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Depression and Risk of Mortality in People with Diabetes Mellitus: A Systematic Review and Meta-Analysis

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  • Fleur E P van Dooren
  • Giesje Nefs
  • Miranda T Schram
  • Frans R J Verhey
  • Johan Denollet
  • François Pouwer

Abstract

Objective: To examine the association between depression and all-cause and cardiovascular mortality in people with diabetes by systematically reviewing the literature and carrying out a meta-analysis of relevant longitudinal studies. Research Design and Methods: PUBMED and PSYCINFO were searched for articles assessing mortality risk associated with depression in diabetes up until August 16, 2012. The pooled hazard ratios were calculated using random-effects models. Results: Sixteen studies met the inclusion criteria, which were pooled in an overall all-cause mortality estimate, and five in a cardiovascular mortality estimate. After adjustment for demographic variables and micro- and macrovascular complications, depression was associated with an increased risk of all-cause mortality (HR = 1.46, 95% CI = 1.29–1.66), and cardiovascular mortality (HR = 1.39, 95% CI = 1.11–1.73). Heterogeneity across studies was high for all-cause mortality and relatively low for cardiovascular mortality, with an I-squared of respectively 78.6% and 39.6%. Subgroup analyses showed that the association between depression and mortality not significantly change when excluding three articles presenting odds ratios, yet this decreased heterogeneity substantially (HR = 1.49, 95% CI = 1.39–1.61, I-squared = 15.1%). A comparison between type 1 and type 2 diabetes could not be undertaken, as only one study reported on type 1 diabetes specifically. Conclusions: Depression is associated with an almost 1.5-fold increased risk of mortality in people with diabetes. Research should focus on both cardiovascular and non-cardiovascular causes of death associated with depression, and determine the underlying behavioral and physiological mechanisms that may explain this association.

Suggested Citation

  • Fleur E P van Dooren & Giesje Nefs & Miranda T Schram & Frans R J Verhey & Johan Denollet & François Pouwer, 2013. "Depression and Risk of Mortality in People with Diabetes Mellitus: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-11, March.
  • Handle: RePEc:plo:pone00:0057058
    DOI: 10.1371/journal.pone.0057058
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    1. Mirjam J Knol & Ruben G Duijnhoven & Diederick E Grobbee & Karel G M Moons & Rolf H H Groenwold, 2011. "Potential Misinterpretation of Treatment Effects Due to Use of Odds Ratios and Logistic Regression in Randomized Controlled Trials," PLOS ONE, Public Library of Science, vol. 6(6), pages 1-5, June.
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    1. Gagnon J & Lussier MT & Daskalopoulou SS & MacGibbon B & Bartlett G, 2017. "Antidepressant Prescription Practices among Primary Health Care Providers for Patients with Diabetes Mellitus," Current Research in Diabetes & Obesity Journal, Juniper Publishers Inc., vol. 2(4), pages 1-8, June.
    2. Johanna W de Joode & Susan EM van Dijk & Florine S Walburg & Judith E Bosmans & Harm WJ van Marwijk & Michiel R de Boer & Maurits W van Tulder & Marcel C Adriaanse, 2019. "Diagnostic accuracy of depression questionnaires in adult patients with diabetes: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-16, June.
    3. L J van der Donk & J Fleer & R Sanderman & P M G Emmelkamp & T P Links & K A Tovote & M J Schroevers, 2019. "Is type of depressive symptoms associated with patient-perceived need for professional psychological care in depressed individuals with diabetes?," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-11, February.
    4. Pablo Martínez & Viviana Guajardo & Víctor E. Gómez & Sebastián Brandt & Wilsa Szabo & Gonzalo Soto-Brandt & Maryam Farhang & Paulina Baeza & Solange Campos & Pablo Herrera & Graciela Rojas, 2021. "Technology-Assisted Collaborative Care Program for People with Diabetes and/or High Blood Pressure Attending Primary Health Care: A Feasibility Study," IJERPH, MDPI, vol. 18(22), pages 1-13, November.
    5. Mareike Hofmann & Birgit Köhler & Falk Leichsenring & Johannes Kruse, 2013. "Depression as a Risk Factor for Mortality in Individuals with Diabetes: A Meta-Analysis of Prospective Studies," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-7, November.
    6. Gagnon J & Lussier MT & Daskalopoulou SS & MacGibbon B & Bartlett G, 2017. "Antidepressant Prescription Practices among Primary Health Care Providers for Patients with Diabetes Mellitus," Current Research in Diabetes & Obesity Journal, Juniper Publishers Inc., vol. 2(4), pages 68-76, June.
    7. Shen-Ju Tsai & Yu-Han Hsiao & Miao-Yu Liao & Meng-Chih Lee, 2022. "The Influence of Depressive Mood on Mortality in Elderly with Different Health Status: Evidence from the Taiwan Longitudinal Study on Aging (TLSA)," IJERPH, MDPI, vol. 19(11), pages 1-11, June.
    8. Maarten Bak & Annemarie Fransen & Jouke Janssen & Jim van Os & Marjan Drukker, 2014. "Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-19, April.
    9. Ram B Singh & Shaw Watanabe & Duo Li & Teiji Nakamura & Lekh Raj Juneja & Toru Takahashi & Anuj Maheshwari & Narsingh Verma & Sanit Wichansawakun & Germaine Cornelissen & Agnieszka Wilczynska & Ibrahi, 2019. "Diet And Lifestyle Guidelines And Desirable Levels Of Risk Factors And Protective Factors For Prevention Of Dementia - A Scientific Statement From Joint Symposium Of Jaas And Apcns," Biomedical Journal of Scientific & Technical Research, Biomedical Research Network+, LLC, vol. 17(3), pages 12844-12864, April.
    10. Kiran Saqib & Afaf Saqib Qureshi & Zahid Ahmad Butt, 2023. "COVID-19, Mental Health, and Chronic Illnesses: A Syndemic Perspective," IJERPH, MDPI, vol. 20(4), pages 1-13, February.

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