Interrelationship Between Socioeconomic Status, Depression, and Neuropathy in People with Diabetes: A Cross-Sectional Study.

Background/

Objectives

The co-occurrence of diabetic peripheral neuropathy and depression increases the symptom burden and risk of long-term complications.

Methods

This cross-sectional study enrolled 131 patients with type 1 (age: 58.47 years; duration of diabetes: 35.61 years) and type 2 diabetes (age: 63.60 years; duration of diabetes: 11.49 years). All patients underwent assessment of socioeconomic status and evaluation using the Hospital Anxiety and Depression Scale, the Mental Component Score of the Short Form Healthy Survey Questionnaire, neuropathy disability score, nerve conduction studies, corneal confocal microscopy and intraepidermal nerve fibre density (IENFD) assessment.

Results

The prevalence of foot pain (45% vs. 23.9%, p = 0.019), tingling (56.7% vs. 32.9%, p = 0.013), weakness (35% vs. 9.9%, p < 0.001), ataxia (40% vs. 16.9%, p = 0.001), and upper limb symptoms (45% vs. 19.7%, p = 0.001) were statistically significantly higher, while cold perception threshold (22.50 ± 8.47 vs. 26.34 ± 3.08, p = 0.007), corneal nerve fibre density (20.49 ± 7.55 vs. 24.16 ± 5.68, p = 0.002) and length (20.06 ± 6.98 vs. 22.95 ± 6.22, p = 0.014) were statistically significantly lower, but no differences in nerve conduction studies or IENFD were observed in patients with depression compared to patients without depression. Furthermore, patients with depression were from a lower socioeconomic class (51.7% vs. 21.1%, p < 0.001), had lower educational attainment (37.9% vs. 12.9%, p < 0.001), had lower income < £37,000 (29.3% vs. 11.4%, p = 0.010) and lived in areas of high deprivation (62.1% vs. 31.4%, p < 0.001).

Conclusions

Comorbid depression in people with diabetes was linked to increased socioeconomic deprivation and a greater prevalence of neuropathic symptoms and small fibre pathology.