Depression and Advanced Complications of Diabetes: a Prospective Cohort Study

Overview

Journal Diabetes Care

Specialty Endocrinology

Date 2009 Nov 26

PMID 19933989

Citations 203

Authors

Elizabeth H B Lin

Carolyn M Rutter

Wayne Katon

Susan R Heckbert

Paul Ciechanowski

Malia M Oliver

Evette J Ludman

Bessie A Young

Lisa H Williams

David K McCulloch

Michael Von Korff

Affiliations

Soon will be listed here.

Abstract

Objective: To prospectively examine the association of depression with risks for advanced macrovascular and microvascular complications among patients with type 2 diabetes.

Research Design And Methods: A longitudinal cohort of 4,623 primary care patients with type 2 diabetes was enrolled in 2000-2002 and followed through 2005-2007. Advanced microvascular complications included blindness, end-stage renal disease, amputations, and renal failure deaths. Advanced macrovascular complications included myocardial infarction, stroke, cardiovascular procedures, and deaths. Medical record review, ICD-9 diagnostic and procedural codes, and death certificate data were used to ascertain outcomes in the 5-year follow-up. Proportional hazard models analyzed the association between baseline depression and risks of adverse outcomes.

Results: After adjustment for prior complications and demographic, clinical, and diabetes self-care variables, major depression was associated with significantly higher risks of adverse microvascular outcomes (hazard ratio 1.36 [95% CI 1.05-1.75]) and adverse macrovascular outcomes (1.24 [1.0-1.54]).

Conclusions: Among people with type 2 diabetes, major depression is associated with an increased risk of clinically significant microvascular and macrovascular complications over the ensuing 5 years, even after adjusting for diabetes severity and self-care activities. Clinical and public health significance of these findings rises as the incidence of type 2 diabetes soars. Further research is needed to clarify the underlying mechanisms for this association and to test interventions to reduce the risk of diabetes complications among patients with comorbid depression.

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References

Whooley M, de Jonge P, Vittinghoff E, Otte C, Moos R, Carney R . Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA. 2008; 300(20):2379-88. PMC: 2677371. DOI: 10.1001/jama.2008.711. View

Ludman E, Katon W, Russo J, Von Korff M, Simon G, Ciechanowski P . Depression and diabetes symptom burden. Gen Hosp Psychiatry. 2004; 26(6):430-6. DOI: 10.1016/j.genhosppsych.2004.08.010. View

Makine C, Karsidag C, Kadioglu P, Ilkova H, Karsidag K, Skovlund S . Symptoms of depression and diabetes-specific emotional distress are associated with a negative appraisal of insulin therapy in insulin-naïve patients with Type 2 diabetes mellitus. A study from the European Depression in Diabetes [EDID] Research.... Diabet Med. 2009; 26(1):28-33. DOI: 10.1111/j.1464-5491.2008.02606.x. View

Katon W, Russo J, Lin E, Heckbert S, Ciechanowski P, Ludman E . Depression and diabetes: factors associated with major depression at five-year follow-up. Psychosomatics. 2009; 50(6):570-9. PMC: 3087499. DOI: 10.1176/appi.psy.50.6.570. View

Heckbert S, Kooperberg C, Safford M, Psaty B, Hsia J, McTiernan A . Comparison of self-report, hospital discharge codes, and adjudication of cardiovascular events in the Women's Health Initiative. Am J Epidemiol. 2004; 160(12):1152-8. DOI: 10.1093/aje/kwh314. View

de Groot M, Anderson R, Freedland K, Clouse R, Lustman P . Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001; 63(4):619-30. DOI: 10.1097/00006842-200107000-00015. View

Lin E, Katon W, Von Korff M, Rutter C, Simon G, Oliver M . Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004; 27(9):2154-60. DOI: 10.2337/diacare.27.9.2154. View

Lin E, Heckbert S, Rutter C, Katon W, Ciechanowski P, Ludman E . Depression and increased mortality in diabetes: unexpected causes of death. Ann Fam Med. 2009; 7(5):414-21. PMC: 2746517. DOI: 10.1370/afm.998. View

Golden S, Lazo M, Carnethon M, Bertoni A, Schreiner P, Diez Roux A . Examining a bidirectional association between depressive symptoms and diabetes. JAMA. 2008; 299(23):2751-9. PMC: 2648841. DOI: 10.1001/jama.299.23.2751. View

10.

Fisher E, Thorpe C, Devellis B, DeVellis R . Healthy coping, negative emotions, and diabetes management: a systematic review and appraisal. Diabetes Educ. 2007; 33(6):1080-103. DOI: 10.1177/0145721707309808. View

11.

Toobert D, Hampson S, Glasgow R . The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000; 23(7):943-50. DOI: 10.2337/diacare.23.7.943. View

12.

McCulloch D, Price M, Hindmarsh M, Wagner E . A population-based approach to diabetes management in a primary care setting: early results and lessons learned. Eff Clin Pract. 1999; 1(1):12-22. View

13.

Black S, Markides K, Ray L . Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care. 2003; 26(10):2822-8. DOI: 10.2337/diacare.26.10.2822. View

14.

Spitzer R, Kroenke K, Williams J . Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999; 282(18):1737-44. DOI: 10.1001/jama.282.18.1737. View

15.

Katon W, Von Korff M, Ciechanowski P, Russo J, Lin E, Simon G . Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care. 2004; 27(4):914-20. DOI: 10.2337/diacare.27.4.914. View

16.

Von Korff M, Katon W, Lin E, Simon G, Ciechanowski P, Ludman E . Work disability among individuals with diabetes. Diabetes Care. 2005; 28(6):1326-32. DOI: 10.2337/diacare.28.6.1326. View

17.

Fishman P, Goodman M, Hornbrook M, Meenan R, Bachman D, OKeeffe Rosetti M . Risk adjustment using automated ambulatory pharmacy data: the RxRisk model. Med Care. 2003; 41(1):84-99. DOI: 10.1097/00005650-200301000-00011. View

18.

Egede L, Zheng D, Simpson K . Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002; 25(3):464-70. DOI: 10.2337/diacare.25.3.464. View

19.

Stratton I, Adler A, Neil H, Matthews D, Manley S, Cull C . Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; 321(7258):405-12. PMC: 27454. DOI: 10.1136/bmj.321.7258.405. View

20.

Ciechanowski P, Katon W, Russo J . Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med. 2000; 160(21):3278-85. DOI: 10.1001/archinte.160.21.3278. View