Online Program

Association of depression with diabetes management among urban American indians/Alaska natives in the United States, 2011

Monday, November 4, 2013

Elizabeth Knaster, MPH, Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA
Amanda Fretts, PhD, Department of Epidemiology, University of Washington, Seattle, WA
Leslie Phillips, PhD, Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA
Background: American Indians/Alaska Natives (AI/ANs) are more than twice as likely to have diabetes as non-Hispanic whites, and all individuals with diabetes are more likely to have depression. There is limited research on the association of depression with diabetes outcomes, particularly among urban AI/ANs. This analysis explores the relationship between depression and diabetes management among urban AI/ANs who received care at Urban Indian Health Organizations (UIHOs). Methods: Data were obtained from the Indian Health Service (IHS) Diabetes Care and Outcomes Audit performed at UIHOs. In 2011, 33 urban facilities participated; 3,741 patient records were audited. Primary exposure was depression as current medical problem. Outcomes included HbA1c, smoking, BMI, systolic blood pressure, creatinine, total cholesterol, and receipt of specific preventive services. Multivariate linear and logistic regression models assessed the relationship of depression with each outcome, using individuals with no depression as the reference group. Results: Individuals with depression and diabetes were 1.5 times more likely to smoke than individuals with diabetes but without depression (OR=1.51; 95% CI: 1.23, 1.86), controlling for age, sex, and facility. The geometric mean BMI in diabetes patients with depression was 3% higher than in patients without depression after adjustment (β=0.034; 95% CI, 0.011, 0.057). Conclusion: Urban AI/ANs with diabetes and depression are more likely to smoke and have higher BMI than those with diabetes but no depression. These findings contribute to the limited urban AI/AN-specific literature on this topic, and inform programmatic efforts to address the care and treatment of patients with both depression and diabetes.

Learning Areas:

Chronic disease management and prevention
Diversity and culture

Learning Objectives:
Describe the cross-sectional relationship between depression and diabetes management among a clinical population of urban American Indians/Alaska Natives. Discuss the role of mental and emotional health in diabetes care for American Indians/Alaska Natives, specifically the impact of stress and trauma experienced by American Indians/Alaska Natives.

Keyword(s): Diabetes, Depression

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I coordinate the Urban Indian Health Institute's diabetes program. This program promotes data driven quality improvement activities by providing technical assistance and by assessing health outcomes of urban American Indians/Alaska Natives (AI/ANs) receiving diabetes care at Urban Indian Health Organizations. Among my scientific interests is the relationship between chronic disease and mental health, including the effects of early life trauma and historical trauma on diabetes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.