Examination of the Association Between Diabetes, Depression, and Suicidality with a Special Focus on the Indigenous Canadian Population

Abstract

Diabetes, depression and suicidal behavior are increasingly prevalent conditions with major public health implications. A potential association between these conditions has been suggested in the literature but not entirely explored. The Indigenous Canadian population is facing a growing epidemic of diabetes, depression and suicidal behavior. Yet, this vulnerable population is consistently under-represented in research that addresses mental health issues among patients with diabetes. Therefore, this thesis aimed to: (a) systematically evaluate the association between diabetes, depression, and suicidal behavior among the general population; and (b) assess the inter-relationship between diabetes, depression, and lifetime suicidal ideation among Indigenous Canadians living off-reserve. A systematic literature review and meta-analysis was conducted to examine the associations of interest among the general population. It included 50 studies, 33 assessed depression, 14 suicidality and 3 studies assessed both. Meta-analysis results showed that diabetic patients were at a significantly higher risk of depression compared to non-diabetics. Additionally, patients with diabetes were at a significantly higher risk for experiencing suicidal ideation and attempting suicide. However, there was not enough evidence to support an association between diabetes and suicidal death. Epidemiological modeling of secondary data from the Aboriginal Peoples Survey was used to examine the associations of interest among the Indigenous Canadian population. The prevalence of depressive symptoms in the Indigenous diabetics was 15.67% compared to 9.27% among the non-diabetic participants. After controlling for socio-demographics, smoking/alcohol use/drug use, anxiety disorders and other chronic illnesses diabetes was still significantly associated with depressive symptoms. The prevalence of suicidal ideation in diabetics was 23.86% compared to 18.71% among the non-diabetic participants. After adjusting for the effect of socio-demographics and health related behavioral factors, diabetes was still significantly associated with a higher risk of reporting suicidal ideation. However, after further adjusting for mental disorders (mood and anxiety) and other chronic illnesses, the association was no longer significant. The increased risk of depression and suicidality in diabetic patients among Indigenous peoples and the wider population highlights the importance of integrating the screening and management of depression and suicidal behavior with diabetes management in primary healthcare settings.