Associations between Depression and Diabetes in the Community: Do Symptom Dimensions Matter? Results from the Gutenberg Health Study

Abstract

ObjectivesWhile 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.Research Design and MethodsIn 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.ResultsWe 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.ConclusionsDiabetes 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.

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“…For example, a study of adults with type 2 diabetes showed that much of the overidentification of depression by a commonly used screening instrument (14) was explained by symptoms involving impairments in sleep, appetite, and energy level (15). Results from a large, population-based study showed that differences in depressive symptoms between adults with and without diabetes were limited to somatic symptoms; no significant differences were found for cognitive-affective symptoms of depression (16). Further, qualitative analysis of structured clinical interviews for depression showed that patients with type 2 diabetes often discuss somatic symptoms of depression as being caused by diabetes and diabetes-related medications (17).…”

The gut–brain axis: The role of melatonin in linking psychiatric, inflammatory and neurodegenerative conditions

“…Many other non-psychiatric medical conditions associate with increased levels of depression, including obesity [42], type II diabetes [43], cardiovascular disease [44], chronic obstructive pulmonary disorder [45], non-alcoholic fatty liver disease (NAFLD) [46] and a variety of different cancers [47,48]. As with depressionassociated psychiatric conditions, the increased rates of depression in general medical inflammatory conditions have classically been attributed to a psychological reaction to an often long-term, chronic condition.…”

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