The Bidirectional Relationship between Diabetes and Depression: A Literature Review

Abstract

Diabetes is a major public health problem worldwide. Depression is a serious mental condition that decreases mental and physical functioning and reduces the quality of life. Several lines of evidence suggest a bidirectional relationship between diabetes and depression: diabetes patients are twice as likely to experience depression than nondiabetic individuals. In contrast, depression increases the risk of diabetes and interferes with its daily self-management. Diabetes patients with depression have poor glycemic control, reduced quality of life, and an increased risk of diabetes complications, consequently having an increased mortality rate. Conflicting evidence exists on the potential role of factors that may account for or modulate the relationship between diabetes and depression. Therefore, this review aims to highlight the most notable body of literature that dissects the various facets of the bidirectional relationship between diabetes and depression. A focused discussion of the proposed mechanisms underlying this relationship is also provided. We systematically reviewed the relevant literature in the PubMed database, using the keywords “Diabetes AND Depression”. After exclusion of duplicate and irrelevant material, literature eligible for inclusion in this review was based on meta-analysis studies, clinical trials with large sample sizes (n≥1,000), randomized clinical trials, and comprehensive national and cross-country clinical studies. The evidence we present in this review supports the pressing need for long, outcome-oriented, randomized clinical trials to determine whether the identification and treatment of patients with these comorbid conditions will improve their medical outcomes and quality of life.

Are normoglycaemic individuals at risk of depression? The depression-dysglycaemic phenotype from a European population-based cross-sectional study

“…It was reported that individuals with depressive symptoms in combination with metabolic dysregulation are at higher risk of diabetes [24]. Known diabetes was only associated with selfreported depression and not with depressive symptoms, which coincides with a Finnish Study conducted in 2007 [10].…”

Diabetes increases the risk of depression: A systematic review, meta-analysis and estimates of population attributable fractions based on prospective studies

“…A number of systematic reviews and meta-analyses (Knol et al, 2006; Cosgrove et al, 2008; Mezuk et al, 2008; Yu et al, 2015; Vancampfort et al, 2015) found that depression was associated with an increased risk of incident diabetes while earlier systematic reviews and meta-analysis found the reverse that is individuals with diabetes had a modestly increased risk of developing depression (Mezuk et al, 2008; Nouwen et al, 2010; Rotella and Mannucci, 2013; Syed et al, 2015; Tong et al, 2016). The possibility of a bidirectional relationship has gained much attention in recent years become the focus of a number of longitudinal prospective studies, literature reviews, systematic reviews and meta-analysis (Pan et al, 2010; Zhuang et al, 2017; Alzoubi et al, 2018; Hasan et al, 2013; Roy and Lloyd, 2012).…”

The Humanistic and Economic Burden Associated with Anxiety and Depression among Adults with Comorbid Diabetes and Hypertension

“…Based on the finding of a recent study, the national burden of comorbid diabetes and hypertension could exceed $350 billion [ 17 ]. Depression and anxiety have been indicated with higher risks of diabetes complications and heart diseases, leading to excess costs from more physician office visits, emergency room or inpatient admissions, and prescription consumption [ 18 , 19 ].…”