Syndemics of depression, sick role and activation status among newly diagnosed adults with diabetes mellitus in Bahir Dar, Ethiopia: a 6-month follow-up study protocol

BMJ Open. 2025 Sep 18;15(9):e104693. doi: 10.1136/bmjopen-2025-104693.

ABSTRACT

INTRODUCTION: Diabetes mellitus (DM) and depression commonly coexist. Each condition increases the risk of developing the other and adversely affects treatment outcomes. Such complex interactions of diseases, referred to as syndemics, have not been well studied. This study aims to assess the syndemics of depression, sick role and activation status among newly diagnosed adults living with DM.

METHODS AND ANALYSIS: A prospective 6-month follow-up study will be conducted with 485 participants. Depression will be assessed with the 9-item Patient Health Questionnaire, applying a cut-off score of 10. The primary outcome will be glycaemic control, and the secondary outcomes will be health-related quality of life (HRQoL) and functional disability status. Depression, the primary outcome and the secondary outcomes, will be measured at baseline, 3 months and 6 months. The sick role, activation status and health system perspectives will be explored using qualitative methods following the second measurement. Data will be collected from adults living with DM, healthcare providers and healthcare managers. Qualitative sampling will continue until data saturation is reached.Quantitative analysis will be done using STATA V.17. The prevalence of depression will be determined at baseline. Associated factors will be analysed using Poisson regression with a robust variance estimator. Incidence rate of depression, glycaemic control, HRQoL and disability status will be measured at 3 and 6 months. A multilevel mixed-effects generalised linear model will be fitted, with the three measurement time points nested within individuals, and individuals nested within health institutions. Qualitative data will be analysed thematically using NVivo V.12 software.

ETHICS AND DISSEMINATION: Ethics approval has been granted by the institutional review board of Bahir Dar University (protocol number 3098/25). Findings will be disseminated through peer-reviewed publications, conference presentations and local channels for community audiences.

TRIAL REGISTRATION NUMBER: Protocol number 3098/25.

PMID:40973379 | DOI:10.1136/bmjopen-2025-104693