Depression and advanced complications of diabetes: a prospective cohort study.
OBJECTIVE
To prospectively examine the association of depression with risks for advanced macrovascular and microvascular complications among patients with type 2 diabetes.


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.
Lin
Elizabeth H B
EH
Group Health Research Institute, Group Health, Seattle, Washington, USA. lin.e@ghc.org
Rutter
Carolyn M
CM
Katon
Wayne
W
Heckbert
Susan R
SR
Ciechanowski
Paul
P
Oliver
Malia M
MM
Ludman
Evette J
EJ
Young
Bessie A
BA
Williams
Lisa H
LH
McCulloch
David K
DK
Von Korff
Michael
M
D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000523:psychology*; D003925:Diabetic Angiopathies / Q000523:psychology; D003928:Diabetic Nephropathies / Q000523:psychology; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology; D008297:Male; D017533:Marital Status; D009203:Myocardial Infarction / Q000523:psychology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012648:Self Care / Q000523:psychology; D020521:Stroke / Q000523:psychology; D011795:Surveys and Questionnaires
D006442:Glycated Hemoglobin