Depression Predicts All-Cause Mortality

Abstract

OBJECTIVEDepression affects up to 20–25% of adults with type 2 diabetes and may increase all-cause mortality, but few well-designed studies have examined the effects of depression on the full range of cardiovascular disease outcomes in type 2 diabetes.RESEARCH DESIGN AND METHODSA total of 2,053 participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Health-Related Quality of Life substudy completed the Patient Health Questionnaire (PHQ)-9 measure of depression symptoms at baseline and 12, 36, and 48 months. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% CI) for the time-varying impact of depression on protocol-defined clinical outcomes with and without adjustment for demographic, trial-related, clinical, and behavioral variables.RESULTSIn fully adjusted models, depression was not significantly related to the ACCORD primary composite outcome (cardiovascular death, nonfatal heart attack, or stroke) (HR 1.53 [95% CI 0.85–2.73]) or to the ACCORD microvascular composite outcome (0.93 [0.53–1.62]), but all-cause mortality was significantly increased both in those with PHQ-assessed probable major depression (2.24 [1.24–4.06]) and PHQ score of ≥10 (1.84 [1.17–2.89]). The effect of depression on all-cause mortality was not related to previous cardiovascular events or to assignment to intensive or standard glycemia control. Probable major depression (by PHQ-9) had a borderline impact on the ACCORD macrovascular end point (1.42 [0.99–2.04]).CONCLUSIONSDepression increases the risk of all-cause mortality and may increase the risk of macrovascular events among adults with type 2 diabetes at high risk for cardiovascular events.

Depression in Adults in the T1D Exchange Clinic Registry

“…Of those we assessed, female sex, African American race or Hispanic ethnicity, low education (i.e., less than high school), being unemployed, being without health insurance coverage, low socioeconomic status, and medical illness are consistently viewed as significant risk factors (24,30), as they were shown to be in this study. For patients with type 2 diabetes, the literature shows that those who are poorer, less educated, unemployed, without insurance, and who have more complications are more likely to be depressed (6)(7)(8)(9)(10)(11)13,14). We found similar results in our sample of adults with T1D.…”

“…We note, however, that "other depression" is not a DSM diagnostic entity, but we use this label to capture a group with symptoms of depression that are not likely to meet DSM criteria. Sullivan et al (11) used this algorithm in the ACCORD trial and found that less than half of those defined as depressed using PHQ-9 $10 as the cutoff were defined as depressed with the algorithm.…”

Associations Between Antidepressant Adherence and Shared Decision-Making, Patient–Provider Trust, and Communication Among Adults with Diabetes: Diabetes Study of Northern California (DISTANCE)

“…3 Depression, an important comorbidity among adults with diabetes, has been associated with poorer disease selfmanagement and greater risk of diabetic complications, including microvascular and macrovascular disease, demen-tia, and early mortality. [4][5][6][7][8] This association is substantial in magnitude; estimates suggest that smoking, poor diet, and inactivity may be increased by 30-100 % and the risk for adverse outcomes including dementia and mortality doubles when diabetes is complicated by depression. [5][6][7] However, depression is often unrecognized among patients with diabetes in primary care settings, and adequate antidepressant treatment is received by less than one-third of such patients.…”

Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes: The Diabetes Study of Northern California (DISTANCE)

“…7 Among adults with diabetes, depression is associated with impaired self-care and increased risk of microvascular and macrovascular complications, dementia, and mortality. [8][9][10][11][12] Therefore, effective treatment for depression is particularly important for people with diabetes. However, little is known about factors that influence adherence to antidepressant medications, the most common treatment for depression, in this population.…”