Depression predicts all-cause mortality: epidemiological evaluation from the ACCORD HRQL substudy

Mark D Sullivan, Patrick O'Connor, Patricia Feeney, Don Hire, Debra L Simmons, Dennis W Raisch, Lawrence J Fine, K M Venkat Narayan, Mohammad K Ali, Wayne J Katon, Mark D Sullivan, Patrick O'Connor, Patricia Feeney, Don Hire, Debra L Simmons, Dennis W Raisch, Lawrence J Fine, K M Venkat Narayan, Mohammad K Ali, Wayne J Katon

Abstract

Objective: Depression affects up to 20-25% of adults with type 2 diabetes and may increase all-cause mortality, but few well-designed studies have examined the effects of depression on the full range of cardiovascular disease outcomes in type 2 diabetes.

Research design and methods: A total of 2,053 participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Health-Related Quality of Life substudy completed the Patient Health Questionnaire (PHQ)-9 measure of depression symptoms at baseline and 12, 36, and 48 months. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% CI) for the time-varying impact of depression on protocol-defined clinical outcomes with and without adjustment for demographic, trial-related, clinical, and behavioral variables.

Results: In fully adjusted models, depression was not significantly related to the ACCORD primary composite outcome (cardiovascular death, nonfatal heart attack, or stroke) (HR 1.53 [95% CI 0.85-2.73]) or to the ACCORD microvascular composite outcome (0.93 [0.53-1.62]), but all-cause mortality was significantly increased both in those with PHQ-assessed probable major depression (2.24 [1.24-4.06]) and PHQ score of ≥ 10 (1.84 [1.17-2.89]). The effect of depression on all-cause mortality was not related to previous cardiovascular events or to assignment to intensive or standard glycemia control. Probable major depression (by PHQ-9) had a borderline impact on the ACCORD macrovascular end point (1.42 [0.99-2.04]).

Conclusions: Depression increases the risk of all-cause mortality and may increase the risk of macrovascular events among adults with type 2 diabetes at high risk for cardiovascular events.

Trial registration: ClinicalTrials.gov NCT00000620.

References

    1. Eaton WW. Epidemiologic evidence on the comorbidity of depression and diabetes. J Psychosom Res 2002;53:903–906
    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, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000;23:934–942
    1. Lin EH, Katon W, Von Korff M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care 2004;27:2154–2160
    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. Lin EH, Heckbert SR, Rutter CM, et al. Depression and increased mortality in diabetes: unexpected causes of death. Ann Fam Med 2009;7:414–421
    1. Zhang X, Norris SL, Gregg EW, Cheng YJ, Beckles G, Kahn HS. Depressive symptoms and mortality among persons with and without diabetes. Am J Epidemiol 2005;161:652–660
    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. Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 2003;26:2822–2828
    1. Egede LE, Nietert PJ, Zheng D. Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care 2005;28:1339–1345
    1. Katon W, Fan MY, Unützer J, Taylor J, Pincus H, Schoenbaum M. Depression and diabetes: a potentially lethal combination. J Gen Intern Med 2008;23:1571–1575
    1. Pan A, Lucas M, Sun Q, et al. Increased mortality risk in women with depression and diabetes mellitus. Arch Gen Psychiatry 2011;68:42–50
    1. Sullivan MD, Anderson RT, Aron D, et al. ACCORD Study Group Health-related quality of life and cost-effectiveness components of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: rationale and design. Am J Cardiol 2007;99(12A):90i–102i
    1. Anderson RT, Narayan KM, Feeney P, et al. Action to Control Cardiovascular Risk in Diabetes (ACCORD) Investigators Effect of intensive glycemic lowering on health-related quality of life in type 2 diabetes: ACCORD trial. Diabetes Care 2011;34:807–812
    1. American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC, American Psychiatric Association, 2000
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–613
    1. Katon W. Depression and diabetes: unhealthy bedfellows. Depress Anxiety 2010;27:323–326
    1. Roy T, Lloyd CE, Pouwer F, Holt RI, Sartorius N. Screening tools used for measuring depression among people with Type 1 and Type 2 diabetes: a systematic review. Diabet Med 2012;29:164–175
    1. Smolderen KG, Spertus JA, Reid KJ, et al. The association of cognitive and somatic depressive symptoms with depression recognition and outcomes after myocardial infarction. Circ Cardiovasc Qual Outcomes 2009;2:328–337
    1. Katon W, Schulberg H. Epidemiology of depression in primary care. Gen Hosp Psychiatry 1992;14:237–247
    1. Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006;23:1165–1173
    1. Schleifer SJM-HM, Macari-Hinson MM, Coyle DA, et al. The nature and course of depression following myocardial infarction. Arch Intern Med 1989;149:1785–1789
    1. Spijkerman T, de Jonge P, van den Brink RH, et al. Depression following myocardial infarction: first-ever versus ongoing and recurrent episodes. Gen Hosp Psychiatry 2005;27:411–417
    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. Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010;363:2611–2620
    1. Hamer M, David Batty G, Seldenrijk A, Kivimaki M. Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey. Eur Heart J 2011;32:437–442

Source: PubMed

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