor diabetic control and depression in these patients suggests the need for more research into this phenomenon.