1. Causes of Depression in the Elderly
Various factors contribute to the occurrence of depression in the elderly, including sociodemographic factors, economic factors, and physical health conditions. Among these factors, it has been found that the presence of chronic diseases is closely related to depression. The incidence of depression is higher in elderly individuals with chronic illnesses, and if proper treatment is not provided when depression occurs in these individuals, it can worsen the symptoms of depression. Conversely, the worsening of depression can also have a negative impact on the treatment progress of physical illnesses.
2. Diabetes and Depression
Diabetes is one of the major diseases with a significant burden in South Korea. From 2008 to 2018, it ranked first in the disease burden for a period of 10 years. Pharmaceutical companies worldwide are continuously developing effective drugs for diabetes treatment. In recent years, clinical trials for the development of combination therapies involving three diabetes medications have been conducted in South Korea, and the development of new drugs for these indications is also underway.
If diabetes is not properly treated, it can lead to complications such as cardiovascular diseases, neuropathy, nephropathy, and retinopathy. In addition to these complications, depression can also occur. Although depression is relatively less recognized compared to other diabetes complications, diabetes is a disease that has a significant psychological impact in terms of onset and disease progression. Diabetic patients often experience various negative psychological changes, which increase the risk of developing depression.
3. Definition of Depression
Depression is a common mental disorder characterized by symptoms such as sadness, loss of interest or pleasure, guilt, low self-esteem, sleep or appetite disturbances, fatigue, and impaired concentration. Depression has been reported to affect over 300 million people worldwide. The World Health Organization (WHO) has identified depression as a leading cause of disability and predicted that it will be the most burdensome disease for humanity by 2030.
4. Current Status of Depression in South Korea
Looking at the current status of depression in South Korea, the number of depression patients has increased by 35.1% (annual average of 7.8%) from 2017 to 2021, with 931,481 patients in 2021 compared to 691,164 patients in 2017. In 2017, patients in their 60s accounted for the largest proportion of total depression patients at 18.7%, but in 2021, patients in their 20s were the largest group at 19.0%.
5. Screening and Diagnosis of Depression
If there are depressive symptoms, it is important to use validated and reliable screening tests to assess the presence of depression. There are various types of depression screening tests available, and the Korean National Health and Nutrition Examination Survey uses the PHQ-9 for depression screening. The CES-D, a 20-item tool developed by Radloff in 1977, measures the level of depressive symptoms based on the frequency experienced over the past week, and a score of 16 is used as the cutoff point internationally, while 21 is used in South Korea for diagnosis.
6. Relationship between Diabetes and Depression
Diabetes is a disease that arises from problems with insulin secretion, which regulates blood glucose levels. It is classified into type 1 diabetes, where the beta cells of the pancreas gradually get destroyed, resulting in a lack of insulin secretion, and type 2 diabetes, which is caused by insulin resistance (reduced effectiveness of insulin) and insufficient insulin secretion. In South Korea, diabetes had the highest disease burden rate for a period of 10 years, and as of 2020, the number of diabetes patients aged 30 and above in South Korea was approximately 6 million, surpassing the predicted number of diabetes patients by the Korean Diabetes Association for the year 2050. Diabetes is known to be a disease with a high risk of developing complications such as cardiovascular diseases, neuropathy, nephropathy, and retinopathy, and depression is one of them.
Depression is known to be the most common psychiatric disorder among diabetes patients and is reported to be twice as high compared to patients without diabetes. The Ministry of Health and Welfare has published guidelines for psychological support for diabetes, stating that depression exacerbates the symptoms of diabetes, reduces treatment compliance, adversely affects blood glucose control, and increases the risk of progression of peripheral organ damage.
The mechanisms by which diabetes triggers depression have not been clearly elucidated yet, but it is believed to result from complex interactions of psychological, physical, and genetic factors. Hypotheses explaining the relationship include increased stress due to the intensity and repetitiveness of diabetes treatment, prolonged duration of diabetes leading to increased burden from other comorbidities and complications, and decreased quality of life. Furthermore, as diabetes and depression are both metabolic disorders, there is mention of their association, and some Mendelian randomization studies have found single-nucleotide polymorphisms known to contribute to diabetes as predictive variables for distress, interpersonal relationships, temperament, and other depressive symptoms, suggesting a link between diabetes and depression.
Studies have shown that in individuals with diabetes, females, those aged 75 and above, those with a high school education or below, those who do not engage in regular exercise, or those living alone have higher depression scores compared to individuals without diabetes. According to the guidelines for psychological support for diabetes published by the designated Type 2 Diabetes Clinical Research Center of the Ministry of Health and Welfare, the onset of diabetes can be a crisis for many people. Emotionally challenging times can be accompanied by clinically evident or latent emotional problems, and pre-existing emotional issues can worsen.
In addition, severe mental disorders such as major depressive disorder or anxiety disorder can occur after the diagnosis of diabetes. If depression occurs in patients with diabetes, it can increase the risk of conditions such as stroke and cardiovascular disease, so it is important to consider both physical aspects and provide emotional support.
Therefore, more attention and affection from families are needed to prevent depression in patients with diabetes. Thank you for your attention.
