A systematic review and meta-analysis of the association between depression and insulin resistance

Carol Kan, Naomi Silva, Sherita Hill Golden, Ulla Rajala, Markku Timonen, Daniel Stahl, Khalida Ismail, Carol Kan, Naomi Silva, Sherita Hill Golden, Ulla Rajala, Markku Timonen, Daniel Stahl, Khalida Ismail

Abstract

Objective: Depression is associated with the onset of type 2 diabetes. A systematic review and meta-analysis of observational studies, controlled trials, and unpublished data was conducted to examine the association between depression and insulin resistance (IR).

Research design and methods: Medline, EMBASE, and PsycINFO were searched for studies published up to September 2011. Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria (study design and measure of depression and IR, excluding prevalent cases of diabetes). Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size using random effects. Subgroup analyses and meta-regression were conducted to explore any potential source of heterogeneity between studies.

Results: Of 967 abstracts reviewed, 21 studies met the inclusion criteria of which 18 studies had appropriate data for the meta-analysis (n = 25,847). The pooled effect size (95% CI) was 0.19 (0.11-0.27) with marked heterogeneity (I(2) = 82.2%) using the random-effects model. Heterogeneity between studies was not explained by age or sex, but could be partly explained by the methods of depression and IR assessments.

Conclusions: A small but significant cross-sectional association was observed between depression and IR, despite heterogeneity between studies. The pathophysiology mechanisms and direction of this association need further study using a purposively designed prospective or intervention study in samples at high risk for diabetes.

Figures

Figure 1
Figure 1
Flowchart of systematic review. *Further information in regards to excluded studies can be found in Supplementary Table 1.
Figure 2
Figure 2
Forest plots showing the effect size of the association between depression and insulin resistance. Estimates are at the center of the boxes and drawn in proportion to the SEs. Lines indicate 95% CIs. Diamond shows the pooled effect size at its center and 95% CI at its horizontal points. IGT, impaired glucose tolerance; NGT, normal glucose tolerance.
Figure 3
Figure 3
Forest plots of the unadjusted and adjusted association between depression and insulin resistance for studies with confounders included. Confounders adjusted for A: age, ethnicity, waist circumference, education, physical activity, antidepressants, medications for nervous conditions, site; B: age, sex, ethnicity, BMI; C: weight, BMI, waist-to-hip ratio; D: weight, BMI, waist-to-hip ratio; E: age, sex, BMI, comorbidity, education, physical activity, smoking, alcohol, geographical location, residential region; F: age, education, physical activity, smoking, alcohol, antidepressants, fish consumption; G: age, education, physical activity, smoking, alcohol, antidepressants, oral contraceptives, fish consumption, polycystic ovary disease; H: age, ethnicity, waist circumference, smoking, systolic blood pressure, triglyceride; I: age, ethnicity, waist circumference, smoking, systolic blood pressure, triglyceride; J: sex, BMI, education, physical inactivity, smoking, alcohol; K: sex, BMI, education, physical inactivity, smoking, alcohol; L: BMI, comorbidity, socioeconomic status, physical inactivity, smoking, alcohol, C-reactive protein, cholesterol level; M: BMI, comorbidity, socioeconomic status, physical inactivity, smoking, alcohol, C-reactive protein, cholesterol level; and N: waist circumference, education, physical inactivity, alcohol, smoking. IGT, impaired glucose tolerance; NGT, normal glucose tolerance.

References

    1. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001;24:1069–1078
    1. Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complications 2005;19:113–122
    1. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med 2001;63:619–630
    1. Ismail K, Winkley K, Stahl D, Chalder T, Edmonds M. A cohort study of people with diabetes and their first foot ulcer: the role of depression on mortality. Diabetes Care 2007;30:1473–1479
    1. Katon WJ, Rutter C, Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care 2005;28:2668–2672
    1. Mezuk B, Eaton WW, Albrecht S, Golden SH. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 2008;31:2383–2390
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.
    1. Morris AA, Ahmed Y, Stoyanova N, et al. The association between depression and leptin is mediated by adiposity. Psychosom Med 2012;74:483–488
    1. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 2000;283:2008–2012
    1. Jüni P, Altman DG, Egger M. Systematic reviews in health care: assessing the quality of controlled clinical trials. BMJ 2001;323:42–46
    1. Owens DK, Lohr KN, Atkins D, et al. AHRQ series paper 5: grading the strength of a body of evidence when comparing medical interventions—agency for healthcare research and quality and the effective health-care program. J Clin Epidemiol 2010;63:513–523
    1. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines World Health Organization, 1992
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR Washington, DC, American Psychiatric Association, 2000
    1. StataCorp, Stata Statistical Software: Release 11. 2009
    1. StataCorp, Stata Statistical Software: Release 10. 2007
    1. Sterne JAC, Newton HJ, Cox NJ. Meta-Analysis in Stata: An Updated Collection from the Stata Journal College Station, TX, Stata Press, 2009
    1. Cooper HM, Hedges LV. The Handbook of Research Synthesis New York, Russell Sage Foundation, 1994
    1. Gilpin AR. Table for conversion of Kendall's Tau to Spearman's Rho within the context of measures of magnitude of effect for meta-analysis. Educ Psychol Meas 1993;53:87–92
    1. Shen Q, Bergquist-Beringer S, Sousa VD. Major depressive disorder and insulin resistance in nondiabetic young adults in the United States: the National Health and Nutrition Examination Survey, 1999-2002. Biol Res Nurs 2011;13:175–181
    1. Rosenthal, R. Meta-analytic Procedures For Social Research Newbury Park, CA, Sage Publications, 1991
    1. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta-Analysis New York, John Wiley & Sons, 2009
    1. Cochran WG. The comparison of percentages in matched samples. Biometrika 1950;37:256–266
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–560
    1. Thompson SGS, Sharp SJ. Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med 1999;18:2693–2708
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–634
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088–1101
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions New York, John Wiley & Sons, 2011
    1. Gilbey MP, Casale C, Lei S, et al. Prevalence and treatment of depression are differentially associated with insulin resistance and obesity. 1st Joint Meeting of the International Society for Autonomic Neuroscience and the American Autonomic Society (ISAN/AAS 2011), Buzios, Rio de Janeiro, Brazil, September 12–16, 2011( Abstracts). Clin Auton Res 2011;21:215–308
    1. Lawlor DA, Smith GD, Ebrahim S, British Women’s Heart and Health Study Association of insulin resistance with depression: cross sectional findings from the British Women’s Heart and Health Study. BMJ 2003;327:1383–1384
    1. Lawlor DA, Ben-Shlomo Y, Ebrahim S, et al. Insulin resistance and depressive symptoms in middle aged men: findings from the Caerphilly prospective cohort study. BMJ 2005;330:705–706
    1. Chiba M, Suzuki S, Hinokio Y, et al. Tyrosine hydroxylase gene microsatellite polymorphism associated with insulin resistance in depressive disorder. Metabolism 2000;49:1145–1149
    1. Timonen M, Laakso M, Jokelainen J, Rajala U, Meyer-Rochow VB, Keinänen-Kiukaanniemi S. Insulin resistance and depression: cross sectional study. BMJ 2005;330:17–18
    1. Adriaanse MC, Dekker JM, Nijpels G, Heine RJ, Snoek FJ, Pouwer F. Associations between depressive symptoms and insulin resistance: the Hoorn Study. Diabetologia 2006;49:2874–2877
    1. Holt RI, Phillips DI, Jameson KA, Cooper C, Dennison EM, Peveler RC, Hertfordshire Cohort Study Group The relationship between depression and diabetes mellitus: findings from the Hertfordshire Cohort Study. Diabet Med 2009;26:641–648
    1. Timonen M, Rajala U, Jokelainen J, Keinänen-Kiukaanniemi S, Meyer-Rochow VB, Räsänen P. Depressive symptoms and insulin resistance in young adult males: results from the Northern Finland 1966 birth cohort. Mol Psychiatry 2006;11:929–933
    1. Pearson S, Schmidt M, Patton G, et al. Depression and insulin resistance: cross-sectional associations in young adults. Diabetes Care 2010;33:1128–1133
    1. Everson-Rose SA, Meyer PM, Powell LH, et al. Depressive symptoms, insulin resistance, and risk of diabetes in women at midlife. Diabetes Care 2004;27:2856–2862
    1. Hung YJ, Hsieh CH, Chen YJ, et al. Insulin sensitivity, proinflammatory markers and adiponectin in young males with different subtypes of depressive disorder. Clin Endocrinol (Oxf) 2007;67:784–789
    1. Kauffman RP, Castracane VD, White DL, Baldock SD, Owens R. Impact of the selective serotonin reuptake inhibitor citalopram on insulin sensitivity, leptin and basal cortisol secretion in depressed and non-depressed euglycemic women of reproductive age. Gynecol Endocrinol 2005;21:129–137
    1. Kahl KG, Bester M, Greggersen W, et al. Visceral fat deposition and insulin sensitivity in depressed women with and without comorbid borderline personality disorder. Psychosom Med 2005;67:407–412
    1. Okamura F, Tashiro A, Utumi A, et al. Insulin resistance in patients with depression and its changes during the clinical course of depression: minimal model analysis. Metabolism 2000;49:1255–1260
    1. Golden SH, Lee HB, Schreiner PJ, et al. Depression and type 2 diabetes mellitus: the multiethnic study of atherosclerosis. Psychosom Med 2007;69:529–536
    1. Krishnamurthy P, Romagni P, Torvik S, et al. P.O.W.E.R. (Premenopausal, Osteoporosis Women, Alendronate, Depression) Study Group Glucocorticoid receptor gene polymorphisms in premenopausal women with major depression. Horm Metab Res 2008;40:194–198
    1. Pan A, Ye X, Franco OH, et al. Insulin resistance and depressive symptoms in middle-aged and elderly Chinese: findings from the Nutrition and Health of Aging Population in China Study. J Affect Disord 2008;109:75–82
    1. Roos C, Lidfeldt J, Agardh CD, et al. Insulin resistance and self-rated symptoms of depression in Swedish women with risk factors for diabetes: the Women’s Health in the Lund Area study. Metabolism 2007;56:825–829
    1. Schlotz W, Ambery P, Syddall HE, et al. Hertfordshire Cohort Study Group Specific associations of insulin resistance with impaired health-related quality of life in the Hertfordshire Cohort Study. Qual Life Res 2007;16:429–436
    1. Timonen M, Salmenkaita I, Jokelainen J, et al. Insulin resistance and depressive symptoms in young adult males: findings from Finnish military conscripts. Psychosom Med 2007;69:723–728
    1. Nouwen A, Winkley K, Twisk J, et al. European Depression in Diabetes (EDID) Research Consortium Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia 2010;53:2480–2486
    1. Pan A, Sun Q, Czernichow S, et al. Bidirectional association between depression and obesity in middle-aged and older women. Int J Obes (Lond) 2012;36:595–602
    1. Musselman DL, Betan E, Larsen H, Phillips LS. Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment. Biol Psychiatry 2003;54:317–329
    1. Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med 2009;71:171–186
    1. Black PH. The inflammatory response is an integral part of the stress response: implications for atherosclerosis, insulin resistance, type II diabetes and metabolic syndrome X. Brain Behav Immun 2003;17:350–364
    1. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000;160:2101–2107
    1. Marcus MD, Wing RR, Guare J, Blair EH, Jawad A. Lifetime prevalence of major depression and its effect on treatment outcome in obese type II diabetic patients. Diabetes Care 1992;15:253–255
    1. McDowell I. Measuring Health: A Guide to Rating Scales and Questionnaires. Newell C, Ed. New York, Oxford University Press, 1987
    1. Kessler RC. The categorical versus dimensional assessment controversy in the sociology of mental illness. J Health Soc Behav 2002;43:171–188
    1. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–419
    1. Rabasa-Lhoret R, Bastard JP, Jan V, et al. Modified quantitative insulin sensitivity check index is better correlated to hyperinsulinemic glucose clamp than other fasting-based index of insulin sensitivity in different insulin-resistant states. J Clin Endocrinol Metab 2003;88:4917–4923
    1. Cobelli C, Caumo A, Omenetto M. Minimal model SG overestimation and SI underestimation: improved accuracy by a Bayesian two-compartment model. Am J Physiol 1999;277:E481–E488

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