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© 2004 by the American Diabetes Association, Inc.
Epidemiology/Health Services/Psychosocial Research |
Depressive Symptoms, Insulin Resistance, and Risk of Diabetes in Women at Midlife
1 Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois
2 Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
3 Department of Psychology, Rush University Medical Center, Chicago, Illinois
4 Department of Obstetrics, Gynecology and Women’s Health, New Jersey School of Medicine & Dentistry, Newark, New Jersey
5 Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
6 Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Address correspondence and reprint requests to Susan A. Everson-Rose, PhD, MPH, Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL 60612. E-mail: susan_everson{at}rush.edu
OBJECTIVE—To examine depression and 3-year change in insulin resistance and risk of diabetes and whether associations vary by race.
RESEARCH DESIGN AND METHODS—We analyzed data from 2,662 Caucasian, African-American, Hispanic, Japanese-American, and Chinese-American women without a history of diabetes from the Study of Women’s Health Across the Nation. We estimated regression coefficients and odds ratios to determine whether depression (Center for Epidemiological Studies Depression Scale score 
16) predicted increases in homeostasis model assessment of insulin resistance (HOMA-IR) and greater risk of incident diabetes, respectively, over 3 years.
RESULTS—Mean baseline HOMA-IR was 1.31 (SD 0.86) and increased 0.05 units per year for all women (P < 0.0001). A total of 97 incident cases of diabetes occurred. Depression was associated with absolute levels of HOMA-IR (P < 0.04) but was unrelated to changes in HOMA-IR; associations did not vary by race. The association between depression and HOMA-IR was eliminated after adjustment for central adiposity (P = 0.85). Depression predicted a 1.66-fold greater risk of diabetes (P < 0.03), which became nonsignificant after adjustment for central adiposity (P = 0.12). We also observed a depression-by-race interaction (P < 0.05) in analyses limited to Caucasians and African Americans, the only groups with enough diabetes cases to reliably test this interaction. Race-stratified models showed that depression predicted 2.56-fold greater risk of diabetes in African Americans only, after risk factor adjustment (P = 0.008).
CONCLUSIONS—Depression is associated with higher HOMA-IR values and incident diabetes in middle-aged women. These associations are mediated largely through central adiposity. However, African-American women with depression experience increased risk of diabetes independent of central adiposity and other risk factors.
Abbreviations: CES-D, Center for Epidemiological Studies Depression Scale • HOMA-IR, homeostasis model assessment of insulin resistance • SWAN, Study of Women’s Health Across the Nation
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