Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus: results from the ZARADEMP project

Abstract

Aims/hypothesis Although several studies have reported on the association between diabetes and depression, none have used both formal psychiatric criteria and a prospective, population-based design. Therefore, it remains unclear whether diabetes is a risk factor for the development of depression. Moreover, it is not clear if this effect is influenced by other chronic diseases and functional disabilities. Methods A large (n=4,803) representative communitybased study in Spanish elderly subjects (at least 55 years of age) was conducted. The presence of major depression was assessed by means of a standardised psychiatric diagnostic interview (Automated Geriatric Examination for Computer Assisted Taxonomy). Subjects underwent a baseline assessment and a follow-up assessment after 2 and 5 years to determine the incidence of depression. Results At baseline 597 subjects (12.5%) were identified as having diabetes. Prevalence and incidence of depression in cases of diabetes were 15.4% and 16.5% respectively. Diabetes was associated with an increased risk of prevalent (odds ratio [OR]=1.47; 95% CI: 1.16-1.83) and incident (OR=1.40; 95% CI: 1.03-1.90) depression. Controlling for potential confounders did not essentially change these findings (prevalent depression: OR 1.41, 95% CI: 1.08-1.83; incident depression: OR 1.26, 95% CI: 0.90-1.77). Conclusions/interpretation In a large, representative prospective population-based sample using strict psychiatric criteria, we confirmed previous findings that diabetes is associated with an increased risk of depression. The effect on the incidence of depression suggests that diabetes may play a role in the development of depression in the elderly. The presence of comorbid medical diseases seems to decrease the effects of diabetes on the risk of prevalent depression, but to increase the risk of incident depression.

Metabolic syndrome and depressive symptoms among Japanese men and women

“…Prospective studies in Italy [28] and Spain [29] have shown that diabetes at baseline is associated with an increased risk of developing depressive symptoms. Moreover, in a meta-analysis involving 42 cross-sectional studies, subjects with diabetes had a twofold increased prevalence of depressive symptoms than subjects without diabetes [30].…”

The Relationship Between the Severity of Depressive Symptoms and Diabetes-Related Emotional Distress in Patients with Type 2 Diabetes

“…Several preceding studies have indicated that there is a significant relationship between diabetes and the prevalence of depressive symptoms (1,2,20); however, the causal mechanisms and direction of the relationship are unclear. Some recent prospective studies have suggested that diabetes is related to the prevalence and incidence of depression or depressive symptoms (13,14), and others have suggested that the association is in the other direction (15,16). Therefore, it is possible there is a bidirectional association between depression and diabetes.…”

“…Preceding studies have pointed out the possibility that the effects of depression may result in poor glycemic control, poor prognosis of diabetic complications, and other clinical covariates (5,6). Additionally, a prospective study that referred to the possibility of an increased risk of depression among patients with diabetes indicated that the increased risk was mainly observed in patients with poor glycemic control (13). However, we suggest that it is insufficient only to consider the glycemic control, state of complications, and other clinical covariates, when we estimate the possibility of the presence or severity of depressive symptoms in patients with diabetes, despite the fact that the causal relationship between depression and diabetes is unclear.…”

“…In patients with diabetes, depression has been related to an increased risk of diabetic vascular complications (3), poor glycemic control (4), and non-adherence to treatment and self-management behaviors (5)(6)(7). To date, even the direction of the cause-effect relationship between depression and diabetes is a controversial issue (10)(11)(12)(13)(14)(15)(16). At least, it is considered that the presence of physical diabetic complications such as blindness and end-stage renal disease may be a strong risk factor for depression.…”

Comorbilidad en personas con depresión que consultan en centros de la atención primaria de salud en Santiago, Chile

“…Se han reportado síntomas elevados de depresión asociados a la presencia de enfermedades crónicas en personas de distintos grupos etarios y procedencia (comunidad [5][6] , atención primaria o ambulatoria 7 , y centros de especialidades) 8 . El hecho que en pacientes con múltiples comorbilidades la enfermedad más común sea la depresión 9 y que en los depresivos crónicos sea usual la presencia de enfermedades crónicas 10 , retrata la compleja interacción entre estas patologías 4 .…”