Purchase of antidepressant agents by patients with type 1 diabetes is associated with increased mortality rates in women but not in men

Ahola, Aila J.; Harjutsalo, Valma; Saraheimo, Markku; Groop, Per Henrik

doi:10.1007/s00125-011-2347-6

Cited by 16 publications

(11 citation statements)

References 25 publications

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“…The follow-up periods of included studies ranged from 2–10 years, with a mean follow-up of 6 years. The mean age at baseline ranged from 62 to 76 years, with exception of the only article focusing on type 1 diabetes, with a mean age of 39 years at baseline [16]. Twelve analyses (75%) showed a statistically significant association between depression and mortality in individuals with diabetes.…”

Section: Resultsmentioning

confidence: 99%

“…For three studies [11], [14], [16] hazard ratios needed to be combined in order to obtain the estimate of interest (example of procedure explained in Figure S1 in Supporting Information S1). In one paper [16] the hazard ratios for men and women were separately reported.…”

Section: Methodsmentioning

confidence: 99%

“…In one paper [16] the hazard ratios for men and women were separately reported. In the case of Lin et al [17] we assembled the hazard ratio for minor and major depression into one depression hazard ratio.…”

Section: Methodsmentioning

confidence: 99%

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Depression and Risk of Mortality in People with Diabetes Mellitus: A Systematic Review and Meta-Analysis

et al. 2013

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ObjectiveTo examine the association between depression and all-cause and cardiovascular mortality in people with diabetes by systematically reviewing the literature and carrying out a meta-analysis of relevant longitudinal studies.Research Design and MethodsPUBMED and PSYCINFO were searched for articles assessing mortality risk associated with depression in diabetes up until August 16, 2012. The pooled hazard ratios were calculated using random-effects models.ResultsSixteen studies met the inclusion criteria, which were pooled in an overall all-cause mortality estimate, and five in a cardiovascular mortality estimate. After adjustment for demographic variables and micro- and macrovascular complications, depression was associated with an increased risk of all-cause mortality (HR = 1.46, 95% CI = 1.29–1.66), and cardiovascular mortality (HR = 1.39, 95% CI = 1.11–1.73). Heterogeneity across studies was high for all-cause mortality and relatively low for cardiovascular mortality, with an I-squared of respectively 78.6% and 39.6%. Subgroup analyses showed that the association between depression and mortality not significantly change when excluding three articles presenting odds ratios, yet this decreased heterogeneity substantially (HR = 1.49, 95% CI = 1.39–1.61, I-squared = 15.1%). A comparison between type 1 and type 2 diabetes could not be undertaken, as only one study reported on type 1 diabetes specifically.ConclusionsDepression is associated with an almost 1.5-fold increased risk of mortality in people with diabetes. Research should focus on both cardiovascular and non-cardiovascular causes of death associated with depression, and determine the underlying behavioral and physiological mechanisms that may explain this association.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Depression and Risk of Mortality in People with Diabetes Mellitus: A Systematic Review and Meta-Analysis

et al. 2013

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“…It has been shown previously that the use of antidepressants is associated with a lowered (26) risk of death from suicide in the general population. It was found among a large cohort of patients with type 1 diabetes in which purchases of antidepressants were used as a marker of depression (27) that about eight per cent of the patients had bought them. Additional cases were observed during the follow-up increasing the percentage to 18, and in the adjusted Cox's regression models, the purchase of antidepressants at baseline was associated with mortality among women, but not among men.…”

Section: Discussionmentioning

confidence: 99%

Excess mortality in Finnish diabetic subjects due to alcohol, accidents and suicide: a nationwide study

Niskanen

Partonen

Auvinen

et al. 2018

European Journal of Endocrinology

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Aims To characterize the burden of external causes of death attributable to alcohol-related causes, accidents and suicide among diabetic patients in a large national cohort. Methods The population included diabetic individuals who had purchased and received reimbursement for at least one insulin prescription and/or one oral antidiabetic drug prescription between January 1997 and December 2010, and a non-diabetic reference population matched by sex, age and area. All new insulin users in this period were included, as well as 50% of new oral drug (OAD) users as a random sample. The data were collected by means of linkage from national registries. We analyzed the cohort data using Poisson regression models separately for each end-point and by gender (mortality rate ratio (MRR)). We subjected the case-cohort data to conditional logistic regression analysis based on exposure information within 1 year of the end-point event. The follow-up started on the date of the first diabetes medication prescription and ended on 31 December 2012 or on the date of death. Results The study population comprised 434 629 individuals (226 372 men; diabetes population: 208 148 subjects, of whom 76% were treated only with OAD). The mean follow-up time was 7.1 years, during which there were 2832 deaths attributable to alcohol, 3187 to accidents and 853 to suicide. The diabetic subjects had higher mortality at almost all end-points, especially those treated with insulin: the adjusted MRRs for alcohol-related deaths were 1.71 for diabetic men treated with OAD and 6.92 for those on insulin; the respective MRRs for diabetic women were 2.10 and 10.60. There were more accident-related deaths among those treated with insulin (MRRs: 2.06 and 1.53 for men and women, respectively), and more suicides (MRR: 2.10 for men treated with insulin and 1.62 among women treated only with OAD). The results from the cohort study and the case-cohort study were rather similar. A time-dependent effect of diabetes was observed in alcohol-related mortality among men. Conclusions The findings from this large nationwide cohort indicate higher mortality attributable to suicide, alcohol-related causes and accidents among diabetic patients than among the non-diabetic population. The results emphasize the importance of effective psychosocial interventions among high-risk diabetic patients.

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“…However, gender-specific analyses have been rarely performed. The coexistence of diabetes and depression has been found to increase mortality in T1D women [ 17 ] and diabetes-associated complications [ 9 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Symptoms of Eating Disorders and Depression in Emerging Adults with Early-Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control

et al. 2015

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BackgroundThis study analyzed the prevalence of and association between symptoms of eating disorders and depression in female and male emerging adults with early-onset, long-duration type 1 diabetes and investigated how these symptoms are associated with metabolic control.MethodsIn a nationwide population-based survey, 211 type 1 diabetes patients aged 18-21 years completed standardized questionnaires, including the SCOFF questionnaire for eating disorder symptoms and the Patient Health Questionnaire (PHQ-9) for symptoms of depression and severity of depressive symptoms (PHQ-9 score). Multiple linear and logistic regression models were used to analyze the association between eating disorder and depressive symptoms and their associations with HbA1c.ResultsA total of 30.2% of the women and 9.5% of the men were screening positive for eating disorders. The mean PHQ-9 score (standard deviation) was 5.3 (4.4) among women and 3.9 (3.6) among men. Screening positive for an eating disorder was associated with more severe depressive symptoms among women (βwomen 3.8, p<0.001). However, neither eating disorder symptoms nor severity of depressive symptoms were associated with HbA1c among women, while HbA1c increased with the severity of depressive symptoms among men (βmen 0.14, p=0.006).ConclusionsBecause of the high prevalence of eating disorder and depressive symptoms, their interrelationship, and their associations with metabolic control, particularly among men, regular mental health screening is recommended for young adults with type 1 diabetes.

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Purchase of antidepressant agents by patients with type 1 diabetes is associated with increased mortality rates in women but not in men

Cited by 16 publications

References 25 publications

Depression and Risk of Mortality in People with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Depression and Risk of Mortality in People with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Excess mortality in Finnish diabetic subjects due to alcohol, accidents and suicide: a nationwide study

Symptoms of Eating Disorders and Depression in Emerging Adults with Early-Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control

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