title: Depression predicts all-cause mortality: epidemiological evaluation from the ACCORD HRQL substudy.
abstract: OBJECTIVE
  Depression affects up to 20-25% of adults with type 2 diabetes and may increase all-cause mortality, but few well-designed studies have examined the effects of depression on the full range of cardiovascular disease outcomes in type 2 diabetes.
  
  
  METHODS
  A total of 2,053 participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Health-Related Quality of Life substudy completed the Patient Health Questionnaire (PHQ)-9 measure of depression symptoms at baseline and 12, 36, and 48 months. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% CI) for the time-varying impact of depression on protocol-defined clinical outcomes with and without adjustment for demographic, trial-related, clinical, and behavioral variables.
  
  
  RESULTS
  In fully adjusted models, depression was not significantly related to the ACCORD primary composite outcome (cardiovascular death, nonfatal heart attack, or stroke) (HR 1.53 [95% CI 0.85-2.73]) or to the ACCORD microvascular composite outcome (0.93 [0.53-1.62]), but all-cause mortality was significantly increased both in those with PHQ-assessed probable major depression (2.24 [1.24-4.06]) and PHQ score of ≥ 10 (1.84 [1.17-2.89]). The effect of depression on all-cause mortality was not related to previous cardiovascular events or to assignment to intensive or standard glycemia control. Probable major depression (by PHQ-9) had a borderline impact on the ACCORD macrovascular end point (1.42 [0.99-2.04]).
  
  
  CONCLUSIONS
  Depression increases the risk of all-cause mortality and may increase the risk of macrovascular events among adults with type 2 diabetes at high risk for cardiovascular events.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA. sullimar@uw.edu
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Connor
authors.forename: Patricia
authors.initials: P
authors.lastname: Feeney
authors.forename: Don
authors.initials: D
authors.lastname: Hire
authors.forename: Debra L
authors.initials: DL
authors.lastname: Simmons
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Raisch
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Fine
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Ali
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000401:mortality; D003863:Depression / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose