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Depression and All-Cause and Coronary Heart Disease Mortality Among Adults With and Without Diabetes

¹ Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
² Center for Health Care Research, Medical University of South Carolina, Charleston, South Carolina
³ Ralph H. Johnson VA Medical Center, Medical University of South Carolina, Charleston, South Caroina
⁴ Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, South Carolina
⁵ Department of Family and Preventive Medicine, Palmetto Health Richland, University of South Carolina School of Medicine, Columbia, South Carolina

Address correspondence and reprint requests to Leonard E. Egede, MD, Medical University of South Carolina, Center for Health Care Research, 135 Cannon St., Suite 403, PO Box 250837, Charleston, SC 29425. E-mail: egedel{at}musc.edu

OBJECTIVE—The aim of this study was to evaluate the effect of depression on all-cause and coronary heart disease (CHD) mortality among adults with and without diabetes.

RESEARCH DESIGN AND METHODS—We studied 10,025 participants in the population-based National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale. Four groups were created based on diabetes and depression status in 1982: 1) no diabetes, no depression (reference group); 2) no diabetes, depression present; 3) diabetes present, no depression; and i4) diabetes present, depression present. Cox proportional hazards regression models were used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group compared with the reference group.

RESULTS—Over 8 years (83,624 person-years of follow-up), 1,925 deaths were documented, including 522 deaths from CHD. Mortality rate per 1,000 person-years of follow-up was highest in the group with both diabetes and depression. Compared with the reference group, HRs for all-cause mortality were no diabetes, depression present, 1.20 (95% CI 1.03–1.40); diabetes present, no depression 1.88 (1.55–2.27); and diabetes present, depression present, 2.50 (2.04–3.08). HRs for CHD mortality were no diabetes, depression present, 1.29 (0.96–1.74); diabetes present, no depression 2.26 (1.60–3.21); and diabetes present, depression present, 2.43 (1.66–3.56).

CONCLUSIONS—The coexistence of diabetes and depression is associated with a significantly increased risk of death from all causes, beyond that due to having either diabetes or depression alone.

Abbreviations: CES-D, Center for Epidemiologic Studies Depression Scale • CHD, coronary heart disease • NHANES, National Health and Nutrition Examination Survey • NHEFS, National Health and Nutrition Examination Epidemiologic Follow-up Study

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Depression and Diabetes

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