title: The association of comorbid depression with mortality in patients with type 2 diabetes.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, Seattle, WA 98195-6560, USA. wkaton@u.washington.edu
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rutter
authors.forename: Greg
authors.initials: G
authors.lastname: Simon
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Leslie
authors.initials: L
authors.lastname: Kinder
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000704:Analysis of Variance; D044466:Asian People / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality*; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires; D013997:Time Factors; D014861:Washington / Q000453:epidemiology / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data