Burden and associated factors of depressive symptoms among older adults with type 2 diabetes mellitus in rural southeast Nigeria: a community-based cross-sectional study

Introduction Type 2 diabetes mellitus (T2DM) increases vulnerability to depression in older adults. This study aimed to assess the burden of depressive symptoms among older adults with T2DM in rural southeast Nigeria and identify sociodemographic and clinical factors associated with severe depressive symptoms. Methods A community-based cross-sectional study was conducted across 25 rural communities in five southeast Nigerian states from September 2025 to February 2026. Multistage random sampling recruited 683 adults aged ≥60 years with confirmed T2DM. Depressive symptoms were assessed using the culturally adapted Geriatric Depression Scale—Short Form. Sociodemographic and clinical data were collected, and associations with depressive symptom severity were examined using χ 2 tests and crude ORs derived from observed frequencies. Statistical significance was set at p<0.05. Results Overall, 83.3% of participants exhibited depressive symptoms, with 39.7% classified as severe. Male gender (COR=3.36, 95% CI 2.43 to 4.64, p=0.001), age ≥71 years (COR=1.53, 95% CI 1.04 to 2.26, p=0.031) and living with family (COR=3.02, 95% CI 2.15 to 4.23, p=0.001) were significantly associated with severe depressive symptoms. Educational attainment showed a reversed pattern, with primary education (COR=0.36, p<0.05) and secondary education (COR=0.27, p<0.05) demonstrating protective associations compared with non-formal education. Indigenous Spiritual Beliefs was associated with higher odds of severe depressive symptoms (COR=1.71, 95% CI 1.11 to 2.65, p=0.015). Age and duration of T2DM were not consistently associated with severe depressive symptoms (p>0.05). Conclusions Depressive symptoms are highly prevalent among older adults with T2DM in rural southeast Nigeria. Sociodemographic characteristics were more strongly associated with severe depressive symptoms than disease duration. Integrating culturally sensitive, gender-responsive and family-centred mental health interventions within routine diabetes care is critical to improving psychological and metabolic outcomes.