Depressive symptoms, antidepressant use, and the incidence of diabetes in the Black Women's Health Study.
OBJECTIVE
To assess the relationship of depressive symptoms and use of antidepressants with incident type 2 diabetes in prospective data from a large cohort of U.S. African American women.


METHODS
The Black Women's Health Study (BWHS) is an ongoing prospective cohort study. We followed 35,898 women from 1999 through 2011 who were without a diagnosis of diabetes and who had completed the Center for Epidemiologic Studies Depression Scale (CES-D) in 1999. CES-D scores were categorized as <16, 16-22, 23-32, and ≥33, which reflected increasingly more depressive symptoms. We estimated incidence rate ratios (IRRs) and 95% CIs for incident diabetes using Cox proportional hazards models. The basic multivariable model included age, time period, family history of diabetes, and education. In further models, we controlled for lifestyle factors and BMI. We also assessed the association of antidepressant use with incident diabetes.


RESULTS
Over 12 years of follow-up, there were 3,372 incident diabetes cases. Relative to CES-D score <16, IRRs (95% CI) of diabetes for CES-D scores 16-22, 23-32, and ≥33 were 1.23 (1.12-1.35), 1.26 (1.12-1.41), and 1.45 (1.24-1.69), respectively, in the basic multivariate model. Multiple adjustment for lifestyle factors and BMI attenuated the IRRs to 1.11 (1.01-1.22), 1.08 (0.96-1.22), and 1.22 (1.04-1.43). The adjusted IRR for antidepressant use was 1.26 (1.11-1.43). Results were similar among obese women.


CONCLUSIONS
Both depressive symptoms and antidepressant use are associated with incident diabetes among African American women. These associations are mediated in part, but not entirely, through lifestyle factors and BMI.
Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA varshav@bu.edu.
Varsha G
VG
Vimalananda
Slone Epidemiology Center, Boston University, Boston, MADepartment of Epidemiology, Boston University School of Public Health, Boston, MA.
Julie R
JR
Palmer
Slone Epidemiology Center, Boston University, Boston, MADepartment of Biostatistics, Boston University School of Public Health, Boston, MA.
Hanna
H
Gerlovin
Slone Epidemiology Center, Boston University, Boston, MADepartment of Epidemiology, Boston University School of Public Health, Boston, MA.
Lauren A
LA
Wise
Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA.
James L
JL
Rosenzweig
Slone Epidemiology Center, Boston University, Boston, MADepartment of Epidemiology, Boston University School of Public Health, Boston, MA.
Lynn
L
Rosenberg
Slone Epidemiology Center, Boston University, Boston, MADepartment of Epidemiology, Boston University School of Public Health, Boston, MA.
Edward A
EA
Ruiz-Narváez
D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001294:Attitude to Health / Q000208:ethnology; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000208:ethnology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000208:ethnology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D016387:Women's Health / Q000208:ethnology*
D000928:Antidepressive Agents