A prospective study of depression and mortality in patients with type 2 diabetes : the Fremantle Diabetes study

• Published in: Diabetologia 2005-12, Vol.48 (12), p.2532-2539
• Main Authors: BRUCE, D. G, DAVIS, W. A, STARKSTEIN, S. E, DAVIS, T. M. E
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Biological and medical sciences; Cardiovascular Diseases - complications; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Causality; Cerebrovascular disease; Cohort Studies; Creatinine; Data Interpretation, Statistical; Depression; Depression - complications; Depression - epidemiology; Depression - psychology; Diabetes; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - mortality; Diabetes Mellitus, Type 2 - psychology; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - complications; Diabetic Angiopathies - epidemiology; Diabetic Angiopathies - mortality; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Male; Medical prognosis; Medical sciences; Mental depression; Middle Aged; Mood disorders; Mortality; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of Life - psychology; Questionnaires; Reproducibility of Results; Risk Factors; Surveys and Questionnaires; Time Factors; Western Australia - epidemiology
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-005-0024-3

Depression is associated with excess mortality in patients with type 2 diabetes. We investigated the impact, and possible causal mechanisms, of depression on all-cause and cardiac mortality in patients with type 2 diabetes. We recruited 1,273 patients with type 2 diabetes from a postcode-defined community (average age 64.1+/-11.2 years, 48.7% males, median duration of diabetes 4 years [range 1.0-9.0]) and followed them for 7.8+/-2.4 years. Depression was assessed using data obtained using a quality-of-life questionnaire, and cause and date of death were obtained from the state registry. Depression was present in 31.5% of subjects at recruitment. Depressed subjects had a longer duration of diabetes, more cardiovascular risk factors, CHD, cerebrovascular disease and diabetic microvascular complications at baseline, and higher all-cause and cardiac mortality rates during follow-up. In Cox proportional hazards models and after adjustment for demographic and diabetes-related variables and cardiovascular risk factors, depression was significantly associated with excess all-cause and cardiac mortality. When diabetic microvascular and macrovascular complications were added to the Cox models, depression was not significantly associated with excess all-cause or cardiac mortality. Depression in patients with type 2 diabetes is associated with a greater prevalence of complications but is not an independent predictor of all-cause or cardiac mortality. Depression may contribute to the progression of important prognostic variables in diabetes, particularly macrovascular and microvascular disease.