The differentiation of health behaviors by depression in U.S. diabetic patients

Background: Diabetes and depression are a growing public health concern. Several behavioral factors predispose the development of type 2 diabetes and depression, which warrants their evaluation when examining the association between depression and adverse health outcomes in type 2 diabetes. Methods: Data were from four cycles, 2011-2018, of the National Health and Nutrition Examination Survey (NHANES). Status of depression was self-reported using the Patient Health Questionnaire while diabetes status was determined using an examination. A Rao-Scott chi-square test measured the bivariate association of depression and health behaviors (smoking status, alcohol use, physical activity, diet). Logistic regression models were used to determine effects of behavioral factors and demographics (age, gender, ethnicity, poverty, education). Results: Of 1467 participants, more than half of respondents reported feeling tired or having little energy and trouble sleeping or sleeping too much. Prevalence of non-smokers (69.9, 95% CI: 66.4-73.5) and those with a good diet (68.4, 95% CI: 64.8-71.9) are significantly higher among participants who reported no to mild depression. Heavy alcohol drinking (81.6, 95% CI: 76.7-86.5) is more prevalent among moderate-severely depressed participants. Conclusion: We recommend strategies be enacted to decrease depression and increase healthy behaviors to help improve the quality of life of diabetic patients.