Clinical Depressive Symptoms and Diabetes in a Binational Border Population

Nelda Mier; Anabel Bocanegra-Alonso; Dongling Zhan; Suojin Wang; Steven M. Stoltz; Rosa I. Acosta-Gonzalez; Miguel A. Zuniga

doi:10.3122/jabfm.2008.03.070255

Article Figures & Data

Tables

View popup

Table 1.

Comparison of Demographic and Health Characteristics Between South Texas and Northern Tamaulipas Samples

	South Texas (n = 172)^† (n [%]^‡)	Northern Tamaulipas (n = 200)^† (n [%]^‡)	P
Demographic characteristics
Gender^*			.022
Female	113 (65.7)	153 (76.5)
Male	59 (34.3)	47 (23.5)
Marital status			.574
Married	110 (64.0)	121 (61.1)
Not married	62 (36.0)	77 (38.9)
Country of origin			.000
Mexico	82 (47.7)	200 (100)
United States	90 (52.3)	0 (0)
Education^*			.007
<High school	98 (57.0)	140 (70.4)
≥High school	74 (43.0)	59 (29.6)
Socioeconomic status			.245
Low	127 (74.7)	158 (79.8)
High	43 (25.3)	40 (20.2)
Acculturation			na
Low	137 (79.3)	na
High	35 (20.3)	na
Health factors
CES_D scores^§			.762
<16	105 (61)	119 (59.5)
≥16	67 (39)	81 (40.5)
Self-rated health status^*			.000
Poor/Very poor	25 (14.6)	57 (28.6)
Fair	49 (28.7)	87 (43.7)
Good	69 (40.4)	35 (17.6)
Excellent/Very good	28 (16.4)	20 (10.1)
Hypertension			.310
Yes	112 (65.1)	120 (60.0)
No	60 (34.9)	80 (40.0)
Heart Disease		(0.053)
Yes	55 (32.0)	46 (23.0)
No	117 (68.0)	154 (77.0)
High Cholesterol^*			.000
Yes	107 (63.7)	79 (39.7)
No	61 (36.3)	120 (50.3)
Amputations
Yes	10 (5.8)	8 (4.0)
No	162 (94.2)	191 (96.0)
Smoking			.207
Yes	13 (7.6)	23 (11.5)
No	158 (92.4)	177 (88.5)
Healthcare use			.273
Emergency room visits (past 12 months)
≥1 times	51 (29.7)	70 (35.0)
0	121 (70.3)	130 (65.0)
Doctor visits^* (past 12 months)			.000
≥Once a month	87 (50.6)	44 (22.2)
<Once a month	85 (49.4)	154 (77.8)
Hospital stays (past 12 months)			.625
≥1	51 (29.7)	64 (68.0)
0	121 (70.3)	136 (32.0)

* Significant difference between 2 groups using the Mann-Whitney U test.
† Because of missing data, the total number of individuals for each variable may be less than the total sample size.
‡ Valid percent.
§ Center for Epidemiological Studies Depression Scale. Scale scores range from 0 to 60, and a cut-off point of 16 and above indicates clinical depressive symptoms.
na, not applicable.

View popup

Table 2.

Comparison of Diabetes-Related Characteristics Between South Texas and Northern Tamaulipas Samples

Characteristic	South Texas (n = 172)^† (n [%]^‡)	Northern Tamaulipas (n = 200)^† (n [%]^‡)	P
Duration of Diabetes (mean[SD])	11.0 (10.1)	10.1 (9.9)	.990
≥10 years	75 (44.4)	88 (44.4)
<10 years	94 (55.6)	110 (55.6)
Use of Insulin^*			.000
Yes	93 (54.1)	40 (20.0)
No	79 (45.9)	160 (80.0)
Frequency of glucose monitoring^*			.000
Daily	130 (75.6)	8 (4.1)
Not Daily	42 (24.4)	189 (95.9)
Diet counseling sessions^* (past 12 mo)			.000
≥2	38 (22.1)	80 (40.0)
1	27 (15.7)	42 (21.0)
0	107 (62.2)	78 (39.0)
Diabetes education sessions (past 12 mo)			.274
≥2	24 (14.0)	29 (14.5)
1	25 (14.5)	16 (8.0)
0	123 (71.5)	155 (77.5)
Vision problems affecting:
Reading			.071
Yes	93 (54.1)	126 (63.3)
No	79 (45.9)	73 (36.7)
Driving			.294
Yes	22 (12.9)	28 (15.7)
No	149 (87.1)	150 (84.3)
Watching television			.007
Yes	51 (29.7)	86 (43.2)
No	121 (70.3)	113 (56.8)
Problems with sexual function			.347
Yes	54 (32.3)	49 (27.7)
No	113 (67.7)	128 (72.3)
Leg discomfort interferes with:
Home activities			.791
Yes	88 (51.2)	98 (49.5)
No	84 (48.8)	100 (50.5)
Wearing preferred shoes			.174
Yes	66 (38.4)	88 (44.7)
No	106 (61.6)	109 (55.3)
Sleep			.259
Yes	55 (32.0)	74 (37.2)
No	117 (68.0)	125 (62.8)
Special diet affects social life			.328
Yes	57 (33.1)	56 (28.4)
No	115 (66.9)	141 (71.6)
Diabetes Symptoms^* (mean[SD])	6.36 (3.52)	6.91 (3.18)	.000
Low sugar reaction (past 4 wk)			.063
Yes	84 (48.8)	76 (38.6)
No	88 (51.2)	121 (61.4)
“Glucose monitoring is painful”^*			.022
Agree	73 (43.2)	63 (31.7)
Disagree	96 (56.8)	136 (68.3)
“Taking medication or insulin is a waste of time”			.689
Agree	14 (8.7)	15 (7.5)
Disagree	147 (91.6)	184 (92.5)
“Testing blood glucose is difficult”^*			.038
Agree	43 (25.6)	32 (16.7)
Disagree	125 (74.4)	160 (83.3)

* Significant difference between two groups using the Mann-Whitney U test.
† Due to missing data, the total number of individuals for each variable may be less than the total sample size.
‡ Valid percent.

View popup

Table 3.

Univariate Correlates to Clinical Depressive Symptoms by Two Study Samples

Significant Correlates^*	South Texas		Significant Correlates^*	Northern Tamaulipas
Significant Correlates^*	OR (95% CI)	P	Significant Correlates^*	OR (95% CI)	P
Demographic factors			Demographic factors
Gender			Gender
Female	2.50 (1.25–5.00)	.010	Female	2.76 (1.61–5.82)	.008
Male	1.00		Male	1.0 (0)
Education			Education
<High school	2.23 (1.17–4.24)	.014	<High school	2.39 (1.09–5.21)	.029
≥High school	1.00		≥High school	1.00
Health factors			Health factors
High cholesterol			High cholesterol
Yes	0.39 (0.20–0.74)	.004	Yes	2.08 (1.07–4.06)	.031
No	1.00		No	1.00
Burden of diabetes symptoms	1.40 (1.24–1.57)	.000	Burden of diabetes symptoms	1.45 (1.27–1.64)	.000

Vision problems affect:			Vision problems affect:
Television watching			Television watching
Yes	2.56 (1.61–5.00)	.006	Yes	2.56 (1.43–4.59)	.002
No	1.00		No	1.00
“Testing blood glucose is difficult”			Reading
Agree	3.25 (1.59–6.66)	.001	Yes	2.04 (1.11–3.76)	.022
Disagree	1.00		No	1.00
Diet limits social life	3.28 (1.69–6.34)	.000	Driving
Yes	1.00		Yes	2.67 (1.17–6.11)	.020
No			No	1.00
Leg discomfort affects:			Leg discomfort affects:
Home activities			Home activities
Yes	5.74 (2.88–11.46)	.000	Yes	5.69 (3.04–10.67)	.000
No	1.00		No	1.00
Wearing preferred shoes			Wearing preferred shoes
Yes	6.09 (3.07–12.07)	.000	Yes	(1.41–4.53)	.002
No	1.00		No
Sleep			Sleep
Yes	4.00 (2.03–7.89)	.000	Yes	3.18 (1.75–5.78)	.000
No	1.00		No	1.00
			Diet limits social life
			Yes	3.19 (1.68–6.06)	.000
			No	1.00
			“Glucose monitoring is painful”
			Yes
			No	3.29 (1.77–6.12)	.000
				1.00
Healthcare use factors			Healthcare use factors
Number of ER visits			Number of ER visits	2.00 (1.11–3.62)	.022
≥1	2.28 (1.17–4.44)	.016	≥1	1.00
0	1.00		0
Hospital stays			Hospital stays
≥1	2.03 (1.04–3.95)	.037	≥1	2.60 (1.41–4.78)	.002
0	1.00		0	1.00
Number of doctor visits	2.76 (1.46–5.21)	.002
≥1 per month	1.00
<1 per month
Social factors
Family support	0.50 (0.26–0.94)	.032
Low	1.00
High

* Only variables that were significant individually were included into the logistic regression model.; P < .05.
CI, confidence interval; OR, odds ratio.

View popup

Table 4.

Multivariate Correlates to Clinical Depressive Symptoms by Two Study Samples

Significant Correlates^*	South Texas		Significant Correlates^*	Northern Tamaulipas
Significant Correlates^*	OR (95% CI)	P	Significant Correlates^*	OR (95% CI)	P
Demographic factors			Health factors
Gender			Leg discomfort interferes with home activities
Female	3.51 (1.19–10.40)	.023	Yes	3.82 (1.60–9.11)	.003
Male	1.00		No	1.00
Education			Diabetes symptoms	1.66 (1.16–1.59)	.000
<High school	4.16 (1.55–11.16)	.005
≥High school	1.00
Health factors
High Cholesterol
Yes	0.37 (0.15–0.92)	.032
No	1.00
Diabetes symptoms	1.27 (1.08–1.50)	.004
Leg discomfort interferes with wearing preferred shoes
Yes	3.21 (1.11–9.24)	.031
No	1.00
“Testing blood glucose is difficult”
Agree	3.14 (1.14–8.66)	.027
Disagree	1.00
Healthcare utilization factors
Number of ER visits
≥1	3.37 (1.02–11.12)	.046
0	1.00

* Only variables that were significant individually were included into the logistic regression model.; P < .05.
CI, confidence interval; OR, odds ratio.
Note: the Nagelkerke R² was 0.527 for the model of the US sample and 0.514 for the model of the Mexico sample. These values indicate that a substantial portion (over 50%) of variation of the depression variable is explained away by the fitted models for both populations. The Hosmer-Lemeshow goodness-of-fit tests for both models were not significant (P = 0.567 for the US model; P = 0.975 for the Mexico model), which suggest adequate model fitting to the data.