A Longitudinal Examination of Depressive Symptoms in a Digital Diabetes Prevention Program

Depression is twice as common in people with type 2 diabetes (T2D). The Diabetes Prevention Program (DPP) can identify and help those with prediabetes and depressive symptoms before a comorbid diagnosis of T2D and depression. This study analyzed depressive symptoms in 3,072 adults (mean age=52.68 years, SE=.16; 80.92% female; 74.77% white) using a digital DPP for six months. It further assessed the effectiveness of a program add-on called Stress Less in reducing depression risk. We studied predictors of high depression risk (Patient Health Questionnaire; PHQ- 2 scores ≥3) at baseline and follow-up and transitioning from high to low risk during the program. We expected an association between higher starting body mass index (BMI) and depressive symptoms and between weight loss and enrollment in Stress Less and reduced depression risk. At baseline, 30.5% of participants scored high risk for depression. A larger percentage of participants enrolled in Stress Less were high-risk (38.5% of n=1,427) compared to non-enrollees (23.8% of n=1,645). Weight loss did not differ between groups (Mean=5.32%, SE=0.11 vs. Mean=5.38%, SE=.10, respectively). Predictors of high depression risk at baseline included Stress-Less enrollment (beta=0.27), age (beta=-0.28), male sex (beta=-0.16), and starting BMI (beta=0.21), all p≤.0001. At six months, additional significant predictors included weight loss (beta=-0.28, p=0.04) and coaching volume (beta=-0.12, p=0.02). Across all participants, Stress Less (beta=0.17, p≤0.01) and starting BMI (beta=0.13, p=0.01) predicted transitioning to low risk. For non-enrollees, weight loss significantly predicted the transition (beta=0.15, p=0.04). A digital DPP integrated depression screening and identified high-risk individuals. Engagement with stress-reduction content and weight loss predicted lower depression risk after six months. Future research could consider a more diverse sample and explore how stress-reduction content may help members experiencing insecurities due to social determinants of health.