Concomitant diabetes and depression increases mortality in women
MedWire News: Cardiovascular disease (CVD) and all-cause mortality are significantly higher in women with diabetes and depression than those with one or neither condition, show results from the Nurses' Health Study.
Previous research has demonstrated that patients with depression have increased CVD and all-cause mortality compared with the general population, with the risk similarly increased in patients with diabetes.
In this study, Frank Hu (Harvard School of Public Health, Boston, Massachusetts, USA) and colleagues assessed the individual and combined effects of diabetes and depression on mortality in 78,282 women who took part in the Nurse's Health Study.
The women were aged 54-79 years at study initiation in 2000 and were followed up until 2006. Diabetes and depression were self-reported by questionnaire. Overall, 333,805 women had neither condition, 68,799 had depression alone, 23,561 had diabetes alone, and 6901 had both. Deaths were reported by next of kin or in the National Death Index.
Writing in the Archives of General Psychiatry, the authors report that women with depression or diabetes alone had a significant 1.76- and 1.71-fold increased relative risk for all-cause mortality, respectively, compared with women with neither condition.
Similarly, the corresponding risks for CVD mortality in these women were 1.81- and 2.67-fold higher compared with in those without depression or diabetes.
The combination of both conditions led to significantly higher risks for both all-cause and CVD mortality, with a respective 3.11- and 5.38-fold increased risk in these women compared with those without depression or diabetes.
The researchers note that multivariate adjustment for various confounders such as body mass index, smoking status, and major comorbidities did weaken the associations, reducing the increased risk for all-cause and CVD mortality to 2.07- and 2.72-fold in those with both conditions, respectively, but these increased risks were still statistically significant.
Patients who had a long duration of diabetes (over 10 years) or who were being treated with insulin and also suffered from depression were found to be at particularly high risk for all-cause or CVD mortality after multivariate adjustment (3.22- and 4.90-fold risk increase in those with both conditions compared with those without either condition).
"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," conclude Hu et al.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Helen Albert