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Depression in Mexican Americans with diagnosed and undiagnosed diabetes

  • R. L. Olvera (a1), S. P. Fisher-Hoch (a2), D. E. Williamson (a1), K. P. Vatcheva (a2) and J. B. McCormick (a2)...



Depression and diabetes commonly co-occur; however, the strength of the physiological effects of diabetes as mediating factors towards depression is uncertain.


We analyzed extensive clinical, epidemiological and laboratory data from n = 2081 Mexican Americans aged 35–64 years, recruited from the community as part of the Cameron County Hispanic Cohort (CCHC) divided into three groups: Diagnosed (self-reported) diabetes (DD, n = 335), Undiagnosed diabetes (UD, n = 227) and No diabetes (ND, n = 1519). UD participants denied being diagnosed with diabetes, but on testing met the 2010 American Diabetes Association and World Health Organization definitions of diabetes. Depression was measured using the Center for Epidemiological Studies – Depression (CES-D) scale. Weighted data were analyzed using dimensional and categorical outcomes using univariate and multivariate models.


The DD group had significantly higher CES-D scores than both the ND and UD (p ⩽ 0.001) groups, whereas the ND and UD groups did not significantly differ from each other. The DD subjects were more likely to meet the CES-D cut-off score for depression compared to both the ND and UD groups (p = 0.001), respectively. The UD group was also less likely to meet the cut-off score for depression than the ND group (p = 0.003). Our main findings remained significant in models that controlled for socio-demographic and clinical confounders.


Meeting clinical criteria for diabetes was not sufficient for increased depressive symptoms. Our findings suggest that the ‘knowing that one is ill’ is associated with depressive symptoms in diabetic subjects.


Corresponding author

* Address for correspondence: R. L. Olvera MD, MPH, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. (Email:


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American Diabetes Association (ADA) (2010). American diabetes association. Standards of medical care in diabetes – 2010. Diabetes Care 33, S11S61.
Alegria, M, Mulvaney-Day, N, Torres, M, Polo, A, Cao, Z, Canino, G (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health 97, 6875.
Ali, S, Stone, MA, Peters, JL, Davies, MJ, Khunti, K (2006). The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabetic Medicine 23, 11651173.
Allan, JD (1998). Explanatory models of overweight among African American, Euro-American, and Mexican American women. Western Journal of Nursing Research 20, 4566.
American Diabetes Association (2014). Standards of medical care in diabetes – 2014. Diabetes Care 37 (Suppl. 1), S14S80.
Anderson, RJ, Freedland, KE, Clouse, RE, Lustman, PJ (2001). The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 24, 10691078.
Batty, GD, Deary, IJ, Gottfredson, LS (2007). Premorbid (early life) IQ and later mortality risk: systematic review. Annals of Epidemiology 17, 278288.
Baumeister, H, Hutter, N, Bengel, J (2012). Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression. Cochrane Database of Systemic Reviews 12, CD008381.
Baumeister, H, Hutter, N, Bengel, J (2014). Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review. Diabetic Medicine 31, 773786.
Bazzazian, S, Besharat, MA (2012). An explanatory model of adjustment to type I diabetes based on attachment, coping, and self-regulation theories. Psychology Health & Medicine 17, 4758.
Black, PH (2006). The inflammatory consequences of psychologic stress: relationship to insulin resistance, obesity, atherosclerosis and diabetes mellitus, type II. Medical Hypotheses 67, 879891.
Black, SA, Markides, KS, Ray, LA (2003). Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 26, 28222828.
Bot, M, Pouwer, F, Ormel, J, Slaets, JP, de Jonge, P (2010). Predictors of incident major depression in diabetic outpatients with subthreshold depression. Diabetic Medicine 27, 12951301.
Brown, SA, Garcia, AA, Kouzekanani, K, Hanis, CL (2002). Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care 25, 259268.
Brown, SA, Hanis, CL (2014). Lessons learned from 20 years of diabetes self-management research with Mexican Americans in Starr County, Texas. The Diabetes Educator 40, 476487.
Crouch, N (2004). Mexicans & Americans: Cracking The Cultural Code. Nicholas Brealey: London.
de Groot, M, Anderson, R, Freedland, KE, Clouse, RE, Lustman, PJ (2001). Association of depression and diabetes complications: a meta-analysis. Psychosomatic Medicine 63, 619630.
Del Ser, T, Gonzalez-Montalvo, JI, Martinez-Espinosa, S, Delgado-Villapalos, C, Bermejo, F (1997). Estimation of premorbid intelligence in Spanish people with the Word Accentuation Test and its application to the diagnosis of dementia. Brain and Cognition 33, 343356.
Diaz, VA, Mainous, AG III, Pope, C (2007). Cultural conflicts in the weight loss experience of overweight Latinos. International Journal of Obesity 31, 328333.
Duangdao, KM, Roesch, SC (2008). Coping with diabetes in adulthood: a meta-analysis. Journal of Behavioral Medicine 31, 291300.
Dziemidok, P, Makara-Studzinska, M, Jarosz, MJ (2011). Diabetes and depression: a combination of civilization and life-style diseases is more than simple problem adding – literature review. Annals of Agricultural and Environmental Medicine 18, 318322.
Egede, LE, Zheng, D (2003). Independent factors associated with major depressive disorder in a national sample of individuals with diabetes. Diabetes Care 26, 104111.
Ennis, SR, Rios-Vargas, M, Albert, NG (2011). The Hispanic Population: 2010. 2010 Census Briefs, United States Census Bureau 1–3.
Fanous, A, Gardner, CO, Prescott, CA, Cancro, R, Kendler, KS (2002). Neuroticism, major depression and gender: a population-based twin study. Psychological Medicine 32, 719728.
Fisher-Hoch, SP, Rentfro, AR, Salinas, JJ, Perez, A, Brown, HS, Reininger, BM, Restrepo, BI, Wilson, JG, Hossain, MM, Rahbar, MH, Hanis, CM, McCormick, JB (2010). Socioeconomic status and prevalence of obesity and diabetes in a Mexican American community, Cameron County, Texas, 2004–2007. Preventing Chronic Disease 7, A53.
Fisher-Hoch, SP, Vatcheva, KP, Rahbar, MH, McCormick, JB (2015). Undiagnosed diabetes and pre-diabetes in Health Disparities. PLoS ONE 10, e0133135.
Fisher, L, Chesla, CA, Mullan, JT, Skaff, MM, Kanter, RA (2001). Contributors to depression in Latino and European-American patients with type 2 diabetes. Diabetes Care 24, 17511757.
Fisher, L, Chesla, CA, Skaff, MM, Gilliss, C, Mullan, JT, Bartz, RJ, Kanter, RA, Lutz, CP (2000). The family and disease management in Hispanic and European-American patients with type 2 diabetes. Diabetes Care 23, 267272.
Gendelman, N, Snell-Bergeon, JK, McFann, K, Kinney, G, Paul Wadwa, R, Bishop, F, Rewers, M, Maahs, DM (2009). Prevalence and correlates of depression in individuals with and without type 1 diabetes. Diabetes Care 32, 575579.
Golden, SH, Lazo, M, Carnethon, M, Bertoni, AG, Schreiner, PJ, Diez Roux, AV, Lee, HB, Lyketsos, C (2008). Examining a bidirectional association between depressive symptoms and diabetes. Journal of the American Medical Association 299, 27512759.
Gottfredson, LS, Deary, IJ (2004). Intelligence predicts health and longevity, but why? Current Directions in Psychological Science 13, 14.
Gragnoli, C (2012). Depression and type 2 diabetes: cortisol pathway implication and investigational needs. Journal of Cellular Physiology 227, 23182322.
Griffin, SL, Mindt, MR, Rankin, EJ, Ritchie, AJ, Scott, JG (2002). Estimating premorbid intelligence: comparison of traditional and contemporary methods across the intelligence continuum. Archives of Clinical Neuropsychology 17, 497507.
Huang, Y, Wei, X, Wu, T, Chen, R, Guo, A (2013). Collaborative care for patients with depression and diabetes mellitus: a systematic review and meta-analysis. BMC Psychiatry 13, 260.
Kaplan, MS, Huguet, N, Newsom, JT, McFarland, BH (2004). The, association between length of residence and obesity among Hispanic immigrants. American Journal of Preventive Medicine 27, 323326.
Karlson, B, Agardh, CD (1997). Burden of illness, metabolic control, and complications in relation to depressive symptoms in IDDM patients. Diabetic Medicine 14, 10661072.
Katon, WJ, Lin, EH, Von Korff, M, Ciechanowski, P, Ludman, EJ, Young, B, Peterson, D, Rutter, CM, McGregor, M, McCulloch, D (2010 a). Collaborative care for patients with depression and chronic illnesses. New England Journal of Medicine 363, 26112620.
Katon, WJ, Russo, JE, Heckbert, SR, Lin, EH, Ciechanowski, P, Ludman, E, Young, B, Von Korff, M (2010 b). The relationship between changes in depression symptoms and changes in health risk behaviors in patients with diabetes. International Journal of Geriatric Psychiatry 25, 466475.
Kendzor, DE, Chen, M, Reininger, BM, Businelle, MS, Stewart, DW, Fisher-Hoch, SP, Rentfro, AR, Wetter, DW, McCormick, JB (2014). The association of depression and anxiety with glycemic control among Mexican Americans with diabetes living near the U.S.-Mexico border. BMC Public Health 14, 176.
Kumanyika, SK (2008). Environmental influences on childhood obesity: ethnic and cultural influences in context. Physiology & Behavior 94, 6170.
Lane, JD, McCaskill, CC, Williams, PG, Parekh, PI, Feinglos, MN, Surwit, RS (2000). Personality correlates of glycemic control in type 2 diabetes. Diabetes Care 23, 13211325.
Lawson, VL, Bundy, C, Harvey, JN (2008). The development of personal models of diabetes in the first 2 years after diagnosis: a prospective longitudinal study. Diabetic Medicine 25, 482490.
Lewinsohn, PM, Seeley, JR, Roberts, RE, Allen, NB (1997). Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging 12, 277287.
Lustman, PJ, Anderson, RJ, Freedland, KE, de Groot, M, Carney, RM, Clouse, RE (2000). Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 23, 934942.
Lyness, JM, Duberstein, PR, King, DA, Cox, C, Caine, ED (1998). Medical illness burden, trait neuroticism, and depression in older primary care patients. American Journal of Psychiatry 155, 969971.
Marin, G, Sabogal, F, Marin, BV, Oterosabogal, R, Perezstable, EJ (1987). Development of a Short Acculturation Scale for Hispanics. Hispanic Journal of Behavioral Sciences 9, 183205.
Markowitz, SM, Gonzalez, JS, Wilkinson, JL, Safren, SA (2011). A review of treating depression in diabetes: emerging findings. Psychosomatics 52, 118.
Mezuk, B, Johnson-Lawrence, V, Lee, H, Rafferty, JA, Abdou, CM, Uzogara, EE, Jackson, JS (2013). Is ignorance bliss? Depression, antidepressants, and the diagnosis of prediabetes and type 2 diabetes. Health Psychology 32, 254263.
Miller-Johnson, S, Emery, RE, Marvin, RS, Clarke, W, Lovinger, R, Martin, M (1994). Parent-child relationships and the management of insulin-dependent diabetes mellitus. Journal of Consulting and Clinical Psychology 62, 603610.
Montez, JK, Eschbach, K (2008). Country of birth and language are uniquely associated with intakes of fat, fiber, and fruits and vegetables among Mexican-American women in the United States. Journal of the American Dietetic Association 108, 473480.
Neuhouser, ML, Thompson, B, Solomon, CC (2004). Higher fat intake and lower fruit and vegetables intakes are associated with greater acculturation among Mexicans living in Washington state. Journal of the American Dietetic Association 104, 5157.
Nouwen, A, Nefs, G, Caramlau, I, Connock, M, Winkley, K, Lloyd, CE, Peyrot, M, Pouwer, FC (2011). Prevalence of depression in individuals with impaired glucose metabolism or undiagnosed diabetes: a systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium. Diabetes Care 34, 752762.
Olvera, RL, Williamson, DE, Fisher-Hoch, SP, Vatcheva, KP, McCormick, JB (in press). Depression, obesity, and metabolic syndrome: prevalence and risks of comorbidity in a population-based representative sample of Mexican Americans. Journal of Clinical Psychiatry.
Quinones, AR, Liang, J, Ye, W (2013). Differences in diabetes mellitus onset for older Black, White, and Mexican Americans. Ethnicity & Disease 23, 310315.
Radloff, LS (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measures 1, 385.
Reuland, DS, Cherrington, A, Watkins, GS, Bradford, DW, Blanco, RA, Gaynes, BN (2009). Diagnostic accuracy of Spanish language depression-screening instruments. Annals of Family Medicine 7, 455462.
Ring, JM, Marquis, P (1991). Depression in a Latino immigrant medical population: an exploratory screening and diagnosis. American Journal of Orthopsychiatry 61, 298302.
Roberts, RE (1980). Reliability of the CES-D Scale in different ethnic contexts. Psychiatry Research 2, 125134.
Ruiz-Grosso, P, Loret de Mola, C, Vega-Dienstmaier, JM, Arevalo, JM, Chavez, K, Vilela, A, Lazo, M, Huapaya, J (2012). Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: a comparative validation study. PLoS ONE 7, e45413.
Sayetta, RB, Johnson, DP (1980). Basic data on depressive symptomatology. United States, 1974–75. Vital and Health Statistics 11, i-v, 137.
Stern, MP, Pugh, JA, Gaskill, SP, Hazuda, HP (1982). Knowledge, attitudes, and behavior related to obesity and dieting in Mexican Americans and Anglos: the San Antonio Heart Study. American Journal of Epidemiology 115, 917928.
Talbot, F, Nouwen, A (2000). A review of the relationship between depression and diabetes in adults: is there a link? Diabetes Care 23, 15561562.
Thoolen, BJ, de Ridder, DT, Bensing, JM, Gorter, KJ, Rutten, GE (2006). Psychological outcomes of patients with screen-detected type 2 diabetes: the influence of time since diagnosis and treatment intensity. Diabetes Care 29, 22572262.
Tuomilehto, J, Lindstrom, J, Eriksson, JG, Valle, TT, Hamalainen, H, Ilanne-Parikka, P, Keinanen-Kiukaanniemi, S, Laakso, M, Louheranta, A, Rastas, M, Salminen, V, Uusitupa, M (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine 344, 13431350.
Wallen, GR, Feldman, RH, Anliker, J (2002). Measuring acculturation among Central American women with the use of a brief language scale. Journal of Immigrant and Minority Health 4, 95102.
Wilkinson, GS (1993). Wide Range Achievement Test. 3. PAR/Psychological Assessment Resources, Inc: Lutz, FL.
Zich, JM, Attkisson, CC, Greenfield, TK (1990). Screening for depression in primary care clinics: the CES-D and the BDI. International Journal of Psychiatry in Medicine 20, 259277.



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