title: Diabetes Mellitus as a Risk Factor for Development of Depressive Symptoms in a Population-Based Cohort of Older Mexican Americans.
abstract: OBJECTIVE
  To determine whether diabetes mellitus increases depressive symptoms in older Latinos in a population-based cohort.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Individuals from the Sacramento Latino Study on Aging aged 60 and older in 1998-99 and followed annually until 2008 (N = 1,586).
  
  
  METHODS
  Diabetes mellitus was defined according to self-report, fasting blood glucose of 126 mg/dL or greater, glycosylated hemoglobin of 6.5% or greater, or diabetic medication use. Depressive symptoms were defined as Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or greater or use of antidepressant medication. Multistate Markov modeling was used to assess the effects of time-dependent diabetes mellitus on transitions between three states over time: low CES-D score (normal), high CES-D score or treated (depressed), and death. Bivariate analyses identified covariates significantly associated with any transition, including sex and baseline measures of age, education, body mass index, hypertension, and stroke.
  
  
  RESULTS
  In a fully adjusted model, participants with diabetes mellitus had a 35% higher rate of developing depressive symptoms or starting treatment with an antidepressant (hazard ratio (HR) = 1.35, 95% confidence interval (CI) = 1.13-1.62). Time-dependent diabetes mellitus was associated with a lower rate of regression from depressed to normal (HR = 0.72, 95% CI = 0.59-0.88) and a 2.3 greater rate pf progression from depressed to death (HR = 2.31, 95% CI = 1.57-3.40).
  
  
  CONCLUSIONS
  Diabetes mellitus increased the risk of developing depressive symptoms in older Mexican Americans. Older Latinos with diabetes mellitus should be screened for depressive symptoms and prioritized for close follow-up, potentially through greater reliance on team-based models of care.
authors.affiliation: Division of General Internal Medicine, University of California at San Francisco and San Francisco General Hospital, San Francisco, California.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Garcia
authors.affiliation: Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
authors.forename: Anne
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
authors.forename: John
authors.initials: J
authors.lastname: Neuhaus
authors.affiliation: Department of Epidemiology, Michigan State University, East Lansing, Michigan.
authors.forename: Hector
authors.initials: H
authors.lastname: Gonzalez
authors.affiliation: Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
authors.forename: Tu My
authors.initials: TM
authors.lastname: To
authors.affiliation: Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
authors.forename: Mary N
authors.initials: MN
authors.lastname: Haan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000209:etiology*; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D017058:Mexican Americans / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013997:Time Factors
keywords: Hispanic health; depression; diabetes; geriatrics; vulnerable populations