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Sex differences in the association between diabetes and depressive symptoms: findings from Mexican National Health and Nutrition Survey 2018–2019
  1. Gabriela Carrillo-Balam1,
  2. Yu-Mei Li2,
  3. Omar Silverman-Retana3,4,5
  1. 1Independent Researcher, Edinburgh, UK
  2. 2Department of Psychology, Bielefeld University, Bielefeld, Germany
  3. 3Department of Public Health, Aarhus University, Aarhus, Denmark
  4. 4Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
  5. 5Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
  1. Correspondence to Dr Gabriela Carrillo-Balam, Independent Researcher, Edinburgh, UK; gabrielacarrillobalam{at}


Aims We set out to investigate the potential sex differences in the association between diabetes and depressive symptoms by conducting an interaction analysis, and to investigate whether sex mediates the effect of diabetes on depressive symptoms.

Methods We conducted analyses on cross-sectional data of adults aged 20 years or older in the Mexican National Health and Nutrition Survey 2018–2019 (ENSANUT 2018–2019). Diabetes was defined by self-reported medical diagnosis, and depressive symptoms were measured using the seven-item Centre for Epidemiologic Studies Depression scale. First, an unadjusted interaction analysis was conducted. Second, the inverse probability of treatment weighting was applied to account for imbalances and biases. Third, the four-way decomposition method was used to estimate the potential mediating effect of sex.

Results In the study population (N=43 074), the prevalence of diabetes was 9.3% for men and 11.7% for women. Depressive symptoms were more prevalent in women (19.0%) than in men (9.5%). Women with diabetes had the greatest odds of having depressive symptoms, compared with men without diabetes (ORwomen-diabetes3.49 (95% CI: 3.16 to 3.86)). The interaction analysis indicated that diabetes and sex interact on both, multiplicative and additive scales (ratio of ORs (95% CI) 1.22 (1.02 to 1.45), and relative excess risk due to interaction (95% CI) 0.99 (0.63 to 1.36)). The four-way decomposition analysis showed that the interaction effect between diabetes and sex is larger than the mediation effect.

Conclusions We found a positive interaction between diabetes and sex in the odds of having depressive symptoms. Mental health and diabetes care services planning would benefit from adopting a sex-informed approach.


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Data availability statement

Data are available in a public, open access repository. Databases available at:

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  • Contributors GC-B conceived the study, Y-ML and OS-R contributed to its design, analysis and write-up, with GC-B acting as the lead analyst. All authors approved the final submitted manuscript. The corresponding author (GC-B) is responsible for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.