{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:32:03Z","timestamp":1790346723415,"version":"4.1.0"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T00:00:00Z","timestamp":1681689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Depression is one of the mental illnesses that cause disability worldwide, and is a significant contributor to the global burden of diseases. Although depression is reported among patients with diabetes in high-income countries, it remains undetected or undiagnosed in low and middle-income countries. This article describes the prevalence of depression and its associated factors among patients with diabetes in Zanzibar, United Republic of Tanzania.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>A cross-sectional study design was conducted at Mnazi Mmoja Referral Hospital (MMRH). A simple random sampling method was used to select the potential participants. Depressive symptoms were assessed using Patient Health Questionnaire-9(PHQ-9). Data were coded and analyzed using SPSS 23.0. A Chi-square test was performed to obtain the association between depression and socio-demographic, medical and psychological factors. A <jats:italic>P<\/jats:italic>-value of &lt;0.05 with a 95% confidence interval was used to determine the significant associations between the variables. Also, multiple logistic regression was performed with the factors with P-value &lt;0.2 to ascertain the confounding factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 267 patients with diabetes responded to the questionnaire of which 142 (53.2%) were males. The mean age of participants was 50 years and a standard deviation of \u00b114. The overall prevalence of depression in this study was 73%. The specific type of depression among diabetic patients varied from severe (8%) to mild depression (30%). Respondents who had difficulties in adhering to the treatment regimen (AOR = 5.7: 95% CI, 2.11\u201315.18, p = 0.001), feeling angry or stressed (AOR = 4.4: 95% CI, 2.44\u20138.10, p&lt;0.001), and had diabetic retinopathy (AOR = 2.8: 95% CI, 1.45\u20135.28, p = 0.002) had symptoms of depression. Furthermore, respondents who had diabetic foot ulcers (AOR = 0.1: 95% CI, 0.04\u20130.49, p = 0.003) and impotence for male patients (AOR = 0.4: 95% CI, 0.20\u20130.68, p = 0.002) were 0.1 and 0.4 times less likely to have depression respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The majority of patients with diabetes have symptoms of depression. Adherence to the treatment regimen, diabetic retinopathy, feeling angry or stressed, impotence and diabetic foot ulcer were associated with depression. Thus, early screening of depression among patients with diabetes is crucial to enhance self-management and good health outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0284566","type":"journal-article","created":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T17:26:03Z","timestamp":1681752363000},"page":"e0284566","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Depression and its associated factors among patients with diabetes: A cross-sectional survey at Mnazi Mmoja Referral Hospital in Zanzibar, Tanzania"],"prefix":"10.1371","volume":"18","author":[{"given":"Mussa R.","family":"Mussa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5881-4435","authenticated-orcid":true,"given":"Masunga K.","family":"Iseselo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith A. 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National Population Projections [Internet]. Dar es Salaam; 2018. https:\/\/www.nbs.go.tz\/nbs\/takwimu\/census2012\/Projection-Report-20132035.pdf."},{"issue":"185","key":"pone.0284566.ref017","article-title":"Journal of Cross-Cultural Psychology","volume":"1","author":"RW Brislin","year":"1970","journal-title":"J Cross Cult Psychol"},{"issue":"118","key":"pone.0284566.ref018","first-page":"1","article-title":"The validity of the Patient Health Questionnaire for screening depression in chronic care patients in primary health care in South Africa","volume":"15","author":"A Bhana","year":"2015","journal-title":"BMC Psychiatry"},{"issue":"1","key":"pone.0284566.ref019","first-page":"6","article-title":"Prevalence of Depression and Associated Factors among Diabetic Patients in an Outpatient Diabetes Clinic","volume":"2019","author":"Zahra D. Khan","year":"2019","journal-title":"Psychiatry J"},{"issue":"1","key":"pone.0284566.ref020","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1186\/s12889-020-8360-2","article-title":"Prevalence of depression and its associated factors among patients with diabetes mellitus at Tirunesh-Beijing general hospital, Addis Ababa, Ethiopia","volume":"20","author":"NA Engidaw","year":"2020","journal-title":"BMC Public Health"},{"issue":"5","key":"pone.0284566.ref021","first-page":"430","article-title":"Prevalence and factors associated with anxiety and depression among type 2 diabetes in Qassim: A descriptive cross-sectional study","volume":"12","author":"AA Al-Mohaimeed","year":"2017","journal-title":"J Taibah Univ Med Sci"},{"issue":"6","key":"pone.0284566.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0218119","article-title":"Depression among people living with type 2 diabetes in an urbanizing community of Nepal","volume":"14","author":"AK Sunny","year":"2019","journal-title":"PLoS One"},{"issue":"2","key":"pone.0284566.ref023","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.diabres.2014.01.001","article-title":"Depression and Type 2 Diabetes in Low and Middle Income Countries: A Systematic Review","volume":"103","author":"E Mendenhall","year":"2014","journal-title":"Diabetes Res Clin Pract"},{"issue":"72","key":"pone.0284566.ref024","first-page":"1","article-title":"Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors","volume":"2","author":"AK Khuwaja","year":"2010","journal-title":"Diabetol Metab Syndr"},{"issue":"4","key":"pone.0284566.ref025","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1097\/PSY.0000000000000169","article-title":"Sex Differences in the Association between Depression, Anxiety, and Type 2 Diabetes Mellitus","volume":"77","author":"RT Demmer","year":"2015","journal-title":"Psychosom Med"},{"issue":"2","key":"pone.0284566.ref026","first-page":"51","article-title":"Symptoms of depression among patients attending a diabetes care clinic in rural western Kenya","volume":"2","author":"K Shirey","year":"2015","journal-title":"J Clin Transl Endocrinol"},{"issue":"1\/2\/3","key":"pone.0284566.ref027","first-page":"01","article-title":"Prevalence of Depression and its Associated Factos in Adults with Diabetes Mellitus: A Cross\u2014Sectional Study in a Teritary Care Centre","volume":"4","author":"S Paulraj","year":"2017","journal-title":"Adv Med Sci An Int J"},{"issue":"4","key":"pone.0284566.ref028","first-page":"1560","article-title":"The relationship between depression and demographic risk factors, individual lifestyle factors, and health complications in patients with type 2 diabetes mellitus","volume":"28","author":"Y Kayar","year":"2017","journal-title":"Biomed Res"},{"issue":"2","key":"pone.0284566.ref029","first-page":"120","article-title":"The association between Diabetes mellitus and Depression Pathophysiological mechanisms","volume":"9","author":"B Sv","year":"2016","journal-title":"J Med Life Vol"},{"key":"pone.0284566.ref030","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1038\/sj.ijir.3901371","article-title":"Is endothelial function impaired in erectile dysfunction patients?","volume":"18","author":"C Kaya","year":"2006","journal-title":"Int J Impot"},{"key":"pone.0284566.ref031","first-page":"1","article-title":"Diabetic retinopathy screening in persons with mental illness: a literature review","volume":"5","author":"ER Bradley","year":"2020","journal-title":"BMJ Open Opthamology"},{"issue":"2","key":"pone.0284566.ref032","article-title":"Sexual Dysfunction, Depression and Quality of Life in Individuals with Diabetes Mellitus Type 2","volume":"3","author":"JM Guti\u00e9rrez-Valverde","year":"2016","journal-title":"Int J Nurs"},{"issue":"9","key":"pone.0284566.ref033","first-page":"1","article-title":"Relationships of sexual dysfunction with depression and acceptance of illness in women and men with type 2 diabetes mellitus","volume":"14","author":"E B\u0105k","year":"2017","journal-title":"Int J Environ Res Public Health"},{"issue":"04","key":"pone.0284566.ref034","doi-asserted-by":"crossref","first-page":"2","DOI":"10.4172\/2161-1017.1000147","article-title":"A Cross Sectional Study on Associated Factors of Depression among Type 2 Diabetic Outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia","volume":"03","author":"TD Habtewold","year":"2014","journal-title":"Endocrinol Metab Syndr"},{"issue":"1","key":"pone.0284566.ref035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12888-016-0809-6","article-title":"Sociodemographic, clinical, and psychosocial factors associated with depression among type 2 diabetic outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia: A cross-sectional study","volume":"16","author":"TD 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