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Epidemiology/Health Services/Psychosocial Research

The Association of Comorbid Depression With Mortality in Patients With Type 2 Diabetes

  1. Wayne J. Katon, MD1,
  2. Carolyn Rutter, PHD2,
  3. Greg Simon, MD, MPH2,
  4. Elizabeth H.B. Lin, MD, MPH2,
  5. Evette Ludman, PHD2,
  6. Paul Ciechanowski, MD, MPH1,
  7. Leslie Kinder, PHD3,
  8. Bessie Young, MD, MPH4 and
  9. Michael Von Korff, SCD2
  1. 1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
  2. 2Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington
  3. 3Health Services Research and Development, Veterans Affairs Puget Sound Health Care Center, Seattle, Washington
  4. 4Department of Medicine, University of Washington, Seattle, Washington
  1. Address correspondence and reprint requests to Wayne Katon, MD, Professor and Vice-Chair, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 N.E. Pacific St., Seattle, WA 98195-6560. E-mail: wkaton{at}u.washington.edu
Diabetes Care 2005 Nov; 28(11): 2668-2672. https://doi.org/10.2337/diacare.28.11.2668
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Abstract

OBJECTIVE—We assessed whether patients with comorbid minor and major depression and type 2 diabetes had a higher mortality rate over a 3-year period compared with patients with diabetes alone.

RESEARCH DESIGN AND METHODS—In a large health maintenance organization (HMO), 4,154 patients with type 2 diabetes were surveyed and followed for up to 3 years. Patients initially filled out a written questionnaire, and HMO-automated diagnostic, laboratory, and pharmacy data and Washington State mortality data were collected to assess diabetes complications and deaths. Cox proportional hazards regression models were used to calculate adjusted hazard ratios of death for each group compared with the reference group.

RESULTS—There were 275 (8.3%) deaths in 3,303 patients without depression compared with 48 (13.6%) deaths in 354 patients with minor depression and 59 (11.9%) deaths among 497 patients with major depression. A proportional hazards model with adjustment for age, sex, race/ethnicity, and educational attainment found that compared with the nondepressed group, minor depression was associated with a 1.67-fold increase in mortality (P = 0.003), and major depression was associated with a 2.30-fold increase (P < 0.0001). In a second model that controlled for multiple potential mediators, both minor and major depression remained significant predictors of mortality.

CONCLUSIONS—Among patients with diabetes, both minor and major depression are strongly associated with increased mortality. Further research will be necessary to disentangle causal relationships among depression, behavioral risk factors (adherence to medical regimens), diabetes complications, and mortality.

  • CAD, coronary artery disease
  • GHC, Group Health Cooperative
  • HMO, health maintenance organization

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted July 21, 2005.
    • Received April 28, 2005.
  • DIABETES CARE
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Diabetes Care: 28 (11)

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November 2005, 28(11)
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The Association of Comorbid Depression With Mortality in Patients With Type 2 Diabetes
Wayne J. Katon, Carolyn Rutter, Greg Simon, Elizabeth H.B. Lin, Evette Ludman, Paul Ciechanowski, Leslie Kinder, Bessie Young, Michael Von Korff
Diabetes Care Nov 2005, 28 (11) 2668-2672; DOI: 10.2337/diacare.28.11.2668

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The Association of Comorbid Depression With Mortality in Patients With Type 2 Diabetes
Wayne J. Katon, Carolyn Rutter, Greg Simon, Elizabeth H.B. Lin, Evette Ludman, Paul Ciechanowski, Leslie Kinder, Bessie Young, Michael Von Korff
Diabetes Care Nov 2005, 28 (11) 2668-2672; DOI: 10.2337/diacare.28.11.2668
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