Burden and associated factors of depressive symptoms among older adults with type 2 diabetes mellitus in rural southeast Nigeria: a community-based cross-sectional study

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) increases vulnerability to depression in older adults. This study aimed to assess the burden of depressive symptoms among older adults with T2DM in rural southeast Nigeria and identify sociodemographic and clinical factors associated with severe depressive symptoms. Methods: tests and crude ORs derived from observed frequencies. Statistical significance was set at p<0.05. Results: Overall, 83.3% of participants exhibited depressive symptoms, with 39.7% classified as severe. Male gender (COR=3.36, 95% CI 2.43 to 4.64, p=0.001), age ≥71 years (COR=1.53, 95% CI 1.04 to 2.26, p=0.031) and living with family (COR=3.02, 95% CI 2.15 to 4.23, p=0.001) were significantly associated with severe depressive symptoms. Educational attainment showed a reversed pattern, with primary education (COR=0.36, p<0.05) and secondary education (COR=0.27, p<0.05) demonstrating protective associations compared with non-formal education. Indigenous Spiritual Beliefs was associated with higher odds of severe depressive symptoms (COR=1.71, 95% CI 1.11 to 2.65, p=0.015). Age and duration of T2DM were not consistently associated with severe depressive symptoms (p>0.05). Conclusions: Depressive symptoms are highly prevalent among older adults with T2DM in rural southeast Nigeria. Sociodemographic characteristics were more strongly associated with severe depressive symptoms than disease duration. Integrating culturally sensitive, gender-responsive and family-centred mental health interventions within routine diabetes care is critical to improving psychological and metabolic outcomes.