State-Specific Prevalence of Depression Among Adults With and Without Diabetes

United States, 2011-2019

Alain K. Koyama, ScD; Israel A. Hora, PhD, MS; Kai McKeever Bullard, PhD, MPH; Stephen R. Benoit, MD, MPH; Shichao Tang, PhD, MPA; Pyone Cho, MBBS, MPH, MA

Disclosures

Prev Chronic Dis. 2023;20(8):E70

Abstract and Introduction

Abstract

Introduction: In 2019 among US adults, 1 in 9 had diagnosed diabetes and 1 in 5 had diagnosed depression. Since these conditions frequently coexist, compounding their health and economic burden, we examined state-specific trends in depression prevalence among US adults with and without diagnosed diabetes.

Methods: We used data from the 2011 through 2019 Behavioral Risk Factor Surveillance System to evaluate self-reported diabetes and depression prevalence. Joinpoint regression estimated state-level trends in depression prevalence by diabetes status.

Results: In 2019, the overall prevalence of depression in US adults with and without diabetes was 29.2% (95% CI, 27.8%–30.6%) and 17.9% (95% CI, 17.6%–18.1%), respectively. From 2011 to 2019, the depression prevalence was relatively stable for adults with diabetes (28.6% versus 29.2%) but increased for those without diabetes from 15.5% to 17.9% (average annual percent change [APC] over the 9-year period = 1.6%, P = .015). The prevalence of depression was consistently more than 10 percentage points higher among adults with diabetes than those without diabetes. The APC showed a significant increase in some states (Illinois: 5.9%, Kansas: 3.5%) and a significant decrease in others (Arizona: −5.1%, Florida: −4.0%, Colorado: −3.4%, Washington: −0.9%). In 2019, although it varied by state, the depression prevalence among adults with diabetes was highest in states with a higher diabetes burden such as Kentucky (47.9%), West Virginia (47.0%), and Maine (41.5%).

Conclusion: US adults with diabetes are more likely to report prevalent depression compared with adults without diabetes. These findings highlight the importance of screening and monitoring for depression as a potential complication among adults with diabetes.

Introduction

Though diabetes incidence has begun to decline, prevalence remains high, and therefore the burden of diabetes complications persists as a major public health concern.^[1] Much of the research and clinical focus on diabetes complications involves conditions such as cardiovascular disease, kidney disease, and neuropathy rather than mental health. While end-organ damage can substantially contribute to a lower quality of life and increased deaths, mental health conditions such as depression can negatively affect management of diet, adequate physical activity, smoking cessation, glycemic control, and medication adherence.^[2] Therefore, whether indirectly through poor disease management or through potentially direct biologic mechanisms,^[3] prevention of depression can be vital to improve diabetes outcomes.

In 2019 in the US, about 1 in 9 adults had diagnosed diabetes,^[1] and 1 in 5 adults had diagnosed depression.^[4] While the prevalence of diabetes increases with age, depression tends to be more prevalent among younger age groups.^[5] Disparate trends are also observed by sex, where men are more likely to have diabetes than women, but women are more likely to have depression than men.^[4] Both conditions are more prevalent among adults of low socioeconomic status.^[6,7] Among adults with diabetes, measuring prevalence of depression can be essential to evaluating its potential to affect diabetes outcomes and to highlight any sociodemographic or geographic disparities in prevalence.

Although the national prevalence of mental health conditions, including depression, among adults with diabetes has been reported,^[8,9] to our knowledge information on state-specific prevalence estimates of depression among adults with diabetes is limited. Additionally, previous studies were published before diabetes incidence began to decline in the US, therefore an updated analysis is merited because the prevalence of comorbid conditions may have also changed. We assessed the state-specific prevalence of diagnosed depression among adults in the US from 2011 through 2019, evaluating trends over time as well as prevalence within sociodemographic subgroups.

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Abstract and Introduction
Methods
Results
Discussion
References
Sidebar

Table 1. Characteristics of US Adults Aged ≥18 Years, by Self-Reported Diabetes Status, 50 States and the District of Columbia, Behavioral Risk Factor Surveillance System, 2019 ^a
Characteristic	Diabetes	No diabetes
Sample size, no.	55,881	353,104
Weighted sample size, no.	27,496,213	221,532,054
Age group, y
Mean age	61.1	46.0
18–44	12.2	50.2
45–64	43.2	31.3
65–74	26.7	11.0
≥75	17.8	7.5
Sex
Men	50.4	48.5
Women	49.6	51.5
Race or ethnicity
Hispanic	17.8	16.7
Non-Hispanic Black	16.1	11.4
Non-Hispanic White	58.4	63.1
Non-Hispanic other^b	7.7	8.7
Education level
Less than high school graduate	20.6	11.8
High school graduate or equivalent	29.9	27.5
Some college	30.4	31.1
College graduate	19.1	29.5
Annual household income, $
<35,000	49.4	33.4
35,000–<50,000	13.5	12.7
50,000–<75,000	13.4	15.2
≥75,000	23.7	38.7
Health insurance coverage
Insured	91.8	86.4
Uninsured	8.2	13.6

^aAll values are weighted percentages unless otherwise noted. All P values are < .001 when comparing characteristics by diabetes status. P values are from χ² tests except for the mean age comparison, in which a 2-sample t test was used.
^bIncludes non-Hispanic American Indian and Alaska Native, non-Hispanic Asian and Pacific Islander, and multiracial groups.

Table 2. State-Specific Age-Adjusted Depression Prevalence Among US Adults With Diabetes, Behavioral Risk Factor Surveillance System, 2011−2019
State	2011	2013	2015	2017	2019	Time Period 1		Time Period 2
State	2011	2013	2015	2017	2019	Years	APC (95% CI)	Years	APC (95% CI)
Alabama	38.6	31.2	37.1	42.8	29.8	2011–2019	0.9 (−3.1 to 5.1)	NA	NA
Alaska	36.5	20.0	33.7	28.2	34.8		−0.1 (−6.9 to 7.3)
Arizona	34.9	34.0	37.3	27.0	26.1		−5.1 (−8.2 to −1.9)
Arkansas	38.0	37.5	35.7	33.7	26.7		−1.9 (−4.8 to 1.1)
California	16.2	19.9	19.3	22.8	17.3		3.3 (−0.9 to 7.7)
Colorado	31.3	31.8	28.6	26.3	24.2		−3.4 (−6.3 to −0.3)
Connecticut	27.3	32.9	31.9	30.7	22.5	2011–2014	12.1 (−7.1 to 35.2)	2014–2019	−7.1 (−14.7 to 1.2)
Delaware	29.4	35.6	22.6	21.6	25.4	2011–2019	−3.5 (−7.7 to 0.9)	NA	NA
District of Columbia	22.5	27.1	25.1	30.6	33.1		3.8 (−1.7 to 9.7)
Florida	31.2	35.6	31.5	28.7	25.8		−4.0 (−6.2 to −1.7)
Georgia	27.4	31.5	34.8	27.6	21.2		−1.9 (−6.4 to 2.8)
Hawaii	20.7	17.6	15.1	17.6	21.9		1.9 (−4.7 to 8.8)
Idaho	41.2	34.1	36.4	38.8	39.1		−0.7 (−5.4 to 4.4)
Illinois	17.2	22.0	24.0	28.9	31.5		5.9 (2.6 to 9.3)
Indiana	34.4	27.8	27.3	41.8	28.9		0.2 (−4.7 to 5.3)
Iowa	28.3	36.2	28.2	37.5	29.3		−0.9 (−4.7 to 3.1)
Kansas	27.0	31.4	35.4	38.8	33.3		3.5 (0.6 to 6.5)
Kentucky	40.8	37.6	31.6	46.0	47.9		2.4 (−0.8 to 5.8)
Louisiana	30.2	29.1	32.2	31.0	32.2		2.0 (−0.9 to 4.9)
Maine	44.6	36.2	42.1	43.2	41.5		0.2 (−2.4 to 2.9)
Maryland	21.5	24.9	26.9	32.7	24.3		0.0 (−4.5 to 4.6)
Massachusetts	27.6	33.1	30.0	27.1	33.7		1.2 (−2.7 to 5.2)
Michigan	35.1	35.1	29.5	35.1	34.0		1.1 (−2.1 to 4.4)
Minnesota	29.1	41.5	33.1	32.2	30.9		−0.6 (−5.0 to 3.9)
Mississippi	31.8	32.6	26.0	32.3	38.1		2.7 (−0.7 to 6.2)
Missouri	42.4	39.2	42.9	37.4	33.4		−1.5 (−5.6 to 2.8)
Montana	47.5	37.1	33.5	40.6	29.7		−2.7 (−7.2 to 2.1)
Nebraska	29.8	30.5	32.6	34.2	26.3	2011–2017	1.8 (−0.6 to 4.2)	2017–2019	−11.6 (−23.4 to 2.1)
Nevada	27.5	32.3	30.0	25.9	19.9	2011–2019	0.2 (−5.6 to 6.4)	NA	NA
New Hampshire	42.3	33.5	33.2	32.7	36.5	2011–2019	−0.3 (−4.5 to 4.1)
New Jersey	21.1	25.2	24.9	18.2	NA^a	2011–2018	−0.6 (−6.3 to 5.5)
New Mexico	31.8	29.8	37.6	31.0	31.7	2011–2019	−0.5 (−3.5 to 2.7)
New York	26.4	27.9	28.6	27.2	24.0		−1.9 (−4.6 to 0.8)
North Carolina	28.3	34.7	35.3	30.1	37.6		1.2 (−1.5 to 3.9)
North Dakota	39.2	35.8	24.3	35.8	26.3		−1.7 (−7.7 to 4.6)
Ohio	27.2	37.5	39.4	39.0	36.2		1.7 (−1.8 to 5.3)
Oklahoma	36.9	46.5	40.3	32.1	33.4		−2.1 (−5.8 to 1.7)
Oregon	45.4	37.4	37.1	37.0	38.8		0.7 (−3.9 to 5.4)
Pennsylvania	36.2	37.5	26.8	38.0	37.6		0.1 (−3.5 to 3.9)
Rhode Island	40.9	33.3	46.8	30.0	26.9		−4.1 (−10.9 to 3.3)
South Carolina	20.5	30.8	31.5	32.1	32.1	2011–2013	23.4 (4.9 to 45.3)	2013–2019	0.5 (−2.3 to 3.4)
South Dakota	29.7	28.4	28.3	30.4	35.7	2011–2019	1.7 (−2.3 to 5.9)	NA	NA
Tennessee	40.1	30.3	32.7	44.7	39.3		3.9 (−0.2 to 8.2)
Texas	28.3	23.0	24.9	30.6	28.2		1.2 (−4.4 to 7.1)
Utah	35.0	33.1	31.1	37.1	30.7		−0.4 (−2.7 to 2.0)
Vermont	37.3	44.1	34.6	41.5	31.7		−2.4 (−6.3 to 1.6)
Virginia	23.9	24.2	24.4	28.8	32.0		2.3 (−1.1 to 5.9)
Washington	37.7	35.8	36.5	37.0	34.9		−0.9 (−1.6 to −0.2)
West Virginia	34.6	40.6	36.6	38.1	47.0		2.8 (0.0 to 5.7)
Wisconsin	18.0	29.5	22.3	27.1	37.0		2.1 (−6.4 to 11.4)
Wyoming	28.2	42.1	35.7	33.1	32.8		−0.3 (−6.7 to 6.4)

Abbreviations: APC, annual percentage change; NA, not applicable.
^aNew Jersey had no survey data in 2019. Prevalence is shown for every other year over the study period for brevity. APC represents the estimated mean percentage change each year in depression prevalence for each period identified by joinpoint regression. APC for 1 time period is shown when joinpoint regression modeled prevalence over the study period as a monotonic linear trend. APC for 2 time periods is shown when joinpoint regression identified a change in linear trend. APC for 6 states (Arizona, Colorado, Florida, Illinois, Kansas, and Washington) was significant (P < .05).