The Association of Comorbid Depression With Mortality in Patients With Type 2 Diabetes

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
Diabetes Care (Impact Factor: 8.42). 12/2005; 28(11):2668-72. DOI: 10.2337/diacare.28.11.2668
Source: PubMed


We assessed whether patients with comorbid minor and major depression and type 2 diabetes had a higher mortality rate over a 3-year period compared with patients with diabetes alone.
In a large health maintenance organization (HMO), 4,154 patients with type 2 diabetes were surveyed and followed for up to 3 years. Patients initially filled out a written questionnaire, and HMO-automated diagnostic, laboratory, and pharmacy data and Washington State mortality data were collected to assess diabetes complications and deaths. Cox proportional hazards regression models were used to calculate adjusted hazard ratios of death for each group compared with the reference group.
There were 275 (8.3%) deaths in 3,303 patients without depression compared with 48 (13.6%) deaths in 354 patients with minor depression and 59 (11.9%) deaths among 497 patients with major depression. A proportional hazards model with adjustment for age, sex, race/ethnicity, and educational attainment found that compared with the nondepressed group, minor depression was associated with a 1.67-fold increase in mortality (P = 0.003), and major depression was associated with a 2.30-fold increase (P < 0.0001). In a second model that controlled for multiple potential mediators, both minor and major depression remained significant predictors of mortality.
Among patients with diabetes, both minor and major depression are strongly associated with increased mortality. Further research will be necessary to disentangle causal relationships among depression, behavioral risk factors (adherence to medical regimens), diabetes complications, and mortality.

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    • "Current epidemiological evidence shows that at least one-third of people with diabetes suffer from depression (Barnard et al., 2006; Anderson et al., 2001; Lustman et al., 2000) whereas the prevalence of depression among healthy population ranges from 1% to 16.9% worldwide (Ronald et al., 2013). Patients with both depression and diabetes are more likely to have higher macrovascular and microvascular complications and higher mortality rates than those who have diabetes mellitus only (De Groot et al., 2001; Katon et al., 2005). While depression may contribute to poor diabetes-related outcomes, diabetes and its complications may also lead to poorer depression outcomes (Lin et al., 2004, Egede et al., 2001; Black et al., 2003). "
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    DESCRIPTION: Accepted for publication by Basic Research Journal of Medicine and Clinical Sciences
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    • "Comorbid major depression independently associated with obesity, sedentary lifestyle and triglycerides ≥400 in patients without known CVD. Katon et al. 2005 [50] "
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    ABSTRACT: This special article pays tribute to Wayne Katon, MD (1950-2015) with a Gedenkschrift, or review, of his prolific academic career. Abstracts of all of Dr. Katon's Medline citations were reviewed to develop a narrative of his seminal epidemiological and interventional research findings. Specifically, we describe: (a) how Dr. Katon's clinical work and observational epidemiology and health services research informed and guided interventional studies; (b) the evolution of multidisciplinary interventional trials from primary care-based psychiatric consultation to primary care-based collaborative care for depression to multicondition collaborative care; and (c) how Dr. Katon's research has informed the work of other leading researchers in the field of psychosomatic medicine and helped develop a new generation of researchers at the interface of psychiatry and primary care. For more than three decades, Dr. Katon led a multidisciplinary research team that conducted seminal epidemiological studies and randomized trials and that influenced the thinking and research in the field of psychiatry in a number of areas: (a) the importance and impact of mental disorders presenting in primary care settings and (b) the organization of effective multidisciplinary care for primary care patients with common mental disorders and comorbid medical conditions. Dr. Katon's work revolutionized the care of psychiatric illnesses in primary care and other medical care settings to the benefit of countless patients worldwide. Copyright © 2015 Elsevier Inc. All rights reserved.
    General hospital psychiatry 07/2015; 37(5). DOI:10.1016/j.genhosppsych.2015.07.005 · 2.61 Impact Factor
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    • "Importantly, this increased risk is also associated with negative outcomes such as increased rates of diabetic complications (Katon et al., 2005) and greater mortality rates, particularly in women (Pan et al., 2011). As associated disorders, there is growing evidence that suggests that they also may share similar underlying neurobiological substrates. "
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    ABSTRACT: Objective The purpose of this study was to examine the relationship between verbal learning and memory performance and hippocampal volume in subjects with co-morbid type 2 diabetes and major depression compared with healthy control subjects and subjects with type 2 diabetes alone. Methods Twenty four subjects with type 2 diabetes and 20 subjects with type 2 diabetes and major depression were recruited from endocrinology clinics and were compared with 32 healthy control subjects recruited from the community. Subjects were scanned on a 1.5 T GE scanner, and hippocampal volumes were measured using Freesurfer. The California Verbal Learning Test assessed learning and memory. Significant predictors of verbal learning performance (e.g., age, gender, education, blood pressure, stroke risk, hemoglobin A1c, and hippocampal volume) were determined using a stepwise linear regression. ResultsSubjects with diabetes and depression had significantly worse performance on verbal list learning compared with healthy control subjects. Hippocampal volume was a strong predictor of performance in healthy control subjects, and age and hippocampal volume were strong predictors in subjects with type 2 diabetes alone. Age alone was a significant predictor of verbal learning performance in subjects with diabetes and depression. Conclusions The relationship between hippocampal volume and performance on the California Verbal Learning Test is decoupled in subjects with type 2 diabetes and major depression and this decoupling may contribute to poor verbal learning and memory performance in this study population. Copyright (c) 2014 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 04/2015; 30(4). DOI:10.1002/gps.4149 · 2.87 Impact Factor
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