The burden of depression among patients with type 2 diabetes: An umbrella review of systematic reviews

Objective: Depression is common among patients with type 2 diabetes (T2D) which is a major global health concern. This umbrella review aims to explore differences in reported depression prevalence among people with type 2 diabetes and to identify the factors contributing to the variation. Methods: A literature search was conducted in PubMed, EMBASE, PsycINFO and Cochrane. We included systematic reviews with or without a meta-analysis that investigated the prevalence of depression in adult patients (age 18 years or older) with T2D. Two independent reviewers screened titles and abstracts. The following data were extracted: study characteristics, depression assessment approach, and depression prevalence from systematic reviews and each primary study. Findings: Of the 23 systematic reviews meeting inclusion criteria, comprising 649 unique primary studies, pooled depression prevalence ranged from 8.9 % to 61.6 %, with substantial heterogeneity (I2 values ranged from 89.41 % to 99.96 %). Studies conducted in the African (0.11 [95%CI 0.04-0.17]), Eastern Mediterranean (0.19 [95%CI 0.15-0.24]) and South-East Asia (0.08 [95%CI 0.03-0.13]) reported higher prevalence compared to the Americas. Additionally, studies utilizing screenings other than the Hamilton Depression Rating Scale (HDRS) exhibited lower prevalence rates (between -22 % and -0.10 %). Conclusion: The burden of depression was high among people with T2D. Substantial variation was found in the prevalence of depression among individuals with T2D, depending on the WHO region and the depression assessment approach.