Associations between diabetes and depressive symptoms across European countries

Abstract Background We examined the potential role of several macro- and micro-sociodemographic factors in moderating the longitudinal bi-directional association between depressive symptom severity and diabetes across European countries. This submission summarizes the results of two empirical studies and workshop-based group discussions with people living with diabetes. Methods We analyzed data from three prospective cohort studies - the English Longitudinal Study on Ageing, the Irish Longitudinal study on Ageing, and the Survey on Health, Ageing and Retirement in Europe. We examined possible country-level and individual-level sociodemographic factors of diabetes, including healthcare quality and expenditure, wealth inequalities, and health behaviors, as moderators of the relationship between newly developed diabetes and depressive symptoms. Lived experience of diabetes reports were collected via two public workshops in Ireland. Results Depressive symptoms were a risk factor for diabetes (HR = 1.14, 95% CI [1.10;1.18]), and vice versa (HR = 1.48, 95% CI [1.37;1.61]), and the hazard ratios were stable across European geographical regions. All sociodemographic factors significantly (all p's < .01) predicted both the risk of diabetes and the incidence of elevated depressive symptoms but, except for BMI, did not moderate the strength of their association (all p's > .01). Workshop reports demonstrated that some people with diabetes in Ireland experience a significant psychological burden because of their condition, about which they felt their healthcare practitioners should be better informed. Conclusions The relationship between depressive symptoms and diabetes was consistent, regardless of most individual- or country-level factors. Because of this, international policies on managing depression-diabetes comorbidity might be applicable across European countries. In Ireland, healthcare practitioners should be better informed about the characteristics of daily living with diabetes. Key messages • The relationship between diabetes and depressive symptoms is stable across Europe, suggesting the same robust underlying mechanism of their mutual interaction. • Healthcare practitioners and public health decision makers in Ireland should be more aware of the challenges to mental health which are associated with diabetes diagnosis.