# Multimorbidity between Type 2 Diabetes and Depressive Symptoms in Mexico: Prevalence and Associated Factors From the Nationally Representative ENSANUT 2022 Survey

## TL;DR

This study finds that Type 2 Diabetes and depression commonly co-occur in Mexico, with strong links to age, gender, and education.

## Contribution

This is the first study to examine the bidirectional relationship between T2DM and depression in a nationally representative Mexican sample.

## Key findings

- T2DM and depression are strongly associated in all age groups in Mexico.
- Women and older adults are more likely to report depression.
- Higher education is protective against both T2DM and depression.

## Abstract

Type 2 Diabetes Mellitus (T2DM) and depression are major public health challenges, with Mexico ranking among the countries with the highest prevalence of both. Research into the bidirectional relationship between the two conditions in Mexico is scarse. This study aims to investigate the prevalence of T2DM and depression, the co‐occurrence of these conditions, the strength of their association, and socio‐demographic, and geographical factors contributing to their prevalence in Mexico.

We used data from the 2022 National Health and Nutrition Survey. T2DM was self‐report. Depression was assessed using the Center for Epidemiological Studies Depression Scale. Descriptive statistics and multivariate logistic regression models were used to explore the bidirectional relationship and associated factors.

A high prevalence of depressive symptoms (16.7%) and Type 2 Diabetes Mellitus (T2DM, 10.9%) was found in a representative sample for the Mexican population (n =11 913). Participants with T2DM had higher odds of depressive symptoms (OR:1.78, 95 95% CI: 1.48–2.14), and those with depressive symptoms were also more likely to have T2DM (OR:1.97, 95% CI:1.52–2.54) for ages 20–59, and for ages 60+ (OR: 1.63, 95% CI: 1.27–2.09). Women were more likely to report depression than men (OR:2.14, 95% CI:1.83–2.51), and older adults (60+) had over three times higher odds of depression compared to younger adults (OR:3.53, 95% CI:3.00–4.15). Higher education was protective against both conditions, with individuals having high school or higher education showing lower odds of depression (OR:0.41, 95% CI: 0.31–0.53) and T2DM (OR: 0.52, 95% CI: 0.37–0.74).

Integrated strategies to address the co‐occurrence of T2DM and depression are needed, particularly among vulnerable and older populations.

What is already known on this topic
○Diabetes and depression frequently co‐occur, with people living with diabetes being two to three times more likely to experience depression, particularly in LMICs like Mexico.○While shared determinants such as age, gender, and socioeconomic status are known to influence both conditions, these determinants interact or differ across countries, and social and geographical contexts.
What this study adds
○This is the first study to examine the bidirectional relationship between T2DM and depression using a representative sample for the Mexican population from the 2022 ENSANUT survey.○It reveals a strong mutual association between the two conditions and shows shared social determinants such as age, gender, education, and well‐being.
How this study might affect research, practice or policy
○Findings support the integration of depression screening into diabetes care and vice versa, especially for older adults and women who are at higher risk.○The results can guide policy and research to tailor interventions based on local social, economic, and geographic conditions, acknowledging that determinants of multimorbidity are context‐dependent.

What is already known on this topic
○Diabetes and depression frequently co‐occur, with people living with diabetes being two to three times more likely to experience depression, particularly in LMICs like Mexico.○While shared determinants such as age, gender, and socioeconomic status are known to influence both conditions, these determinants interact or differ across countries, and social and geographical contexts.

Diabetes and depression frequently co‐occur, with people living with diabetes being two to three times more likely to experience depression, particularly in LMICs like Mexico.

While shared determinants such as age, gender, and socioeconomic status are known to influence both conditions, these determinants interact or differ across countries, and social and geographical contexts.

What this study adds
○This is the first study to examine the bidirectional relationship between T2DM and depression using a representative sample for the Mexican population from the 2022 ENSANUT survey.○It reveals a strong mutual association between the two conditions and shows shared social determinants such as age, gender, education, and well‐being.

This is the first study to examine the bidirectional relationship between T2DM and depression using a representative sample for the Mexican population from the 2022 ENSANUT survey.

It reveals a strong mutual association between the two conditions and shows shared social determinants such as age, gender, education, and well‐being.

How this study might affect research, practice or policy
○Findings support the integration of depression screening into diabetes care and vice versa, especially for older adults and women who are at higher risk.○The results can guide policy and research to tailor interventions based on local social, economic, and geographic conditions, acknowledging that determinants of multimorbidity are context‐dependent.

Findings support the integration of depression screening into diabetes care and vice versa, especially for older adults and women who are at higher risk.

The results can guide policy and research to tailor interventions based on local social, economic, and geographic conditions, acknowledging that determinants of multimorbidity are context‐dependent.

Using 2022 ENSANUT data, we found high prevalence of depressive symptoms (16.7%) and T2DM (10.9%) in Mexico, with 4.6% reporting both. Prevalence varied widely across states. T2DM and depression were strongly associated in all age groups, with women and older adults more likely to report depression. Higher education was protective against both conditions.