Prevalence and Associated Factors of Depression among Type 2 Diabetes Patients on Follow-up at Referral Hospital in Rwanda

Document Type : Original Article


1 Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Africa

2 Mental Health and Behavior Research Group, College of Medicine and Health Sciences, University of Rwanda, Africa

3 Rwanda National Commission for Children, Rwanda, Africa

4 Department of Public Health, College of Medicine and Health Sciences, University of Rwanda, Africa


Introduction: Despite substantial evidence showing that diabetes and psychiatric disorders influence each other in multiple ways, these two issues remain largely unstudied in Rwanda.  This study therefore, was aimed to determine the predictors of depression, and the moderating factors of its association with glycaemic level.
Method: A convenient sample of 96 patients with Type 2 Diabetes (T2D) (MA=55, SD=11.63) from Butare University Teaching Hospital (CHUB) was selected for participation in this institutional based cross-sectional study. Data were collected using the standardized measures of mental disorders and social support, and analyzed using the IBM SPSS version 28.
Results: Results indicated that 83.34% of the sample had clinical levels of moderate to severe depression. Its associated factors were glycemic levels (b=.74, p˂.001), psychiatric symptoms (b=.46, p˂.05), gender and self-esteem (b=-.25, p˂.05). Notably, self-esteem (b=.79, p =.0001), psychiatric symptoms (b=.90, p=.000), gender (b=-.32, p=.001), and poverty (b=.38, p=.00001) were significant moderators of the associations between glycemic level and depression symptoms.
Conclusion: Our findings highlight the factors of depression, and the moderators of the relationship between glycemic level and depression among patients with T2D. These findings will inform both endocrinologist and mental health professionals about the associations that should be monitored, and issues to be addressed to avoid worsening of glycemic control and depression.


  1. Khan MAB, Hashim MJ, King JK, et al. Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends. J Epidemiol Glob Health 2020; 10: 107-111. DOI: 10.2991/jegh.k.191028.001.
  2. Ogurtsova K, da Rocha Fernandes J, Huang Y, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes research and clinical practice 2017; 128: 40-50.
  3. Association CMH. Recommendations for preventing and managing co-existing chronic physical conditions and mental illnesses. 2008. 2016.
  4. Association AD. Standards of medical care in diabetes—2010. Diabetes care 2010; 33: S11-S61.
  5. Kamuhabwa AR and Charles E. Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam. Drug Healthc Patient Saf 2014; 6: 155-165. 20141024. DOI: 10.2147/DHPS.S68786.
  6. Luigi P, Chiara FM, Laura Z, et al. Arterial Hypertension, Metabolic Syndrome and Subclinical Cardiovascular Organ Damage in Patients with Asymptomatic Primary Hyperparathyroidism before and after Parathyroidectomy: Preliminary Results. International Journal of Endocrinology 2012; 2012: 1-10. DOI: 10.1155/2012/408295.
  7. Holt RIG, De Groot M and Golden SH. Diabetes and Depression. Current Diabetes Reports 2014; 14. DOI: 10.1007/s11892-014-0491-3.
  8. Kalra S, Jena BN and Yeravdekar R. Emotional and Psychological Needs of People with Diabetes. Indian J Endocrinol Metab 2018; 22: 696-704. DOI: 10.4103/ijem.IJEM_579_17.
  9. Turner J and Kelly B. Emotional dimensions of chronic disease. West J Med 2000; 172: 124-128. DOI: 10.1136/ewjm.172.2.124.
  10. Bădescu S, Tătaru C, Kobylinska L, et al. The association between diabetes mellitus and depression. Journal of medicine and life 2016; 9: 120.
  11. Jeong JH, Um YH, Ko SH, et al. Depression and Mortality in People with Type 2 Diabetes Mellitus, 2003 to 2013: A Nationwide Population-Based Cohort Study. Diabetes Metab J 2017; 41: 296-302. DOI: 10.4093/dmj.2017.41.4.296.
  12. Lustman PJ, Freedland KE, Griffith LS, et al. Fluoxetine for depression in diabetes: a randomized double-blind placebo-controlled trial. Diabetes Care 2000; 23: 618-623. DOI: 10.2337/diacare.23.5.618.
  13. Rubin RR, Ma Y, Marrero DG, et al. Elevated depression symptoms, antidepressant medicine use, and risk of developing diabetes during the diabetes prevention program. Diabetes Care 2008; 31: 420-426. 20071210. DOI: 10.2337/dc07-1827.
  14. Mukeshimana M and Chironda G. Depression and Associated Factors Among the Patients with Type 2 Diabetes in Rwanda. Ethiop J Health Sci 2019; 29: 709-718. DOI: 10.4314/ejhs.v29i6.7.
  15. Mezuk B, Eaton WW, Albrecht S, et al. Depression and Type 2 Diabetes Over the Lifespan. Diabetes Care 2008; 31: 2383-2390. DOI: 10.2337/dc08-0985.
  16. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571. DOI: 10.1001/archpsyc.1961.01710120031004.
  17. Kaltiala-Heino R, Rimpelä M, Rantanen P, et al. Finnish modification of the 13-item Beck Depression Inventory in screening an adolescent population for depressiveness and positive mood. Nordic Journal of Psychiatry 1999; 53: 451-457. DOI:
  18. Collet L and Cottraux J. [The shortened Beck depression inventory (13 items). Study of the concurrent validity with the Hamilton scale and Widlöcher's retardation scale]. Encephale 1986; 12: 77-79.
  19. Derogatis LR. SCL-90-R: Administration, scoring & procedures manual-II for the (revised) version and other instruments of the psychopathology rating scale series. Clinical Psychometric Research 1992: 1-16.
  20. Hardt J, Gerbershagen HU and Franke P. The symptom check-list, SCL-90-R: its use and characteristics in chronic pain patients. Eur J Pain 2000; 4: 137-148. DOI: 10.1053/eujp.2000.0162.
  21. Spielberger CD. Test anxiety inventory. The Corsini encyclopedia of psychology 2010: 1-1.
  22. Zsido AN, Teleki SA, Csokasi K, et al. Development of the short version of the spielberger state-trait anxiety inventory. Psychiatry Res 2020; 291: 113223. 20200612. DOI: 10.1016/j.psychres.2020.113223.
  23. NISHIKAWA H, NAKAMURA K and NAKANO S. Adequate information to patients on lorazepam and its expected actions enhances the antianxiety effect of this drug during dental treatment. Rinsho yakuri/Japanese Journal of Clinical Pharmacology and Therapeutics 2005; 36: 89-100.
  24. Rosenberg M. Society and the adolescent self-image (Revised edition). Middletown, CT. Wesleyan University Press Retrieved November 1989; 11: 2006.
  25. Zimet GD, Powell SS, Farley GK, et al. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess 1990; 55: 610-617. DOI: 10.1080/00223891.1990.9674095.
  26. Zimet GD, Dahlem NW, Zimet SG, et al. The multidimensional scale of perceived social support. Journal of personality assessment 1988; 52: 30-41.
  27. Aiken LS, West SG and Reno RR. Multiple regression: Testing and interpreting interactions. sage, 1991.
  28. Azad N, Gondal M, Abbas N, et al. Frequency of depression and anxiety in patients attending a diabetes clinic. Journal of Ayub Medical College Abbottabad 2014; 26: 323-327.
  29. Mir K, Mir K, Malik I, et al. Prevalence of Co-morbid Depression in Diabetic Population. J Ayub Med Coll Abbottabad 2015; 27: 99-101.
  30. Khullar S, Dhillon H, Kaur G, et al. The Prevalence and Predictors of Depression in Type 2 Diabetic Population of Punjab. Community Ment Health J 2016; 52: 479-483. 20160102. DOI: 10.1007/s10597-015-9985-y.
  31. Rivera-Hernandez M. Depression, self-esteem, diabetes care and self-care behaviors among middle-aged and older Mexicans. Diabetes Res Clin Pract 2014; 105: 70-78. 20140428. DOI: 10.1016/j.diabres.2014.04.017.
  32. Mutabaruka J, Séjourné N, Bui E, et al. Traumatic grief and traumatic stress in survivors 12 years after the genocide in Rwanda. Stress Health 2012; 28: 289-296. 20111005. DOI: 10.1002/smi.1429.
  33. Ridley M, Rao G, Schilbach F, et al. Poverty, depression, and anxiety: Causal evidence and mechanisms. Science 2020; 370. DOI: 10.1126/science.aay0214.
  34. Habumugisha E and Mutabaruka J. War Exposure, Peritraumatic Distress, Traumatic Grief and PTSD among Democratic Republic of Congo (DRC) Refugees living in Rwanda: Kigeme and Gihembe Camps. J Trauma Stress Disor Treat 5 2016; 1: 2.
  35. Zarei S and Fuladvand K. Boredom Mediates the Relationship between Depression Symptoms and Compulsive Buying Behavior among Female Adolescents. International Journal of Behavioral Sciences 2021; 15: 107-112. DOI: 10.30491/IJBS.2021.263575.1449.
  36. Rezazadeh Z, Hossein Sabet F and Sohrabi F. Predicting Adolescents' Resiliency Rate Based on Parenting Styles Mediated by the Basic Psychological Needs Satisfaction. International Journal of Behavioral Sciences 2020; 14: 136-142.
  37. Jarso MH and Likasa DD. Prevalence and Associated Factors of Depression Among Diabetic Outpatients in Ethiopia. Prim Care Companion CNS Disord 2020; 22 20200402. DOI: 10.4088/PCC.19m02479.
  38. Raval A, Dhanaraj E, Bhansali A, et al. Prevalence and determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian J Med Res 2010; 132: 195-200.