Depression and diabetes: Synergistic impact on exercise and meals prepared away from home

Background:Depression is associated with negative behaviors and is more common in people with diabetes. It is unknown if the combination of depression and diabetes has a negative synergistic effect on exercise and preparing meals at home, two important behaviors for diabetes control.

Methods:We included all adults age 20 or over from the National Health and Nutrition Examination Survey (NHANES) 2007-2008, 2009-2010 cohorts. Logistic and Modified Poisson regression models were run for two outcome variables: any exercise and daily meals prepared away from home. Any exercise was defined as doing any moderate or vigorous intensity recreational activities for at least 10 minutes. Daily meals prepared away from home was defined as 7+ meals in the last week prepared away from home. Study variables: depression, diabetes, depression*diabetes interaction term. Depression was defined as a positive PHQ-9 screen (score>=10). Diabetes was defined as ever told by a doctor you have diabetes. Models were adjusted for age, race, sex, education, income, marital status, overall health.  Analyses accounted for complex survey design.

Results:12,153 adults were included.  8.0% had depression, 8.6% had diabetes. Mean age was: 46.9 overall, 44.8 in people with depression, 59.0 in people with diabetes, 54.9 in people with both depression and diabetes. Depression was more common in people with diabetes (13.5% vs. 7.3%; p<.0001). 51.2% did any exercise; this rate was lower in people with depression (28.1% vs. 54.5%; p<.0001) or diabetes (33.1% vs. 53.2%; p<.0001), and was just 8.6% in people with both diabetes and depression. 18.9% had a daily meal prepared away from home; this was not associated with depression (16.8% vs. 19.1%; p=.1664) but was less common in people with diabetes (14.3% vs. 19.3%; p<.0001) and was 16.9% in people with both. After adjusting, associated with getting any exercise: depression (23% less likely; p<.0001) and depression*diabetes (61% less likely; p=.0235), but not diabetes. Thus, people with depression and diabetes were 70% less likely to get any exercise than people with neither. Associated with daily meals prepared away from home: neither depression or diabetes alone, but people with depression and diabetes were 95% more likely(p=.0215), and among those aged 50 or older, people with depression and diabetes were 3.7 times as likely(p=.0007).

Conclusion: The combination of depression and diabetes has a powerful synergistic negative impact on getting exercise and preparing meals at home. Since depression is particularly prevalent in people with diabetes, this is a major concern for diabetes control.