Depression and Mortality in People with Type 2 Diabetes Mellitus, 2003 to 2013: A Nationwide Population-Based Cohort Study

Abstract

BackgroundPrevious reports have demonstrated a bidirectional relationship between depression and diabetes mellitus (DM), accentuating a need for more intensive depression screening in DM patients. There is a relative paucity of data on the mortality of depressed DM patients in Korea.MethodsRetrospective data from January 2003 to December 2013 were collected for adult type 2 diabetes mellitus (T2DM) patients older than 30 years using the National Health Information database maintained by the Korean National Health Insurance Service (NHIS). Demographic characteristics were analyzed with descriptive statistics, and the annual prevalence of depression was estimated. Mortality rates and hazard ratios for each age group (stratified into six age groups) of patients diagnosed with T2DM in 2003 were estimated using a Cox proportional hazard method, with the Kaplan-Meier cumulative survival curve showing the overall survival rates according to the T2DM status until the given year of 2013.ResultsThe annual prevalence of depression was consistently higher in T2DM group from 2003 to 2013. The mortality hazard ratio was higher in the depressed in all age groups, and the risk was higher in male groups and in younger-aged groups.ConclusionDepression was significantly associated with a high mortality risk in T2DM patients; hence, a more systematic surveillance of T2DM patients to identify risk factors for depression might contribute significantly to reducing mortality risk in this group of patients.

Past and Current Status of Adult Type 2 Diabetes Mellitus Management in Korea: A National Health Insurance Service Database Analysis

“…Previously, the prevalence of depression in patients with T2DM in Korea has been reported as high as 22.6% to 28.8% [ 18 19 ]. In the analysis using the NHIS DB, depression in T2DM was defined as both T2DM and depression (ICD-10 code of F320-349) with at least one prescription for antidepressants ( Table 1 ) [ 20 ].…”

“…According to the analysis of the NHIS DB from 2003 to 2013, the annual prevalence rates of depression consistently increased both in T2DM and the general population without T2DM ( Fig. 4 ) [ 20 ]. During the study period, the prevalence rate of depression in T2DM was about two-fold higher compared to the general population (9.6% vs. 4.6% in 2013).…”

“…During the study period, the prevalence rate of depression in T2DM was about two-fold higher compared to the general population (9.6% vs. 4.6% in 2013). In addition, T2DM patients with depression demonstrated a significantly higher mortality risk than those without depression, especially in males and younger age groups [ 20 ]. The 10-year mortality rate in T2DM with depression was 1.4-fold higher compared to T2DM without depression, particularly for those in their 30s and 40s [ 20 ].…”

The Association between Diabetes Complications, Diabetes Distress, and Depressive Symptoms in Patients with Type 2 Diabetes Mellitus

“…Patients with T2DM often have comorbid depression, and up to 27.6% of patients with T2DM have suffered from clinically relevant depressive symptoms (Lloyd et al, 2018). Comorbid depression may worsen health outcomes, such as poor self-management (Schmitt et al, 2017), worse glycemic control (Alzughbi et al, 2020), a lower quality of life (Patra et al, 2020), and a higher risk of mortality (Jeong et al, 2017). Exploring the causes and mechanisms of depression in patients with T2DM may provide a new avenue for identifying the risk factors and for formulating targeted interventions to prevent the onset or delay the progression of depression.…”

Depression and Mortality in Type 2 Diabetes Mellitus

“…Jeong et al [ 9 ] retrospectively showed that the annual prevalence of depression was higher in T2DM and higher morality was shown in the depressed subjects from the nationwide health insurance service database in Korea. It was the first longitudinal data from Koreans, and the findings are consistent with the previous results that patients with depressed symptoms showed increased mortality in patients with diabetes mellitus.…”