title: Depression as a risk factor for mortality in individuals with diabetes: a meta-analysis of prospective studies.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Giessen, Giessen, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Hofmann
authors.forename: Birgit
authors.initials: B
authors.lastname: Köhler
authors.forename: Falk
authors.initials: F
authors.lastname: Leichsenring
authors.forename: Johannes
authors.initials: J
authors.lastname: Kruse
mesh_terms: D003863:Depression / Q000150:complications*; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality*; D006801:Humans; D012307:Risk Factors