https://orcid.org/0000-0002-3143-3672
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Abstract
Purpose
Diabetes mellitus (DM) increases the risk of cardiovascular and all-cause mortality. The coexistence of depression and DM is associated with an increased risk of DM complications and functional morbidity. The independent effect of depression on mortality in patients with DM is unclear, and relevant Asian studies have provided inconsistent results. Accordingly, this study assessed the independent and additive effects of DM and depression on mortality in a nationally representative cohort of older adults in Taiwan over a 10-year observation period.
Patients and Methods
A total of 5041 participants aged 50 years or older were observed between 1996 and 2007. We defined depression as a score of ≥8 on the 10-item Center for Epidemiologic Studies Depression (CES-D 10) scale. Additionally, we defined participants as having type 2 DM if they had received a diagnosis of type 2 DM from a health-care provider. Cox proportional hazard models were applied to analyze predictors of mortality in depression and DM comorbidity groups.
Results
During the 10-year follow-up period, 1637 deaths were documented. After adjustment for potential confounders, the hazard ratios for mortality in participants with both depression and DM, DM only, and depression only were 2.47 (95% confidence interval [CI]: 2.02–3.03), 1.95 (95% CI: 1.63–2.32), and 1.23 (95% CI: 1.09–1.39), respectively.
Conclusion
The co-occurrence of depression with DM in Asian adults increased overall mortality rates. Our results indicate that the increased mortality hazard in individuals with DM and depression was independent of sex.
Abbreviations
DM, diabetes mellitus; CES-D 10, Center for Epidemiologic Studies Depression Scale; HPA, hypothalamic–pituitary–adrenal axis; SHLSET, Survey of Health and Living Status of the Elderly in Taiwan; ADA, American Diabetes Association; ADL, activities of daily living; AIC, Akaike Information Criterion.
Data Sharing Statement
Due to legal restrictions, no dataset analyzed during this study was publicly available from the Bureau of Health Promotion, Department of Health in Taiwan. However, datasets are available from the corresponding author upon reasonable request.
Ethics Approval and Consent to Participate
This study was approved by the Institutional Review Board of Chung Shan Medical University Hospital. Written informed consent was obtained from all participants.
Acknowledgments
This study used data from the SHLSET database provided and managed by the Bureau of Health Promotion, Department of Health in Taiwan. The interpretations and conclusions presented herein do not represent those of the Bureau of Health Promotion, Department of Health.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
Dr Roger S McIntyre reports grants from CIHR/GACD/National Natural Science Foundation of China (NSFC); personal fees from Lundbeck, Janssen, Alkermes, Neumora Therapeutics, Boehringer Ingelheim, Sage, Biogen, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Abbvie, and Atai Life Sciences; he is the CEO for Braxia Scientific Corp., outside the submitted work. The other authors report no conflicts of interest in this work.