Depression and Advanced Complications of Diabetes

A prospective cohort study

  1. Elizabeth H.B. Lin, MD, MPH1,
  2. Carolyn M. Rutter, PHD1,
  3. Wayne Katon, MD2,
  4. Susan R. Heckbert, MD, PHD3,
  5. Paul Ciechanowski, MD, MPH2,
  6. Malia M. Oliver, BA1,
  7. Evette J. Ludman, PHD1,
  8. Bessie A. Young, MD, MPH4,
  9. Lisa H. Williams, MD, MS5,
  10. David K. McCulloch, MD1 and
  11. Michael Von Korff, SCD1
  1. 1Group Health Research Institute, Group Health, Seattle, Washington;
  2. 2Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington;
  3. 3Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington;
  4. 4Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, University of Washington School of Medicine, Seattle, Washington;
  5. 5Department of Medicine/Dermatology, University of Washington School of Medicine, Seattle, Washington.
  1. Corresponding author: Elizabeth H.B. Lin, lin.e{at}


OBJECTIVE To prospectively examine the association of depression with risks for advanced macrovascular and microvascular complications among patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS A longitudinal cohort of 4,623 primary care patients with type 2 diabetes was enrolled in 2000–2002 and followed through 2005–2007. Advanced microvascular complications included blindness, end-stage renal disease, amputations, and renal failure deaths. Advanced macrovascular complications included myocardial infarction, stroke, cardiovascular procedures, and deaths. Medical record review, ICD-9 diagnostic and procedural codes, and death certificate data were used to ascertain outcomes in the 5-year follow-up. Proportional hazard models analyzed the association between baseline depression and risks of adverse outcomes.

RESULTS After adjustment for prior complications and demographic, clinical, and diabetes self-care variables, major depression was associated with significantly higher risks of adverse microvascular outcomes (hazard ratio 1.36 [95% CI 1.05–1.75]) and adverse macrovascular outcomes (1.24 [1.0–1.54]).

CONCLUSIONS Among people with type 2 diabetes, major depression is associated with an increased risk of clinically significant microvascular and macrovascular complications over the ensuing 5 years, even after adjusting for diabetes severity and self-care activities. Clinical and public health significance of these findings rises as the incidence of type 2 diabetes soars. Further research is needed to clarify the underlying mechanisms for this association and to test interventions to reduce the risk of diabetes complications among patients with comorbid depression.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received June 11, 2009.
    • Accepted November 13, 2009.
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  1. Diabetes Care vol. 33 no. 2 264-269
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