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Diabetes Res Clin Pract. 2014 Feb;103(2):276-85. doi: 10.1016/j.diabres.2014.01.001. Epub 2014 Jan 13.

Depression and type 2 diabetes in low- and middle-income countries: a systematic review.

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Science, Technology, and International Affairs Program, Walsh School of Foreign Service, 301 Intercultural Center, Georgetown University, Washington D.C. 20057, United States. Electronic address:
MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Indian Institute of Public Health and Public Health Foundation of India, Hyderabad, India.
Centre of Excellence for Cardiometabolic Risk Reduction in South Asia (CARRS), and Centre for Chronic Disease Control, New Delhi, India.


Eighty percent of people with type 2 diabetes reside in low- and middle-income countries (LMICs). Yet much of the research around depression among people with diabetes has been conducted in high-income countries (HICs). In this systematic review we searched Ovid Medline, PubMed, and PsychINFO for studies that assessed depression among people with type 2 diabetes in LMICs. Our focus on quantitative studies provided a prevalence of comorbid depression among those with diabetes. We reviewed 48 studies from 1,091 references. We found that this research has been conducted primarily in middle-income countries, including India (n = 8), Mexico (n = 8), Brazil (n = 5), and China (n = 5). There was variation in prevalence of comorbid depression across studies, but these differences did not reveal regional differences and seemed to result from study sample (e.g., urban vs rural and clinical vs population-based samples). Fifteen depression inventories were administered across the studies. We concluded that despite substantial diabetes burden in LMICs, few studies have reviewed comorbid depression and diabetes. Our review suggests depression among people with diabetes in LMICs may be higher than in HICs. Evidence from these 48 studies underscores the need for comprehensive mental health care that can be integrated into diabetes care within LMIC health systems.


Comorbidity; Depression; Diabetes; Low- and middle-income countries

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