Contributions of diabetic macro-vascular complications and hip fracture to depression onset in elderly patients with diabetes: An 8-year population-based follow-up study

• Published in: Journal of psychosomatic research 2012-09, Vol.73 (3), p.180-184
• Main Authors: Pan, Hsueh-Hsing, Li, Chung-Yi, Chen, Pei-Chun, Lee, Ming-Der, Liang, Chun-Yu, Hou, Wen-Hsuan, Wang, Kwua-Yun
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Cardiovascular Diseases - complications; Cardiovascular Diseases - psychology; Depression; Depressive Disorder - etiology; Diabetic Angiopathies - complications; Diabetic Angiopathies - psychology; Diabetic complications; Elderly; Female; Follow-Up Studies; Hip Fractures - complications; Hip Fractures - psychology; Humans; Male; Poisson Distribution; Population-based; Proportional Hazards Models; Prospective Studies; Psychiatry; Risk; Sex Factors; Taiwan
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2012.06.003

Abstract Objective To prospectively examine the roles of diabetic macro-vascular complications and hip fracture in association with depression onset in Taiwan's elderly diabetic population. Methods A representative sample of elderly diabetic patients ( n = 144,216) identified in 2000 were linked to National Health Insurance claims (2000–2007) to ascertain the diagnoses of depression in both outpatient and inpatient settings. The person-year approach with Poisson assumption was used to estimate the hazard rates. Using Cox proportional hazard regression model, we evaluated the relative risk of depression in relation to diabetic macro-vascular complications and hip fracture. The additive effects from the above medical conditions were also assessed. Results The 8-year cumulative risk of depression was 5.08%, representing an incidence density of 8.40 per 1000 patient-years. Hazard ratio (HR) with 95% confidence interval (CI) for the elderly diabetes associated with cardiovascular disease (CVD), hip fracture, and lower extremity amputation was 1.13 (1.04–1.23), 1.10 (0.91–1.34), and 1.25 (0.95–1.65), respectively. Additionally, we found that the more the complications or hip fracture, the higher the risk of depression onset in elderly diabetes. Conclusion The increased number of diabetic macro-vascular complications and hip fracture is significantly associated with a higher risk of depression onset in elderly diabetes. Future studies should be conducted to assess the feasibility and cost-effectiveness of intensive depression screening program in elderly diabetes suffering from macro-vascular complications and hip fracture.