Association of Coexisting Diabetes and Depression With Mortality After Myocardial Infarction

  1. Peter de Jonge, PHD1,2
  1. 1Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, the Netherlands
  2. 2Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  3. 3Department of Cardiology, Thoraxcenter, University Medical Center Groningen, Groningen, the Netherlands
  1. Corresponding author: Mariska Bot,{at}


OBJECTIVE Diabetes and depression are both linked to an increased mortality risk after myocardial infarction (MI). Population-based studies suggest that having both diabetes and depression results in an increased mortality risk, beyond that of having diabetes or depression alone. The purpose of this study was to examine the joint association of diabetes and depression with mortality in MI patients.

RESEARCH DESIGN AND METHODS Data were derived from two multicenter cohort studies in the Netherlands, comprising 2,704 patients who were hospitalized for MI. Depression, defined as a Beck Depression Inventory score ≥10, and diabetes were assessed during hospitalization. Mortality data were retrieved for 2,525 patients (93%).

RESULTS During an average follow-up of 6.2 years, 439 patients died. The mortality rate was 14% (226 of 1,673) in patients without diabetes and depression, 23% (49 of 210) in patients with diabetes only, 22% (118 of 544) in patients with depression only, and 47% (46 of 98) in patients with both diabetes and depression. After adjustment for age, sex, smoking, hypertension, left ventricular ejection fraction, prior MI, and Killip class, hazard ratios for all-cause mortality were 1.38 (95% CI 1.00–1.90) for patients with diabetes only, 1.39 (1.10–1.76) for patients with depression only, and as much as 2.90 (2.07–4.07) for patients with both diabetes and depression.

CONCLUSIONS We observed an increased mortality risk in post-MI patients with both diabetes and depression, beyond the association with mortality of diabetes and depression alone.

  • Received September 16, 2011.
  • Accepted December 6, 2011.

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  1. Diabetes Care vol. 35 no. 3 503-509
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