title: Associations between depression and diabetes in the community: do symptom dimensions matter? Results from the Gutenberg Health Study.
abstract: OBJECTIVE
  While a bidirectional relationship between diabetes and depression has been established, there is little knowledge if the associations are due to somatic-affective or cognitive-affective dimensions of depression.
  
  
  METHODS
  In a population-based, representative survey of 15.010 participants we therefore studied the associations of the two dimensions of depression with diabetes and health care utilization among depressed and diabetic participants. Depression was assessed by the Patient Health Questionnaire PHQ-9.
  
  
  RESULTS
  We found a linear and consistent association between the intensity of depression and the presence of diabetes increasing from 6.9% in no or minimal depression to 7.6% in mild, 9% in moderate and 10.5% in severe depression. There was a strong positive association between somatic-affective symptoms but not with cognitive-affective symptoms and diabetes. Depression and diabetes were both independently related to somatic health care utilisation.
  
  
  CONCLUSIONS
  Diabetes and depression are associated, and the association is primarily driven by the somatic-affective component of depression. The main limitation of our study pertains to the cross-sectional data acquisition. Further longitudinal work on the relationship of obesity and diabetes should differentiate the somatic and the cognitive symptoms of depression.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Wiltink
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Michal
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site RhineMain, Mainz, Mainz, Germany.
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Wild
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Jochem
authors.initials: J
authors.lastname: König
authors.affiliation: Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Blettner
authors.affiliation: Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulz
authors.affiliation: Department of Medicine 1, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Medicine 1, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Fottner
authors.affiliation: Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Pfeiffer
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Lackner
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Manfred E
authors.initials: ME
authors.lastname: Beutel
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology*; D048909:Diabetes Complications / Q000453:epidemiology / Q000523:psychology*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence