January 3, 2011Archives of General Psychiatry185 citations
View Full PaperIncreased Mortality Risk in Women With Depression and Diabetes Mellitus
Key Result
The coexistence of depression and diabetes in women was associated with a significantly increased risk of all-cause (RR 2.07; 95% CI 1.79-2.40) and CVD mortality (RR 2.72; 95% CI 2.09-3.54).
Key Points
- To evaluate the individual and combined effects of depression and type 2 diabetes mellitus on all-cause and cardiovascular disease mortality rates in older women.
- Prospective cohort study analyzing 78,282 women aged 54 to 79 years from the Nurses' Health Study across 11 US states, followed from 2000 to 2006 (433,066 person-years).
- Depression was assessed via self-reported clinical diagnosis, antidepressant medication use, or 5-item Mental Health Index score ≤52; type 2 diabetes was confirmed by supplementary questionnaire.
- Across 4,654 total deaths (979 CVD deaths), multivariate-adjusted relative risks for women with both conditions versus neither were 2.07 (95% CI, 1.79-2.40) for all-cause mortality and 2.72 (95% CI, 2.09-3.54) for CVD mortality.
- CVD mortality was markedly higher when depression co-occurred with diabetes duration >10 years (multivariate RR, 3.22) or insulin therapy (multivariate RR, 4.90).
Study Design
Type
Cohort (n=78,282)
Multicenter
Yes
Structured PICO
Does the coexistence of depression and diabetes increase the risk of all-cause and CVD mortality in women?
P
Population
78,282 women aged 54 to 79 years from the Nurses' Health Study, followed for 6 years to evaluate the joint effects of depression and diabetes on mortality.
E
Exposure
Presence of depression (self-reported diagnosis, antidepressant treatment, or severe depressive symptoms) and/or type 2 diabetes.
C
Comparator
Participants without either depression or diabetes.
O
Outcome
All-cause and cardiovascular disease (CVD)-specific mortality rate.hard clinical
The coexistence of depression and diabetes in older women synergistically increases the risk of all-cause and cardiovascular mortality, identifying a particularly high-risk population.
Main Result
Relative Risk: 2.07 (95% CI 1.79–2.4)
Abstract
CONTEXT: Depression and diabetes mellitus have been associated with an increased risk of all-cause and cardiovascular disease (CVD) mortality. However, data evaluating the joint effects of these 2 conditions on mortality are sparse. OBJECTIVES: To evaluate the individual and joint effects of depression and diabetes on all-cause and CVD mortality rate. DESIGN: Prospective cohort study. SETTING: The 11 states of the Nurses' Health Study. PARTICIPANTS: A total of 78 282 women who participated in the Nurses' Health Study aged 54 to 79 years at baseline in 2000 were followed up until 2006. Depression was defined as having self-reported diagnosed depression, treatment with antidepressant medications, or a score indicating severe depressive symptoms (ie, a 5-item Mental Health Index score ≤52). Self-reported type 2 diabetes was confirmed using a supplementary questionnaire. MAIN OUTCOME MEASURES: All-cause and CVD-specific mortality rate. RESULTS: During 6 years of follow-up (433 066 person-years), 4654 deaths were documented, including 979 deaths from CVD. Compared with participants without either condition, the age-adjusted relative risks (RRs) (95% confidence interval) for all-cause mortality were 1.76 (1.64-1.89) for women with depression only, 1.71 (1.54-1.89) for individuals with diabetes only, and 3.11 (2.70-3.58) for women with both conditions. The corresponding age-adjusted RRs of CVD mortality were 1.81 (1.54-2.13), 2.67 (2.20-3.23), and 5.38 (4.19-6.91), respectively. These associations were attenuated after multivariate adjustment for other demographic variables, body mass index, smoking status, alcohol intake, physical activity, and major comorbidities (including hypertension, hypercholesterolemia, heart diseases, stroke, and cancer) but remained significant, with the highest RRs for all-cause and CVD mortality found in those with both conditions (2.07 1.79-2.40 and 2.72 2.09-3.54, respectively). Furthermore, the combination of depression with a long duration of diabetes mellitus (ie, >10 years) or insulin therapy was associated with a particularly higher risk of CVD mortality after multivariate adjustment (RRs, 3.22 and 4.90, respectively). CONCLUSIONS: Depression and diabetes are associated with a significantly increased risk of all-cause and CVD mortality rate. The coexistence of these conditions identifies women at particularly high risk.