Prevalence Study of Depression in Chinese Patients With Type 2 Diabetes (HK13)
Condition: Diabetes; Depression
MeSH terms: Diabetes Mellitus; Depression; Depressive Disorder
Study type: Observational

Summary: 
      The investigators aim to:

        1. Estimate the prevalence of depression in a consecutive cohort of Chinese patients
           diagnosed with Type 2 Diabetes (T2D) living in areas of China with different
           socioeconomical affluence

        2. Examine patients' awareness of the frequent coexistence of these 2 conditions

        3. Analyze the associations between depression and T2D, in particularly the role of
           metabolic control, socioeconomical status and cognitive-psychological-behavioral factors

        4. To document the predisposing, precipitating and perpetuating factors for depression and
           their interrelationships in Chinese type 2 diabetic patients
    

Detailed description: 
      Overall objectives of this multicentre study are to document;

        1. the prevalence and diagnosis rates of depression in type 2 diabetic (T2D) patients
           attending 7 centres in 4 major cities in China including Hong Kong (HK), Shanghai (SH),
           Guangzhou (GZ) and Beijing (BJ)

        2. the predisposing, precipitating and perpetuating factors for depression and their
           interrelationships in Chinese T2D patients

      This study includes two phases. In the phase I pilot study, the investigators shall confirm
      and compare the validity of Patient Health Questionnaire (PHQ-9) and Clinical Epidemiological
      Scale for Depression (CESD) in predicting depression in Chinese T2D patients using the SCID
      as a gold standard. Other questionaires which measure personal and external factors, diabetes
      associated distress and anxiety, quality of life, mental wellness, self efficacy,
      health-related behavior and compliance will also be used to document possible predisposing,
      precipitating and perpetuating factors for depression in diabetes. These results will be used
      to select a set of tools which are most informative in the evaluation of depression and
      mental wellness in T2D patients based on their predictions for health behavior, compliance
      and metabolic control. A random sample of 100 T2D patients will be recruited from 3 Diabetes
      Centres in GZ, BJ and HK who will complete a full set of questionnaires and structured
      clinical assessments using a web-based electronic portal. In each of the three centres, all
      patients found to have positive symptoms for mild to severe depression by PHQ9 or CESD
      (PHQ>10 and/or CES>16) and a random sample of 20 subjects with no or mild symptoms will
      undergo face-to-face interview by psychiatrists using the following instruments: SCID, BDI,
      SSI-28 (somatization), Coping (Brief Cope 28, Chinese version).

      In Phase II, the investigators shall use a subset of the most informative questionaires to
      document the rates of depression (diagnosed and undiagnosed) and
      cognitive-psychological-behavioral factors in a consecutive cohort of Chinese patients with
      T2D and its associations with metabolic control and psychological behavioral factors. In each
      of the 7 participating centres in HK, SH, BJ and GZ, 500 consecutive patients will undergo
      comprehensive clinical assessments for risk factors, complications and medications the JADE
      (Joint Asia Diabetes Evaluation) e-portal, giving a total of 3500 patients.

      This survey which documents the rate of depression in T2D patients using similar
      methodologies will provide a comprehensive data set for exploratory analysis of the
      multicausality and heterogeneity of clinical presentation and risk factors in Chinese
      populations. Once this cohort is established and subject to availability of future funding,
      they can be followed up prospectively to validate and discover risk factors for new onset of
      depression. Apart from raising awareness, these data are essential in our design of care
      models and interventions to tailor the unmet needs of these patients. Data from this study
      will also provide insights into the effects of rapid acculturation and migration on the
      double burden of diabetes and depression in Chinese populations.
    

Intervention name(s): Psychiatrist Interview; Depression screening - control
Intervention type(s): Other; Other
Intervention description(s): Patients will receive a face-to-face interview by a trained clinician or psychiatrist using the following instruments:
MINI
SSI-28 (somatization); All study participants will undergo;
a comprehensive diabetes assessment by completing a full set of questionnaires and clinical assessments, using the JADE e-portal
a detailed psychological and behavioral assessments using validated questionnaires
several specialist questionnaires on depression, self care and quality of life
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Tertiary Hospitals and community centre
      
Keywords: Diabetes; Depression