title: Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis.
abstract: OBJECTIVE
  Evidence strongly suggests that depression and type 2 diabetes are associated, but the direction of the association is still unclear. Depression may occur as a consequence of having diabetes, but may also be a risk factor for the onset of type 2 diabetes. This study examined the latter association by reviewing the literature and conducting a meta-analysis of longitudinal studies on this topic.
  
  
  METHODS
  Medline and PsycInfo were searched for articles published up to January 2005. All studies that examined the relationship between depression and the onset of type 2 diabetes were included. Pooled relative risks were calculated using fixed and random effects models. To explore sources of heterogeneity between studies, subgroup analyses and meta-regression analyses were performed.
  
  
  RESULTS
  Nine studies met our inclusion criteria for this meta-analysis. The pooled relative risk was 1.26 (1.13-1.39) using the fixed effects model and 1.37 (1.14-1.63) using the random effects model. Heterogeneity between studies could not be explained by (1) whether studies controlled for undetected diabetes at baseline; (2) the method of diabetes assessment at follow-up; (3) the baseline overall risk of diabetes in the study population; and (4) follow-up duration.
  
  
  CONCLUSIONS
  Depressed adults have a 37% increased risk of developing type 2 diabetes mellitus. The pathophysiological mechanisms underlying this relationship are still unclear and warrant further research. A randomised controlled study is needed to test whether effective prevention or treatment of depression can reduce the incidence of type 2 diabetes and its health consequences.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Knol
authors.forename: J W R
authors.initials: JW
authors.lastname: Twisk
authors.forename: A T F
authors.initials: AT
authors.lastname: Beekman
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: F J
authors.initials: FJ
authors.lastname: Snoek
authors.forename: F
authors.initials: F
authors.lastname: Pouwer
mesh_terms: D003863:Depression / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D012307:Risk Factors