Bruce, D. G., Davis, W. A., Starkstein, S. E. & Davis, T. M. A prospective study of depression and mortality in patients with type 2 diabetes: the Fremantle Diabetes Study. Diabetologia 48, 2532-2539

School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
Diabetologia (Impact Factor: 6.67). 01/2006; 48(12):2532-9. DOI: 10.1007/s00125-005-0024-3
Source: PubMed


Depression is associated with excess mortality in patients with type 2 diabetes. We investigated the impact, and possible causal mechanisms, of depression on all-cause and cardiac mortality in patients with type 2 diabetes.
We recruited 1,273 patients with type 2 diabetes from a postcode-defined community (average age 64.1+/-11.2 years, 48.7% males, median duration of diabetes 4 years [range 1.0-9.0]) and followed them for 7.8+/-2.4 years. Depression was assessed using data obtained using a quality-of-life questionnaire, and cause and date of death were obtained from the state registry.
Depression was present in 31.5% of subjects at recruitment. Depressed subjects had a longer duration of diabetes, more cardiovascular risk factors, CHD, cerebrovascular disease and diabetic microvascular complications at baseline, and higher all-cause and cardiac mortality rates during follow-up. In Cox proportional hazards models and after adjustment for demographic and diabetes-related variables and cardiovascular risk factors, depression was significantly associated with excess all-cause and cardiac mortality. When diabetic microvascular and macrovascular complications were added to the Cox models, depression was not significantly associated with excess all-cause or cardiac mortality.
Depression in patients with type 2 diabetes is associated with a greater prevalence of complications but is not an independent predictor of all-cause or cardiac mortality. Depression may contribute to the progression of important prognostic variables in diabetes, particularly macrovascular and microvascular disease.

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    • "The outcome of the studies was either all-cause mortality, reported in all 16 studies, or cardiovascular mortality, reported in five papers [9], [25], [29], [31], [32]. One study distinguished between all-cause, cardiac, cancer and noncardiac/noncancer mortality [29]. "
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    ABSTRACT: To quantify the impact of depression measured by self-reports and depression measured by clinical interview on all-cause mortality in individuals with diabetes and to analyze the strength of both associations, the influence of covariates, and possible differences between studies assessing self-rated depressive symptoms and those using a clinical interview to measure depression as predictors of mortality. PUBMED and PsycINFO were searched up to July 2013 for prospective studies assessing depression, diabetes and mortality. The pooled hazard ratios were calculated using random-effects models. Sixteen studies met the inclusion criteria. After adjustment for demographic variables depression measured by self-reports was associated with an increased all-cause mortality risk (pooled HR = 2.56, 95% CI 1.89-3.47), and the mortality risk remained high after additional adjustment for diabetes complications (HR = 1.76, 95% CI 1.45-2.14,). Six studies reporting adjusted HRs for depression measured by clinical interviews supported the results of the other models (HR = 1.49, 95% CI 1.15-1.93). Both depression measured by self-report and depression measured by clinical interview have an unfavorable impact on mortality in individuals with diabetes. The results, however, are limited by the heterogeneity of the primary studies. It remains unclear whether self-reports or clinical interviews for depression are the more precise predictor.
    Full-text · Article · Nov 2013 · PLoS ONE
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    • "Depression is not only associated with impaired life quality,1 but also with poor glycaemic control, increased risks for the development of diabetes complications and higher mortality rates.2-4 Although the relationship between depression and diabetes is not fully understood and many studies are still going on, the high healthcare expenditure5 and increased mortality6,7 caused by depression indicated that all patients with diabetes should undergo regular screening for depression. "
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    ABSTRACT: Objectives: The prevalence of depression is relatively high in individuals with diabetes. However, screening and monitoring of depressive state in patients with diabetes is still neglected in developing countries and the treatment of diabetes-related depression is rarely performed in these countries. In this study, our aim was to study the role of diabetes education in the improvement of depressive state in newly diagnosed patients with type 2 diabetes. Methods: The Dutch version of the center for epidemiological studies depression scale (CES-D scale) and the problem areas in diabetes (PAID) questionnaire were used to assess depression and diabetes-specific emotional distress in 1200 newly diagnosed male adult patients with type 2 diabetes before and after a two-week diabetes education by professionally trained nurses. Pearson correlation and regression analysis were used to analyze the factors related to depression in patients with type 2 diabetes. Results: The incidence of depression in newly diagnosed patients with type 2 diabetes was 28%, and the rate of diabetes-specific emotional distress was 65.5%. High education levels, low income were correlated to depression in individuals with diabetes. After two weeks of diabetes education, the incidence of depression and diabetes-specific emotional distress decreased significantly to 20.5% (P < 0.05) and 11% (P < 0.001), respectively. Conclusions: The incidence of depression, especially diabetes-specific emotional distress, was relatively high in newly diagnosed patients with type 2 diabetes. The depression state could be improved by diabetes education.
    Full-text · Article · Sep 2013 · Pakistan Journal of Medical Sciences Online
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    • "Furthermore, depression is associated with physiological abnormalities, including the activation of the hypothalamus-pituitary-adrenal axis, the sympathetic nervous system, and the proinflammatory cytokines [18] [20], which can induce a resistance to insulin, and thus increase the risk of diabetes. Diabetes might increase the risk of depression and anxiety because of feelings of threat and loss related to the announcement of the diagnosis and the need to make lifestyle changes [11]. Finally, the association between mood disorders and diabetes can be partly explained by the existence of comorbidities [3] [18]. "
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    ABSTRACT: Objectives. To estimate the prevalence of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) in a population aged over sixty years with type 2 diabetes and to study the impact of anxiety and depression on glycemic balance and disease outcome. Results. The prevalence of anxiety and depression in the 62 subjects included in the study was, respectively, 40.3% and 22.6%. We found a relationship between these disorders and complicated diabetes. The subjects having an imperfectly balanced diabetes had a higher average anxiety score than those having a good glycemic control (9.1 ± 4.2 versus 6.5 ± 3.1; P = 0.017). No relationship was found between diabetes balance and depression. Conclusion. Association between anxiety and depressive disorders and diabetes is frequent and worsens patients' outcome, in terms of diabetes imbalance as well as in terms of diabetic complications. Our study shows that there is need for physicians to detect, confirm, and treat anxiety and depressive disorders in elderly diabetic patients.
    Full-text · Article · Jun 2013 · Depression research and treatment
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