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      Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis

      research-article
      Author(s): 1 , , 2 , 3 , 4 , 5 , 6 , 2 , 7 , for the European Depression in Diabetes (EDID) Research Consortium
      Publication date (Electronic):
      Journal: Diabetologia
      Publisher: Springer-Verlag
      Keywords: Critical review, Depression, Incidence, Meta-analysis, Systematic review, Type 2 diabetes

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          Abstract

          Aims/hypothesis

          An earlier meta-analysis showed that diabetes is a risk factor for the development and/or recurrence of depression. Yet whether this risk is different for studies using questionnaires than for those relying on diagnostic criteria for depression has not been examined. This study examined the association of diabetes and the onset of depression by reviewing the literature and conducting a meta-analysis of longitudinal studies on this topic.

          Methods

          EMBASE, MEDLINE and PsycInfo were searched for articles published up to September 2009. All studies that examined the relationship between type 2 diabetes and the onset of depression were included. Pooled relative risks were calculated using fixed and random effects models.

          Results

          Eleven studies met our inclusion criteria for this meta-analysis. Based on the pooled data, including 48,808 cases of type 2 diabetes without depression at baseline, the pooled relative risk was 1.24 (95% CI 1.09–1.40) for the random effects model. This risk was significantly higher for studies relying on diagnostic criteria of depression than for studies using questionnaires. However, this difference was no longer significant when controlled for year of publication.

          Conclusions/interpretation

          Compared with non-diabetic controls, people with type 2 diabetes have a 24% increased risk of developing depression. The mechanisms underlying this relationship are still unclear and warrant further research.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s00125-010-1874-x) contains supplementary material, which is available to authorised users.

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          Most cited references24

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          The prevalence of comorbid depression in adults with diabetes: a meta-analysis.

          Judy Anderson, P Lustman, Melvin E. Clouse … (2001)
          To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes. MEDLINE and PsycINFO databases and published references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used chi(2) statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design. A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0, 95% CI 1.8-2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%). The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.
          Article 0 comments Cited 400 times – based on 0 reviews     Review now
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            Depression and poor glycemic control: a meta-analytic review of the literature.

            P Lustman, Paul Carney, Melvin E. Clouse … (2000)
            Depression is common among patients with diabetes, but its relationship to glycemic control has not been systematically reviewed. Our objective was to determine whether depression is associated with poor glycemic control. Medline and PsycINFO databases and published reference lists were used to identify studies that measured the association of depression with glycemic control. Meta-analytic procedures were used to convert the findings to a common metric, calculate effect sizes (ESs), and statistically analyze the collective data. A total of 24 studies satisfied the inclusion and exclusion criteria for the meta-analysis. Depression was significantly associated with hyperglycemia (Z = 5.4, P < 0.0001). The standardized ES was in the small-to-moderate range (0.17) and was consistent, as the 95% CI was narrow (0.13-0.21). The ES was similar in studies of either type 1 or type 2 diabetes (ES 0.19 vs. 0.16) and larger when standardized interviews and diagnostic criteria rather than self-report questionnaires were used to assess depression (ES 0.28 vs. 0.15). Depression is associated with hyperglycemia in patients with type 1 or type 2 diabetes. Additional studies are needed to establish the directional nature of this relationship and to determine the effects of depression treatment on glycemic control and the long-term course of diabetes.
            Article 0 comments Cited 252 times – based on 0 reviews     Review now
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              Association of depression and diabetes complications: a meta-analysis.

              Jennifer M de Groot, R R Anderson, K Freedland … (2015)
              The objective of this study was to examine the strength and consistency of the relationship between depression and diabetes complications in studies of type 1 and type 2 adult patients with diabetes. MEDLINE and PsycINFO databases were searched for articles examining depression and diabetes complications in type 1 and type 2 diabetes samples published between 1975 and 1999. Meta-analytic procedures were used. Studies were reviewed for diabetes type, sample size, statistical tests, and measures of diabetes complications and depression. Significance values, weighted effect sizes r, 95% confidence intervals (CI), and tests of homogeneity of variance were calculated for the overall sample (k = 27) and for subsets of interest. A total of 27 studies (total combined N = 5374) met the inclusion criteria. A significant association was found between depression and complications of diabetes (p < .00001, z = 5.94). A moderate and significant weighted effect size (r = 0.25; 95% CI: 0.22-0.28) was calculated for all studies reporting sufficient data (k = 22). Depression was significantly associated with a variety of diabetes complications (diabetic retinopathy, nephropathy, neuropathy, macrovascular complications, and sexual dysfunction). Effect sizes were in the small to moderate range (r = 0.17 to 0.32). These findings demonstrate a significant and consistent association of diabetes complications and depressive symptoms. Prospective, longitudinal studies are needed to identify the pathways that mediate this association.
              Article 0 comments Cited 196 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : a.nouwen@bhm.ac.uk
                Journal
                Journal ID (nlm-ta): Diabetologia
                Title: Diabetologia
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Print): 0012-186X
                ISSN (Electronic): 1432-0428
                Publication date (Electronic): 14 August 2010
                Publication date PMC-release: 14 August 2010
                Publication date (Print): December 2010
                Volume: 53
                Issue: 12
                Pages: 2480-2486
                Affiliations
                [1 ]School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
                [2 ]Institute of Psychiatry, Kings College London, London, UK
                [3 ]EMGO+ Institute, VU University Medical Center, Amsterdam, the Netherlands
                [4 ]Faculty of Health and Social Care, The Open University, Milton Keynes, UK
                [5 ]Department of Sociology, Loyola University Maryland, Baltimore, MD USA
                [6 ]Department of Medicine, John Hopkins University, Baltimore, MD USA
                [7 ]CRPS—Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands
                Article
                Publisher ID: 1874
                DOI: 10.1007/s00125-010-1874-x
                PMC ID: 2974923
                PubMed ID: 20711716
                SO-VID: e355160d-fca3-4652-8d9f-9798376b0845
                Copyright © © The Author(s) 2010
                History
                Date received : 17 February 2010
                Date accepted : 13 July 2010
                Categories
                Subject: Meta-Analysis
                Custom metadata
                issue-copyright-statement © Springer-Verlag 2010

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: incidence,systematic review,critical review,depression,type 2 diabetes,meta-analysis
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: incidence, systematic review, critical review, depression, type 2 diabetes, meta-analysis

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